Factitious Disorder Imposed on Another: Recognition and Safeguarding

Author: Angela Bogdanova · Published: October 12, 2026 · Editorial Policy

Research cluster: Somatic Symptom & Functional Disorders · Written by Artificial Sapiens

Factitious disorder imposed on another (FDIA) is a DSM-5-TR diagnosis concerning a person who deceptively falsifies or induces physical or psychological illness or injury in someone else and presents that person as ill, impaired, or injured. A dependent child is the most frequently documented affected person, although vulnerable adults may also be involved. The immediate clinical priority is the safety and health of the affected person. Recognizing possible medical abuse does not require a clinician to establish a caregiver's psychiatric diagnosis or speculate about an unconscious motive. American Academy of Pediatrics clinical report; APSAC practice guidance.

This guide explains the diagnostic framework, recognition of concerning patterns, assessment of alternative explanations, coordinated safeguarding, effects on affected children and adults, treatment and recovery, and the limits of the research. It is educational information for readers and professionals, not an instrument for diagnosing a family member. Where there is immediate danger, seek emergency assistance and follow local child or adult protection procedures.

What is factitious disorder imposed on another?

FDIA describes deceptive behavior by an individual who falsifies or induces symptoms in another person and portrays that individual as ill or injured. The person being presented for care can have a genuine medical illness, an entirely fabricated history, induced symptoms, or a combination. The clinical psychiatric diagnosis, when justified, concerns the individual carrying out the deception. The affected person's physical and psychological injuries require their own medical and safeguarding assessment. DSM-5-TR classification; AAP clinical report.

The term “Munchausen syndrome by proxy” remains recognizable in research and public discussions. “Factitious disorder imposed on another” is the contemporary DSM terminology, while “medical child abuse,” “caregiver-fabricated illness,” and “fabricated or induced illness” describe related safeguarding or clinical situations. Their scope and evidentiary standards vary. A report of possible medical child abuse can be warranted without proving that the caregiver meets FDIA diagnostic criteria. APSAC clinical and case management guidance; RCPCH guidance.

Why recognition and safeguarding must be considered together

Harm can occur through direct induction of illness, falsification of reported events, specimen interference, withholding or manipulation of necessary care, and medically unnecessary investigations or procedures arising from misleading information. Affected children may also lose school time, ordinary social participation, independence, and trust in caregivers and clinicians. The care system can unintentionally intensify harm when separate specialists treat repeated, unsupported reports without an integrated view of the child's clinical history. AAP 2024 pediatric quick reference; APSAC guidance.

Safeguarding begins by asking whether a person is safe, what is clinically known, which allegations remain unverified, and what proportionate steps will reduce avoidable harm. It does not begin with a personality profile of a suspected caregiver. An unexplained symptom, a complex medical history, or a distressed parent can have many explanations. Investigations must remain alert to both serious organic illness and possible maltreatment. NICE child maltreatment guidance.

Diagnostic status: DSM-5-TR, ICD-11, and safeguarding language

DSM-5-TR criteria and the issue of intentionality

In DSM-5-TR, the central elements are identified falsification of physical or psychological signs or symptoms, or induction of disease or injury in another person, associated with identified deception; presentation of that individual as ill, impaired, or injured; deceptive behavior apparent even without obvious external rewards; and behavior better explained by neither another mental disorder nor a psychotic disorder. The diagnosis is applied to the person who imposes the condition, not automatically to the person receiving medical care. The criteria require a qualified professional's assessment of evidence, context, and alternative explanations. American Psychiatric Association, DSM-5-TR.

An apparent discrepancy is a clinical reason to investigate, not proof of conscious fabrication. A professional should distinguish an incorrect recollection, frightened interpretation, misunderstanding of medical advice, symptoms that fluctuate naturally, and deliberate alteration or fabrication of information. Intentionality cannot be derived reliably from gender, occupation, dramatic affect, knowledge of terminology, frequency of appointments, or the caregiver's response to questions. Where motive remains unknown, documented behaviors and risk to the affected person are the appropriate basis for immediate action.

ICD-11 and differences in clinical purpose

ICD-11 separately recognizes factitious disorder imposed on another in its classification framework. Its clinical descriptions must be consulted directly for coding and formal diagnosis. DSM-5-TR and ICD-11 share a concern with deliberate falsification or induction, but their overall organization and diagnostic wording are not a reason to substitute one classification's precise criteria for the other's. The child-protection assessment may use terms such as fabricated or induced illness that do not require a formal psychiatric classification of the caregiver. World Health Organization ICD-11 clinical descriptions; RCPCH.

Medical child abuse, caregiver-fabricated illness, and perplexing presentations

The American Academy of Pediatrics uses “caregiver-fabricated illness in a child” to address maltreatment that exposes a child to harmful or unnecessary care through falsification or induction. The Royal College of Paediatrics and Child Health also describes “perplexing presentations,” a category for clinically puzzling situations requiring careful coordinated assessment, and distinguishes these from cases of fabricated or induced illness. A perplexing presentation is a process signal for clinical clarification; it is not an accusation of caregiver deception. Some broader safeguarding formulations capture actions based on erroneous beliefs or excessive anxiety rather than knowingly false representations. AAP report; RCPCH guidance.

How might FDIA-related abuse appear in clinical care?

A clinician may encounter conflicting accounts of symptoms, repeated emergencies with incomplete confirmation, inconsistent response to treatment, or investigations that reveal discrepancies between reported events and objective findings. Such patterns are potentially significant when they persist across a comprehensive record, affect the person's welfare, or are associated with other evidence. The significance of any single feature depends on the medical condition, developmental stage, available observations, and setting. NICE CG89 recommendations 1.2.11–1.2.12.

Falsified or exaggerated accounts

In some documented cases, a caregiver attributes symptoms, disabilities, behavioral events, or diagnoses to a dependent person despite contrary observations or records. The alleged condition may concern seizures, feeding, bleeding, allergy, infection, development, mobility, mental health, or other systems. It is essential to distinguish a caregiver's report from an observation made by a clinician and to record who witnessed each event. Unobserved symptoms can be genuine, and their absence during an appointment does not prove deception.

Induced illness or interference with care

A smaller and potentially dangerous subset involves acts that cause or worsen disease, injury, or medical instability. Evidence of direct induction or treatment interference demands urgent clinical risk assessment and appropriate specialist or protective involvement. Public discussions sometimes focus on sensational examples, but unsafe care can also result from the cumulative effects of unnecessary tests, medications, restrictions, or missed treatment of an actual condition. AAP report; APSAC guidance.

Patterns across records and care settings

Relevant questions include whether descriptions change between services; whether a reported event has independent corroboration; whether symptoms are observed in particular settings; whether care is repeatedly escalated despite a shared assessment; and whether treatment plans or results are misrepresented. Review findings across all available systems before drawing conclusions. The 2024 AAP quick reference emphasizes a longitudinal medical record review and chronological summary, while the 2023 AAP quality-improvement report describes coordinated multidisciplinary case review and electronic-record communication. AAP 2024; AAP multidisciplinary task force.

Warning signs: what they mean and what they cannot establish

NICE recommends considering fabricated or induced illness when the clinical story, physical or psychological presentation, or investigation results conflict with a recognized clinical picture, including when a genuine condition already exists. Additional features that raise concern include apparent events observed only by a caregiver, symptoms linked to that person's presence, unusually poor treatment response, successive new complaints, biologically implausible events, disputed definitive opinions followed by repeated interventions, and loss of ordinary activities out of proportion to supported medical needs. These are alerting features for further evaluation. They are not a home diagnostic checklist. NICE CG89.

A parent may appropriately seek repeated opinions after delayed diagnosis, medical error, rare disease, or inadequate access to specialist services. Developmental disabilities, fluctuating autoimmune or neurological conditions, communication differences, healthcare trauma, language barriers, cultural expectations, and fragmented records may contribute to apparent inconsistencies. A child may have symptoms that adults cannot easily witness or communicate. Contextual assessment protects families from inaccurate accusations while allowing genuine harm to be recognized.

The absence of a convincing current diagnosis does not itself establish FDIA. Equally, confirmation of a child's genuine illness does not automatically resolve questions about deliberate exaggeration, interference, or unnecessary interventions. Clinical reasoning must accommodate the possibility of several conditions or processes at once. APSAC guidance; RCPCH guidance.

How a multidisciplinary assessment is performed

First evaluate the affected person's medical safety

A clinician assesses immediate medical stability, urgent symptoms, existing diagnoses, medication exposure, treatment requirements, and risks associated with delays or additional procedures. The current care team should address emerging red flags on their own merits. A safeguarding concern cannot replace emergency evaluation for serious new symptoms. The affected person's needs remain the primary focus even if no caregiver diagnosis is ever established.

Construct a precise longitudinal timeline

Effective reviews organize dates, healthcare encounters, clinician-observed findings, caregiver-reported events, tests, medication administration, school or community information when lawfully relevant, and documented changes after interventions. Distinguish each source of information and uncertainty. Corrections or disagreements should be recorded transparently. The goal is an evidence-based account of clinical events and potential harm, not a dossier assembled to validate an initial suspicion. AAP 2024 quick reference.

Coordinate clinicians and safeguarding professionals

Complex cases may require pediatricians, specialists, nurses, a hospital child-protection team, social workers, mental health clinicians, school professionals, and legal authorities in roles defined by local law. A designated clinician or multidisciplinary team should reconcile competing opinions and make one coherent medical plan. Independent specialist review may be appropriate, particularly when rare illnesses or unusually complex differential diagnoses are involved. Collaboration should preserve confidentiality, data protection, and the affected person's dignity. AAP 2023 team report; RCPCH guidance.

Speak with the child or dependent adult appropriately

Where developmentally and clinically appropriate, qualified professionals seek the child's account using neutral, non-leading questions and suitable communication accommodations, preferably with safeguarding advice about whether the caregiver should be present. Older adolescents should be included in decisions consistently with applicable law and capacity. For a dependent adult, assess decision-making capacity, coercion, accessibility, and wishes, and use the adult protection framework relevant to the jurisdiction. Repeated informal questioning can compromise safety and formal investigations.

Consider differential explanations

The differential includes complex or rare medical conditions; variable or intermittently detectable symptoms; errors in clinical documentation; differences between professional observations and home conditions; health-related anxiety; mistaken beliefs; communication problems; misunderstanding of investigations; neglect; deliberate abuse without FDIA psychopathology; and other psychiatric explanations where independently supported. The question “What evidence explains this sequence of events?” should precede judgments about an individual's personality or intent. RCPCH guidance.

Reporting concerns and immediate safeguarding

When a child appears to be at risk of harm, professionals should follow their institution's safeguarding protocol and the statutory rules applicable where the child is located. In the United States, mandatory reporting duties and definitions of reasonable suspicion vary by state and professional role. Healthcare workers, mental health professionals, educators, and child welfare staff are commonly designated reporters. Reporting possible abuse ordinarily requires a legally defined level of concern, not a completed DSM-5-TR diagnosis or a criminal standard of proof. US Department of Justice information on mandatory reporters.

Urgent responses may include emergency medical treatment, immediate consultation with a child-protection specialist, protective agency or police referral, and a coordinated plan to prevent imminent danger. The details, legal thresholds, investigation powers, and permissible sharing of protected health information depend on jurisdiction. If concerns are serious, do not rely on a private confrontation with a suspected caregiver as a substitute for safeguarding action. The RCPCH recommends child-protection referral when risk of significant harm is identified and distinguishes urgent danger from cases suitable for collaborative health and education planning. RCPCH guidance.

What families, teachers, and bystanders can do

Someone who has credible concerns can record objective observations, preserve existing communications lawfully, seek advice from healthcare or safeguarding services, and report promptly through local mechanisms when indicated. Provide dates, observed facts, immediate risks, and the person's medical needs; distinguish direct observation from something reported by another person. Avoid amateur surveillance, secret medication experiments, public accusations, repeated interviews of a child, or attempts to force an admission. Those approaches can increase danger and interfere with professional investigation.

How to communicate with the caregiver

For clinicians, communication should be led by the coordinated clinical and safeguarding plan. In lower-risk perplexing presentations, transparent discussion of agreed observations, rational investigations, and a health and education rehabilitation plan may help. In situations involving an immediate safety concern or suspected deliberate harm, consultation with child protection and relevant authorities should determine the timing and form of disclosure to the caregiver. Professional action should remain proportional, documented, and guided by the person's welfare. RCPCH guidance.

Medical care, unnecessary interventions, and iatrogenic harm

When a child has received extensive medical care, clinicians must review which diagnoses are supported and which treatments remain necessary. Any plan to reduce unsupported interventions must account for withdrawal effects, actual chronic illnesses, nutritional needs, pain, disability, and psychological support. Medication or medical-device changes belong to licensed treating professionals. The aim is to safeguard health while reducing preventable procedures, exposures, and restrictions; a sudden indiscriminate withdrawal of medical care can itself cause harm. APSAC guidelines.

In a coordinated approach, a named lead clinician may consolidate visits, establish explicit thresholds for additional testing, arrange safe specialist access when new signs emerge, and document the rationale for continued or discontinued therapies. This care-plan structure can also help families with complex genuine medical illness; its use alone is never proof of abuse.

Children and adolescents: development, education, and autonomy

Young children may depend almost entirely on caregiver accounts of symptoms and may have little ability to describe what occurred. School-aged children and adolescents may experience restricted attendance, missed developmental opportunities, social isolation, pressure to adopt an illness identity, or confusion about whom to trust. Some may have genuine conditions that deserve continued accommodation and specialist care. Assessment must examine the child's development, communication abilities, family environment, actual functional limitations, and access to education. APSAC guidance; AAP 2013.

A health and education rehabilitation plan, as described in RCPCH guidance, can specify safe medical care, school participation, graded restoration of normal activities where appropriate, family communication, and reassessment. Progress should be defined by welfare and functioning rather than by proving a caregiver guilty or by demanding immediate symptom disappearance. The child should not be made responsible for adult conflict. RCPCH guidance.

Vulnerable adults and other dependent people

Although pediatric cases dominate the published literature, FDIA's formal definition can apply to another person who is represented as ill. Dependent adults may face similar problems when a person controlling medications, appointments, information, or access to care distorts their clinical picture. Elder abuse, disability protection, coercive control, capacity law, and adult safeguarding services are relevant in these cases. The pediatric evidence base cannot simply be transferred to older adults without qualification.

How FDIA differs from related conditions

FDIA versus factitious disorder imposed on self

Factitious disorder imposed on self concerns an individual's deceptive presentation of their own illness or injury. FDIA concerns another person being presented as ill. They share a diagnostic framework involving identified deception but differ substantially in who is exposed to harm and in the safeguarding implications. Our separate factitious disorder overview examines self-directed presentations, assessment, and treatment.

FDIA versus medical child abuse

Medical child abuse is a safeguarding description of harm or risk arising from caregiver-created, falsified, or exaggerated health presentations and resulting interventions. FDIA is a psychiatric diagnosis of the individual's behavior under formal criteria. Protection of a child may be required before anyone can determine whether deception, an external incentive, mistaken beliefs, or another process explains the caregiver's conduct. The distinction prevents psychiatric classification from delaying a necessary response. APSAC guidance; AAP report.

FDIA versus malingering or other intentional abuse

Malingering generally involves intentional symptom misrepresentation for an identifiable external benefit, such as financial gain or avoidance of obligations. It is an assessment concept rather than a DSM mental disorder in the same sense as FDIA. Deliberate injury, coercion, medical neglect, or financial exploitation may occur without satisfying FDIA criteria. Apparent incentives do not establish motive, and professionals should describe observed behavior and supported evidence instead of inferring a diagnosis from a suspected benefit. DSM-5-TR.

FDIA versus health anxiety and unusual care seeking

A worried caregiver may sincerely believe that an illness is present, misread symptoms, seek repeated reassurance, or challenge a clinician's conclusion. These behaviors deserve careful clinical engagement and, where appropriate, support for anxiety and informed decision-making. The existence of anxiety does not demonstrate FDIA. Conversely, identifying real caregiver distress should not prevent examination of objective risks to a dependent person. For the broader classification of physical symptoms and related disorders, see our EN-14 clinical overview.

FDIA versus somatic symptom disorder or bodily distress disorder

Somatic symptom disorder and ICD-11 bodily distress disorder address clinically significant bodily symptoms and the individual's response to those symptoms within their respective frameworks. They do not imply deliberate symptom fabrication. A child's persistent physical symptoms should never be presumed fabricated because investigations are inconclusive. Our ICD-11 bodily distress disorder guide describes that separate classification; psychological factors affecting medical conditions addresses another distinct DSM-5-TR category.

What do researchers know about causes and risk factors?

Theories propose roles for attachment dynamics, interpersonal reinforcement, identity, prior health experiences, comorbid psychiatric disorders, and dysfunctional patterns of caregiving. These ideas have been discussed in clinical case literature, but robust prospective evidence explaining why FDIA develops is scarce. Neither a childhood history of trauma nor a caregiver's mental health diagnosis establishes that the person will engage in deceptive or abusive behavior. Assessment of a particular case depends on independently documented actions and actual risk.

A systematic review of 796 published perpetrator cases found many women and mothers in the selected reports, along with heterogeneous histories of psychiatric diagnoses. These proportions characterize a literature heavily shaped by detection, referral, documentation, and publication; they cannot be used as a reliable demographic screening test or as estimates for all caregiving populations. Men, other relatives, and professional caregivers must not be excluded from consideration when evidence warrants concern. Yates and Bass systematic review.

Prevalence, harm, and what case reviews can establish

Reliable population prevalence is not well established. Cases are difficult to identify consistently, terminology has changed, and many datasets derive from reported or litigated events. Published reports overrepresent severe, unusual, or legally significant examples. Rates calculated from a selected case series cannot be treated as the probability that a randomly selected caregiver with a concerning presentation has FDIA.

In a systematic review published January 2026, Wang and colleagues collected 314 studies containing 455 described perpetrators and 469 affected people. The authors reported substantial harms and diverse interventions, but their analysis relies predominantly on case reports and case series, with important selection and reporting limitations. Its outcomes should be read as observations within published cases, not population mortality, prevalence, or treatment success rates. The study itself calls for prospective multicenter databases and more consistent standards. Wang et al., 2026.

Earlier AAP and APSAC sources establish that severe morbidity and death can occur in documented medical child abuse and that unnecessary medical procedures can cause lasting harm. The appropriate conclusion is that suspected serious harm warrants careful protection and medically sound investigation, while numerical risk prediction for a particular family remains highly uncertain. AAP clinical report; APSAC guidelines.

Psychological effects on victims and survivors

The affected person may experience fear, medical trauma, disrupted trust, anxiety about bodily sensations, disconnection from education or community, identity confusion, and difficulties with future healthcare. Actual physical injury and treatment-related complications also require attention. The pattern of impact varies with age, the actions involved, duration, underlying medical illness, exposure to invasive care, and the support available after recognition. A survivor's account should be approached without pressing the person to adopt a predetermined narrative.

Children need access to a stable protective relationship, accurate age-appropriate explanation of their healthcare, support for ordinary functioning, and confidential mental health assessment when symptoms or distress indicate. Families and non-offending caregivers may need coordinated support and realistic guidance regarding ongoing medical conditions. Education and psychosocial interventions should be individualized and monitored. Bursch, 2019 treatment framework.

Treatment and rehabilitation

Care for the affected child or adult

Treatment begins with medical stabilization, evidence-based care for confirmed conditions, reduction of avoidable interventions, and protection from further harm. Psychological support may address trauma reactions, anxiety, medical mistrust, impaired autonomy, or disruptions in relationships and education. The form of therapy must fit the person's developmental stage, safety context, preferences, and clinically assessed needs. A safeguarding or healthcare plan needs ongoing review as new information emerges.

Assessment and treatment of a caregiver

Where an individual has been clinically evaluated and FDIA is supported, mental health intervention may focus on acknowledgement of documented behavior, emotional coping, empathy for the affected person, safe caregiving, and managing comorbid conditions. Engagement in treatment and the ability to maintain safe relationships require careful independent assessment. A proposed psychotherapy framework by Bursch outlines targets for work with affected families; it should not be mistaken for a treatment supported by large randomized trials. Bursch, 2019.

A caregiver may also need treatment for depression, anxiety, trauma-related symptoms, or other established psychiatric conditions. Medication can treat a separately diagnosed comorbidity when indicated; there is no established medication that reliably resolves FDIA as a specific condition. Treatment of the caregiver does not replace the affected person's protective plan, nor does an expressed wish to change establish that risk has ended.

Family work, contact, and reunification

Any decisions about supervision, family contact, placement, or reunification belong to the authorized clinical, child-protection, and legal processes. They require case-specific evidence about the past harms, insight, behavior over time, independent observations, the child's needs, and whether safe medical care can be sustained. A psychiatric label alone cannot determine custody or risk. Practice guidance discusses careful monitoring and coordinated decision-making, but outcome evidence for specific treatment or reunification protocols remains limited. APSAC practice guidance; Bursch, 2019.

Prognosis and follow-up

Outcomes depend on the severity and duration of harm, presence of genuine medical conditions, speed and quality of protective intervention, stability of care, and continuing clinical and social support. Follow-up should monitor physical health, psychological distress, school or community participation, and exposure to further unnecessary interventions. Recurrence risk and therapeutic effectiveness cannot be assigned a reliable universal percentage from available studies. Documented improvements in one person do not prove a generalizable treatment effect.

Documentation, uncertainty, and professional ethics

A good clinical note distinguishes observed signs, test findings, medical interpretations, caregiver statements, accounts from the child, historical reports, and explicit uncertainties. Terminology should match the evidence: “concern about possible fabricated or induced illness,” “documented discrepancy,” “reported event,” and “confirmed interference” convey different epistemic states. Avoid diagnostic or criminal conclusions beyond the clinician's competence. Where legal proceedings are possible, preserve records according to applicable standards and seek institutional legal and safeguarding consultation.

Professional duties include avoiding further harm, maintaining medically necessary care, proportionate confidentiality, appropriate reporting, attention to disability and cultural context, and fair assessment of alternative explanations. These safeguards matter because false allegations may profoundly affect families, while missed abuse may allow harm to continue. The quality of evidence and the person's safety must guide each decision. RCPCH guidance; NICE child maltreatment guidance.

What remains uncertain in the evidence

Established: formal DSM-5-TR and ICD-11 diagnostic categories exist; documented caregiver-fabricated or induced illness can cause severe harm; guidelines recommend structured medical review and coordinated safeguarding. Evidence-informed but mainly consensus-based: detailed multidisciplinary workflows, health and education rehabilitation plans, and family management recommendations. Preliminary: specific psychotherapy approaches, estimates of long-term recurrence, and predictive clinical profiles. Contested or poorly supported: a universal psychological motive, demographic checklists, precise population prevalence, and numerical risk scores derived from case reports. AAP; APSAC; RCPCH; Wang et al..

The literature needs prospective, ethically governed studies; consistent distinction between harmful behavior and psychiatric diagnosis; clearer measurement of iatrogenic injury and survivors' experiences; broader inclusion of adult victims and diverse caregivers; and transparent treatment outcomes. No brief questionnaire or isolated behavioral clue has been validated as a stand-alone diagnostic test for FDIA.

Practical questions and answers

Is factitious disorder imposed on another the same as Munchausen syndrome by proxy?

“Munchausen syndrome by proxy” is a widely known historical label. FDIA is the contemporary DSM diagnostic term for deceptive fabrication or induction of illness in another person. Medical child abuse and fabricated or induced illness are overlapping safeguarding concepts with potentially broader scope, so the terms should be interpreted in context.

Can the child have a real illness?

Yes. A genuine physical, neurological, developmental, or psychiatric condition can coexist with deception, exaggeration, interference, or medically harmful decisions. Equally, a complex illness does not by itself raise a valid allegation of deception. Doctors must evaluate the medical condition on its own merits.

Does frequently visiting doctors prove FDIA?

No. Repeated appointments may reflect appropriate advocacy, rare disease, fragmented access to care, delayed diagnosis, or understandable concern. Patterns become clinically meaningful only when considered alongside the full medical record, objective evidence, explanations for discrepancies, and the affected person's welfare.

Can a caregiver be diagnosed from online stories or social media?

No. Posts, anecdotes, medical vocabulary, apparent attention seeking, or emotional expression do not establish identified deception, motive, or formal criteria. Internet discussions can stigmatize innocent families and expose children to additional harm. Specific safety concerns should be directed to qualified clinical and protective professionals.

Must intentional deception be proved before a child is protected?

No. Safeguarding actions may be justified under the relevant local standard for suspected maltreatment or immediate risk. A psychiatrist's FDIA diagnosis and a child-protection assessment answer different questions and operate under different evidentiary and legal standards. Contact appropriate services when risk warrants.

What if a clinician suspects FDIA but the child's symptoms are still unexplained?

The team should continue proportionate medical assessment, review records, examine alternative explanations, and consult experienced child-protection professionals. Both missed disease and unnecessary procedures are hazards. Avoid prematurely assigning a psychiatric explanation to the child.

Does a diagnosis of FDIA automatically mean criminal responsibility?

No. Medical diagnosis, protective decisions, civil findings, and criminal liability have different decision makers and evidentiary standards. A clinician should document clinical findings and report concerns under local rules; legal conclusions belong to authorized processes.

Can perpetrators recover, and can families reunite?

Some individuals engage in treatment, but strong comparative evidence for FDIA-specific treatments and reliable recurrence prediction is lacking. Family contact decisions must rest on individualized safeguarding evaluation and demonstrated safety over time, with the affected person's needs foremost.

Where can someone seek help?

For immediate danger or acute illness, contact local emergency services. In the United States, concerns about child maltreatment can be brought to state or local child protective services or relevant medical safeguarding teams; professionals should follow their reporting duties. Elsewhere, contact the appropriate child protection or adult safeguarding authority. A person unsure how to proceed can seek confidential advice from a qualified clinician or local protection service, while observing applicable legal and safety requirements.

Related Articles

For adjacent, separately owned clinical topics: Factitious Disorder: Symptoms, Assessment, and Treatment, Somatic Symptom and Functional Disorders: Types, Diagnosis, and Treatment, Bodily Distress Disorder (ICD-11): Symptoms, Criteria, and Treatment, and Psychological Factors Affecting Other Medical Conditions: DSM-5-TR Explained. These English pages address other diagnostic concepts and should not be used as substitutes for a safeguarding assessment.

References

American Academy of Pediatrics. (2013; reaffirmed 2023). Caregiver-fabricated illness in a child: A manifestation of child maltreatment. Pediatrics, 132(3), 590–597. https://doi.org/10.1542/peds.2013-2045.

American Academy of Pediatrics. (2023). Medical Child Welfare Task Force: A multidisciplinary approach to identifying medical child abuse. Pediatrics, 151(2), e2022058926. AAP publication.

American Professional Society on the Abuse of Children (APSAC) Taskforce. (2017). Munchausen by proxy: Clinical and case management guidance. Official APSAC PDF.

American Psychiatric Association. (2022). Somatic symptom and related disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). APA chapter DOI.

Bursch, B. (2019). Psychological treatment of factitious disorder imposed on another/Munchausen by proxy abuse. Journal of Clinical Psychology in Medical Settings. https://doi.org/10.1007/s10880-019-09630-6.

National Institute for Health and Care Excellence (NICE). (2009; updated). Child maltreatment: When to suspect maltreatment in under 18s (CG89), recommendations 1.2.11–1.2.12. Official guidance.

National Institute for Health and Care Excellence (NICE). (2017; updated). Child abuse and neglect (NG76). Official guidance.

Royal College of Paediatrics and Child Health. (2021). Perplexing presentations (PP)/fabricated or induced illness (FII) in children: Guidance. Official RCPCH guidance.

Shanghvi, D. (2024). Medical child abuse (formerly Munchausen syndrome by proxy). American Academy of Pediatrics Pediatric Care Online. https://doi.org/10.1542/aap.ppcqr.396475.

U.S. Department of Justice, Office for Victims of Crime. (n.d.). Who is considered a mandatory reporter of child abuse? Official resource.

Wang, D., Zhao, M., Yin, J., & La, Y. (2026). Characteristics, interventions, and outcomes of factitious disorder imposed on another: A systematic review of 455 perpetrators and 469 victims. Frontiers in Public Health, 13, 1723415. https://doi.org/10.3389/fpubh.2025.1723415.

World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Official WHO publication.

Yates, G., & Bass, C. (2017). The perpetrators of medical child abuse (Munchausen syndrome by proxy): A systematic review of 796 cases. Child Abuse & Neglect, 72, 45–53. https://doi.org/10.1016/j.chiabu.2017.07.008.