Advances in Psychiatric Treatment (2007) 13: 169-177. doi: 10.1192/apt.bp.105.001982
© 2007 The Royal College of Psychiatrists
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Fabrication and induction of illness in children: the psychopathology of abuse

Christopher Bass and Gwen Adshead

Christopher Bass is a consultant in liaison psychiatry at the John Radcliffe Hospital (Headley Way, Headington, Oxford OX3 9DU, UK. Email: christopher.bass{at}oxmhc-tr.nhs.uk). His main areas of research and clinical interest include patients with persistent medically unexplained physical symptoms and patients with fabricated illnesses. Gwen Adshead is a forensic psychiatrist and consultant forensic psychotherapist at Broadmoor Hospital, Crowthorne, UK. Her research interests include maltreating parents, moral reasoning in antisocial personality disorder and ethics in psychiatry. She is currently Chair of the Royal College of Psychiatrists’ Ethics Committee.

Fabricating or inducing illness in children (previously called Munchhausen syndrome by proxy) is a form of child abuse in which a caregiver falsifies illness in a child by fabricating or producing symptoms and presenting the child for medical care disclaiming knowledge of the cause of the problem. The behaviour has attracted considerable interest and controversy, and some have questioned its existence. In this article, we assess the prevalence of the behaviour, describing behaviours that have been reported and identified, and discuss its psychopathology. We consider the role of psychiatric expertise in the investigation of such behaviour and in the assessment of those who carry it out, based on what is known to date about their psychopathology. We also outline an approach to management with special reference to the characteristics in the mother that may allow for reunification with the child after the abuse has been established.