Factitious Disorder Imposed on Another (Munchausen by proxy) Differential Diagnoses

Updated: Jun 25, 2020
  • Author: Marc D Feldman, MD; Chief Editor: Glen L Xiong, MD  more...
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DDx

Diagnostic Considerations

As with other forms of abuse, a high index of suspicion is necessary to detect factitious disorder imposed on another (FDIA). The stakes are high; FDIA abuse is dangerous, but falsely accusing caregivers is disastrous as well. A diagnosis of FDIA may be considered from the beginning of interaction with a caregiver/potential victim, but the ultimate conclusion depends on evidence. The professional should not hesitate to reach out to colleagues and consultants who are experienced in FDIA cases as well as protective agencies. Often confirmation/disconfirmation of a case requires a painstaking review of all possible family records, specialized forensic interviews with key informants, and formation of a multidisciplinary team.

Differential diagnoses for the perpetrator may include:

  • Psychosis or delusional beliefs about the victim
  • Misinformed or negligent caregiving
  • Cultural differences in caregiving

Differential Diagnoses