Factitious Disorder in Children and Adolescents

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Factitious Disorder in Children and Adolescents

• Hailey Granger

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Definition

• Factitious Disorder intentional feigning of
  illness with the motivation "to assume the sick
  role" and an absence of "external incentives" for
  the behavior (Libow, 2000).
• Munchausen's is a form of factitious disorder but
  is not recognized in the DSM IV TR

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Timeline

• 1838- Hector Gavin uses the term in his book and
  uses the term to describe evidence that has been
  tampered with to gain personal attention (Kannan
  Wessely, 2010)
• 1843- Lancet one of the earliest descriptions
  provided by Chowne (OShea, 2003).
• 1951- Richard Asher described factitious disorder
  in modern day form Munchausen's Syndrome (Kannan
  Wessely, 2010)
• 1968- Renamed factitious disorder by Spiro. Wider
  diagnosis that included Munchausens
  (Overholser,1990).
• 1980- Classified as a mental illness and entered
  into DSM III (Kannan Wessely, 2010)

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Subtypes

• Nuclear long term history, many hospital visits,
  more common in males, lower IQ
• Non-nuclear more common in females and have
  knowledge of medical field, under diagnosed
• Perpetrators of Factitious Disorder by Proxy A
  caregiver making a child sick in order to gain
  attention for their own emotional needs
• (OShea, 2003)

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Malingering vs. Factious

• MALINGERING
• A child or adult fakes an illness for personal
  gain. For example, a child doesnt want to go to
  school an adult wants to sue someone following a
  car accident
• (Overholser, 1990)

• FACTITIOUS
• No known reason for adapting the sick role and it
  can be attributed to psychological reasons. More
  likely to undergo surgeries and extensive medical
  treatments

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Characteristics

• 31 more common in females
• Age range from 8-18
• Bland, flat and indifferent during medical
  evaluations
• Often takes at least 14 months to diagnose,
  easier to diagnose in younger children because of
  less complex means of making themselves ill
• (Libow, 2000)

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Frequent Imitations

• Asthma, arm swelling, lip crusting, hypoglycemia,
  renal stones, feculent urine, clenched fist
  syndrome, Secretans disease, hematuria, oral
  injury, purpura, sneezing, vomiting, diarrhea,
  fever, diabetes
• (Hickson Stutts, 1999)

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Causes

• Lack of a support system at home (illness of
  parent, loss of parent or little parent
  involvement)
• Depression
• Dependence
• Lifelong involvement with physicians
• (Hickson Stutts, 1999)

• Poor sense of self
• Suicidal tendencies
• Sexual/physical abuse
• Extreme poverty/homelessness
• Chronic lying
• Institutionalization
• Chronic illness

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Treatment

• Completing Psychological Evaluation to discover
  if there is another mental illness to treat
  (Hickson Stutt, 1999)
• In Patient Treatment (OShea, 2003)
• Behavioral Therapy (OShea, 2003)
• Involving Child Protective Services when a child
  in the case of Factitious Disorder by Proxy
  (Hickson Stutt, 1999)
• Parental Response

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Special Education

• Disorder starting to receive a lot of attention
  in the medical world not is not fully recognized
  in school settings
• Child with disorder will most likely be receiving
  special education services as a result of
  extensive absences and medical needs. The TEAM
  becomes essential in trying to recognize disorder
• (Coard Fournier, 2000)

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School Interventions

• Ask for written documentation of doctor reports
  and do not assume verbal reports are accurate
• Be aware of frequent appointments without much
  explanation
• Obtain releases to necessary medical personnel
• Communicate with school social worker and school
  psychologist
• Report to Child and Protection Services in the
  case of Factitious Disorder by Proxy

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Impact of Disability on Learning and Development

• Children often miss a lot of classes, which
  impedes their ability to progress academically
• Children often lack social skills
• Emotional needs to be addressed as soon as
  possible

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Supports and Services

• Medical or Social Emotional Disability
• Social Skills groups
• Counseling
• Evaluations
• Decreasing the amount of individual attention the
  child receives simply because of the disability
• Spend individual time with a child in another way
  besides sympathy
• Therapeutic School or Inpatient Hospitals

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Case Study

1. If this child was in your classroom, what would
   your response be?
2. Would you question what the mother was reporting?
3. What steps do you feel that the school could make
   to help the child?
4. In school settings, we are taught the value of
   listening to the parents to address the childs
   needs. Does a parent have too much freedom in a
   situation like this?

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References

• Coard III, H., Fournier, C. (2000). Factitious
  Disorder in School Settings A Case Example with
  Implications For School Psychologists. Psychology
  in the Schools, 37(6), 547. Retrieved from Child
  Development Adolescent Studies database.
• Hickson, G., Stutts, J. (1999). Factitious
  disorders in children and adolescents.
  Ambulatory Child Health, 5(4), 313. Retrieved
  from Academic Search Premier database.
• Kannan, R., Wessely, S. (2010). The origins of
  factitious disorder. History of the Human
  Sciences, 23(2), 68-85. doi10.1177/09526951093571
  28.
• Libow, J. (2000). Child and Adolescent Illness
  Falsification. Pediatrics, 105(2), 336.
  Retrieved from Academic Search Premier
  database.
• OShea, B. (2003). Factitious Disorders the
  Baron's legacy. International Journal of
  Psychiatry in Clinical Practice, 7(1), 33.
  Retrieved from Academic Search Premier database.
• Overholser, J. (1990). Differential Diagnosis of
  Malingering and Factitious Disorder with Physical
  Symptoms. Behavioral Sciences the Law, 8(1),
  55-65. Retrieved from Academic Search Premier
  database.
• Peebles, R., Sabella C., Franco K.,  Goldfarb
  J. (2005). Factitious Disorder and
• Malingering in Adolescent Girls Case Series
  and Literature Review. Clinical
  Pediatrics, 44(3), 237-43.  Retrieved October
  3, 2010, from ProQuest Psychology Journals.
  (Document ID 825038991).