Pediatricians and other medical professionals will often be the first people to suspect that medical child abuse is taking place. Their attention and sympathy is typically one of the primary goals of abusers with Factitious Disorder Imposed on Another. In Medical Child Abuse, the medical professional becomes the very tool of the abuser as the caregiver fabricates—or even induces—illness in their child.
Though their role in these situations is central, medical professionals receive insufficient training about MCA. Medical and other clinical training does not prepare primary care doctors (PCPs) or specialists to doubt or question the history provided by a caregiver, particularly when they appear dedicated and competent. Furthermore, because of the highly manipulative nature of perpetrators with FDIA, doctors can experience professional blowback and even media scrutiny as a result of reporting their suspicions. It can be extremely damaging emotionally and psychologically for doctors to learn that they’ve been used to hurt a child. This type of abuse is very real and very much underreported; medical professionals who suspect it is happening should be heard and supported. The welfare of the child must always be top of mind for everyone involved.
We strongly advise reading the full APSAC Practice Guidelines and the APSAC Advisor.
Important Points for Medical Professionals
- Some victims have genuine symptoms, disorders, or impairments that are being intentionally exaggerated or exacerbated by the abuser, while in others these are complete fabrications.
- It is a common misconception among medical professionals that other causes need to be ruled out to prove this abuse is taking place.
- Abusers are almost always a child’s mother and often have coexisting cluster B personality disorders such as borderline, histrionic, or antisocial (sociopathic) disorders, or they have a mixture of problem personality traits.
- Factitious Disorder Imposed on the Self is common in these abusers.
- Factitious Disorder Imposed on Another involves intentional deception—differentiating it from delusional disorder. Though other motives—such as financial gain—may co-exist, external rewards do not drive this behavior.
- A diagnosis of FDIA does not release an abuser from liability; it may be similar to making a diagnosis of pedophilic disorder: Both types of abusers ignore the well-being of the child to meet their own needs.
- Falsification can encompass a wide variety of methods. (table 1)
- Even very young victims are often coached to cooperate or collaborate with their abuser.
- Abuse typically extends beyond the clinical setting, with the abuser maintaining the falsehoods with friends, family, and other professionals.
- Deceptions are conscious and carefully researched, planned, and executed by the abuser.
- Common medical conditions falsified by the abuser include: allergies, asthma, apnea, gastrointestinal problems, failure to thrive, fevers, infections, rashes, and seizures. (full diagnostic aid)
- Placement of tubes such as G-tubes or central lines is extremely common in MCA victims.
Victims often feel protective of the abuser and will sometimes vigorously defend them.
- In cases of suspected abuse, clinical documentation of details such as who reported symptoms, names of past clinicians, episodes of nonadherence, requests for specific procedures, and other concerning behaviors is crucial. (table 2)
- Analysis of medical records is the cornerstone for evaluating whether abuse took place and creating a detailed chronological table of events is recommended. (table 3)
- Record review can be extremely time-consuming; enlisting help from a nurse or social worker when possible can reduce the burden on the physician.
- Covert video surveillance (CVS) may also be used if abuse is suspected and can be used to capture cases of induction or simulation, or to document absence of falsely reported symptoms.
- The hospital or facility should have a policy in place regarding use of CVS to ensure that such evidence is legally robust when collected.
- Separating the victim from their abuser for a length of time can be an important tool in evaluating abuse. See table 5 for visitation guidelines. (table 5)
- Medical professionals involved in MCA cases can suffer from second victim syndrome, betrayal trauma, and PTSD. They should seek support and professional help if needed.