Fabricated or induced illness

The term factitious or induced illness (FII) has replaced Munchausen's syndrome by proxy, originally described by Meadow in 1977. We review evidence for the existence of this clinical problem, which is a form of child abuse. We described the epidemiology of FII and the methods of assessment of the perpetrators, and outline the psychological and demographic characteristics of these individuals. Three quarters of these (mostly women) have factitious or somatoform disorders, 90% or more severe personality disorders (particularly cluster B), and half report histories of repeated self-harm. One particular characteristic noted in over half the women with FII is the tendency to pathological lying (pseudologia fantastica), which in some can be traced to adolescence. There is an important relation between factitious illness in an adult and factitious or induced illness in a child, and the detection of one should provoke a search for the other. Families are selected for intervention where a psychiatric formulation is apparent and a treatment plan can be applied to this. Factors that influence selection include the potential for working in partnership, where there is some degree of parental acknowledgement of problems, and where better prognostic factors exist. Total denial of maltreatment or any problems means that intervention is not feasible, except in the mildest of cases. If treatment aimed at reunification is embarked upon, a clear treatment plan with explicit criteria for success, shared with all professionals is necessary. Effective management includes containment of the fabricator's long term tendency to somatize or deceive, harnessing the strength of the non-abusive carer or family members, and management of any parenting breakdown that has accompanied FII behaviour. Long-term follow up by primary health, paediatric and child and family psychiatric teams will be necessary to maintain the child's progress and prevent future relapse, or a return to somatization by the abuser.