Child and Adolescent Mental Health Professionals
Falsified pediatric mental health conditions may be even more complicated to detect than falsified physical conditions. Mental health providers are trained to create an empathic environment through active listening, which typically involves accepting and validating the histories provided by the parent. Given their expertise in human behavior, mental health professionals may also overestimate their ability to detect deception. However, MBP perpetrators typically present as normal, competent, loving caregivers. Additionally, learning, developmental, and behavioral conditions are easier to fabricate than physical problems because of the reliance on parental history and reports of a young child’s symptoms.
Important Points for Mental Health Professionals
- Some victims have genuine symptoms, disorders, or impairments that are being intentionally exaggerated or exacerbated by the abuser while in other cases these are complete fabrications.
- It is a common misconception among professionals that all 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 Self is common in the history of these abusers; many also have a history of depression, though this feature may be misrepresented.
- Factitious Disorder Imposed on Another (Munchausen by Proxy) involves intentional deception—differentiating it from delusional disorder and other psychotic ailments. Though other motives—such as financial gain—may co-exist, external rewards are not the principal driving force for this behavior. However, motives can change over time.
- A psychiatric 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.
- Even very young victims are often coached to cooperate 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 conditions falsified by the abuser include: ADHD, Autism Spectrum Disorder, Speech Disorders, Dyspraxia, and various types of learning disabilities.
- Victims often are manipulated to 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.