Factitious Disorder in Children and Adolescents

1. Factitious Disorder in Children and Adolescents Hailey Granger

2. 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

3. 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 (O’Shea, 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 Munchausen’s (Overholser,1990). • 1980- Classified as a mental illness and entered into DSM III (Kannan & Wessely, 2010)

4. 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 (O’Shea, 2003)

5. MALINGERING: A child or adult fakes an illness for personal gain. For example, a child doesn’t 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 Malingering vs. Factious

6. Characteristics • 3:1 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)

7. Frequent Imitations Asthma, arm swelling, lip crusting, hypoglycemia, renal stones, feculent urine, clenched fist syndrome, Secretan’s disease, hematuria, oral injury, purpura, sneezing, vomiting, diarrhea, fever, diabetes (Hickson & Stutts, 1999)

8. 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 Causes

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

10. 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)

11. 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

12. 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

13. 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

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

15. 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. doi:10.1177/0952695109357128. Libow, J. (2000). Child and Adolescent Illness Falsification. Pediatrics, 105(2), 336. Retrieved from Academic Search Premier database. O’Shea, 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).