Factitious disorder imposed on another

Essential (Required) Features:

• Feigning, falsifying, or intentionally inducing medical, psychological, or behavioural signs and symptoms or injury in another person, most commonly a child dependent, associated with identified deception. If a pre-existing disorder or disease is present in the other person, the individual intentionally exaggerates of aggravates existing symptoms or falsifies or induces additional symptoms.
• The individual seeks treatment for the other person or otherwise presents him or her as ill, injured, or impaired based on the feigned, falsified, or induced signs, symptoms, or injuries.
• The deceptive behaviour is not solely motivated by obvious external rewards or incentives (e.g., obtaining disability payments or avoiding criminal prosecution for child or elder abuse).
• The behaviour is not better accounted for by another mental disorder (e.g., Schizophrenia or Other Primary Psychotic Disorder).

Note: The diagnosis of Factitious Disorder Imposed on Another is assigned to the individual who is feigning, falsifying or inducing the symptoms in another person, not to the person who is presented as having the symptoms. Occasionally the individual induces or falsifies symptoms in a pet rather than in another person.

Additional Clinical Features:

• The range of behaviours involved in Factitious Disorder Imposed on Another is similar to those in Factitious Disorder Imposed on Self, and includes reporting episodes of neurological or mental symptoms in the other person; manipulating laboratory tests to falsely indicate an abnormality (e.g., adding sugar to urine); falsifying past or current medical records to indicate an illness; administering a substance (e.g., warfarin) to produce an abnormal laboratory result or illness; and physically injuring or intentionally inducing illness in the other person (e.g., intentional exposure to infectious or toxic agents).
• The simulation or induction of illness or injury in Factitious Disorder Imposed on Another may be quite dramatic, resulting in numerous medical investigations and interventions in spite of negative or inconclusive findings.
• The person presented as ill, injured, or impaired would in many cases be considered to be a victim of physical or psychological maltreatment (i.e., abuse), which should be classified separately using the appropriate code from the chapter on External Causes of Morbidity or Mortality.
• There is evidence that a significant proportion of perpetrators of Factitious Disorder Imposed on Another have a history of Factitious Disorder Imposed on Self.

Boundary with Normality (Threshold):

• Some individuals whose loved ones have medical conditions may exaggerate the reports of symptoms to medical professionals in order to get their loved one’s care prioritized or to access additional treatments they perceive as necessary or potentially beneficial. Factitious Disorder Imposed on Another should only be considered if there is evidence that the person is feigning, falsifying, or intentionally inducing or aggravating the symptoms of the other person.

Sex- and/or Gender-Related Features:

• The most common presentation of Factitious Disorder Imposed on Another is a mother who fabricates symptoms in one or more of her children.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with motivated deception related to physical abuse: Caregivers who lie about the cause of abuse injuries in their dependents (e.g., claiming that an injury was the result of an ‘accident’ rather than child or elder abuse) solely in order to avoid criminal prosecution or the intervention of child protective services should not be diagnosed with Factitious Disorder Imposed on Another. The diagnosis of Factitious Disorder Imposed on Another requires a clinical judgment that there are additional motivations for the deceptive behaviour, such as obtaining the attention and admiration of health care providers.
• Boundary with mental disorders with psychotic symptoms: Individuals with other mental disorders (e.g., Schizophrenia or Other Primary Psychotic Disorders, Mood Disorders) may sometimes harm others, including their children, in response to a command hallucination or a delusion or as part of a suicide attempt. In such cases, there is typically no evidence of deception associated with the harmful behaviour other than to avoid criminal prosecution for child abuse or other intervention (e.g., removal of a child by protective services).