Playing Sick? Untangling the Web of Munchausen by Proxy, Malingering, and Factitious Disorder

Author(s):  
Stephen M. Adams
1995 ◽  
Vol 25 (4) ◽  
pp. 389-399 ◽  
Author(s):  
Marc D. Feldman ◽  
Jacqueline M. Feldman

Objective: Patients who simulate or actually self-induce illnesses to assume the “sick role” present a number of imposing psychotherapeutic challenges. The purpose of this article is to discuss the countertransferential reactions that are mobilized in therapy with these patients. Method: Literature searches of the MEDLINE and HEALTH databases were performed using the term “factitious disorder.” The resulting citations were examined for descriptions of the potential and actual countertransference responses in therapy with such patients. The few citations with relevant material were supplemented with other clinical literature on countertransference as well as observations from cases in which the authors have served as therapists or consultants. Results: Once the medical dissimulation has been exposed, the most conspicuous difficulty is in persuading the patient to agree to therapy. When therapy does take place, both the patient's overt behaviors, such as actual bodily damage, and his or her underlying emotional issues can mobilize particularly intense reactions in the therapist. Conclusions: Recognition and management of the countertransference reactions likely to emerge in therapy with factitious disorder patients are particularly important if the therapy is to be maximally effective.


2002 ◽  
Vol 32 (2) ◽  
pp. 201-208 ◽  
Author(s):  
Ioanna Savvidou ◽  
Vasilis P. Bozikas ◽  
Athanasios Karavatos

The diagnosis of factitious disorder by proxy is still under investigation. Few studies have researched the psychological status and potential underlying psychopathology of the perpetrator, as well as the impact on the child's development and the pathological reactions of rearing a child within the context of a distorted reality. In this article, we present the case of a 12-year-old boy where this diagnosis was suspected. Both he and his parents brought forth false allegations of repeated physical abuse induced by his schoolteacher. The parents presented with shared psychosis and the child presented with conduct disorder, factitious disorder, and emotional problems. We suggest that this case represents a Munchausen by proxy-like syndrome involving both the legal and medical systems. Hypotheses regarding the pathogenesis of symptoms in the child are noted, underscoring the differences between Munchausen by proxy syndrome appearing in infancy with that appearing in older children.


Sign in / Sign up

Export Citation Format

Share Document