Fabricated or Induced Illness

Fabricated or Induced Illness (FII) is the preferred term for the form of abuse previously referred to as Munchausen Syndrome by Proxy. This review groups the varied behaviours that result in FII into six Physical Impact Categories (PICs). The age of identification of abuse is inversely related to the severity of physical impact, whereas the age of onset of abuse is early in life in all PICs. PIC 5 (High Toxicity Poisoning) and PIC 6 (Apparent Life-threatening Events) have very significant mortality for both index cases (17% and 12%) and siblings (19% and 57%). 94% of perpetrators are female. The majority of male perpetrators inflict the severest forms of FII (PICs 5 and 6). Intrinsic illness co-exists with FII in 3–56% of cases. Co-morbidity occurred in 15–63% of cases. In PICs 1, 3 and 4 co-morbidity was predominantly FII commonly of the same PIC as the index presentation. In PICs 5 and 6 the commonest co-morbidities were death of a sibling and physical abuse of the index case or sibling. Pregnancy and perinatal problems are common in perpetrators of FII. A number of psychological features have been reported in perpetrators with Personality Disorder and Somatization being the most common features. However, such features may be absent and there is no single ‘profile’ of behaviour which is pathognomic of perpetrators of FII. Identification of FII depends on a clinical method which integrates process, content and physical findings. The concepts of ‘The Bargain in Health Care’ and the ‘Falsifiability Principle’ underpin such a clinical approach. Confirmation of FII abuse is obtained by close observation and separation, toxicology or Covert Video Surveillance.