Factitious Disorder Imposed on Another (Munchausen by proxy) Treatment & Management

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

Approach Considerations

Treatment of factitious disorder imposed on another (FDIA) most centrally involves protecting and treating the victim (most commonly, a child). Attention should also be paid to the perpetrator (typically a parent, most frequently the biologic mother) and the family. [46, 47]

Common steps in case management following the confirmation of FDIA include:

  • Informing the perpetrator of the diagnosis. As already stated, this must be a planned confrontation with protection in place for the victim and all participants.

  • If possible, remove the victim and other persons at risk (e.g., siblings) from the care and influence of the perpetrator. This action generally requires a court order.

  • Create short- and long-term plans for the welfare of the victim and treatment of the perpetrator. Plans can include: 

    • Continued temporary placement of the victim with a specific reunification plan, or work towards permanent placement away from the perpetrator.

    • Management of the victim’s care by a single, well-informed professional (e.g., pediatrician who accepts that FDIA has been diagnosed).

    • Plans for long-term close monitoring of the situation by the court and/or protective agency.

    • Psychological/psychiatric care for the perpetrator and (if appropriate) the victim. Any therapist involved must understand and accept the diagnosis of FDIA. The perpetrator must agree to full communication with the protective agency and all other involved professionals.

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Treatment of the FDIA Perpetrator

Treatment of the person who has perpetrated factitious disorder imposed on another (FDIA) involves thorough evaluation, individual therapy, and other facets. Without successful treatment, the relapse rate is high. However, treatment is difficult because those with the disorder often deny there is a problem. The success of treatment depends on the person’s ability and willingness to tell the truth. FDIA perpetrators may be so entrenched in their deception that they have trouble telling fact from fiction.

It is important not to overlook any real medical and other psychiatric illnesses that may be present. Clinical investigations are conducted to determine if there are other problems that require treatment.  Psychotherapy generally focuses on changing the thinking and behavior of the individual with the disorder. [12]  Therapy is aimed at decreasing anxiety, stressors, and other problems that perpetuate the illness. Elements of therapy in FDIA perpetrators include the following: [48]

  • Identified problems must be appropriately managed

  • The perpetrator must show a genuine willingness to engage in therapy

  • The perpetrator must admit fully what has happened and to assume responsibility for their behavior [27]

  • The perpetrator must demonstrate understanding of why the behavior occurred

  • The perpetrator must improve their coping skills and learn how to form relationships that are not associated with being ill or providing care for others

  • The perpetrator must be able to place their victim’s needs above their own

  • Parenting classes may also be needed to teach how to parent effectively while meeting the perpetrator’s own needs

If the patient cannot overcome the issues found, the prognosis for recovery is poor and reunification with the victim should not be considered.

No information is available regarding the use of medications in the treatment of FDIA per se.  Antidepressants or mood stabilizers can assist to the extent that depression or bipolar disorder are “driving” the abusive behaviors.

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Treatment of the Abuse Victim

The primary concern in cases of factitious disorder imposed on another (FDIA) is to ensure the safety and protection of the victim. Treatment for the child comprises several areas, as follows:

  • First, the victim must be placed in a safe environment where his or her symptoms can be monitored in the absence of the patient with FDIA; there, the victim can receive appropriate therapies

  • Treatment may involve a variety of therapies, depending on the victim's age and situation

  • The victim's true health status should be clarified and appropriate care provided

  • A single practitioner who is familiar with the case and accepts that FDIA has occurred should be responsible for monitoring and treating the vitcim; however, managing a case involving FDIA often requires a team that includes social workers, foster care organizations, risk management, and law enforcement, in addition to healthcare providers

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Treatment of the Family

The family in which factitious disorder imposed on another (FDIA) has occurred may need consultation with mental or other health professionals to understand the deception, how the determination was made, and the prognosis and plans for the future. Continued mental health services may be necessary to assist one or more family members in coming to terms with the situation.

In some jurisdictions, family will be considered the first resource for victim placement. If this is part of planning, it is vital that potential caregivers understand and accept the FDIA determination, and agree to work cooperatively with protective services. 

If other children live in the victim’s home, their status should be evaluated, especially for purported problems similar to the victim’s. Appropriate treatment should be provided

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Consultations

Many authorities feel that timely diagnosis and appropriate management of factitious disorder imposed on another (FDIA) are best achieved if professionals from multiple disciplines are involved. Consultations with the following may be indicated:

  • Psychiatrist

  • Psychologist

  • Social worker

  • Attorney

  • Law enforcement personnel

  • Family court personnel

  • Institutional risk manager

  • Institutional discharge planner

  • Protective services

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