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Child and adolescent illness falsification
1Department of Psychiatry, Children's Hospital Oakland, Oakland, California 94609, USA. jlibow@mail.cho.org
Objective:
To review the current state of knowledge on factitious illness in children and adolescents to help clarify the relationship of this phenomenon to a range of somatizing disorders in children and factitious disorder by proxy.
Design:
The literature of the past 30 years was reviewed for cases describing children <18 years old who have intentionally falsified symptoms of illness, without known parental involvement. Cases in which a parent was involved, the child acknowledged a credible motive, the deception was identified after age 18, or which appeared in foreign languages were excluded. Data on age, gender, factitious symptoms, method, duration of deception, and outcome of confrontation, where available, were gathered from case studies.
Results:
Forty-two cases of illness falsification by children were identified, with a mean age of 13.9, and a range from 8 to 18 years. The majority of patients were female (71%), and the gender imbalance was greater for the older children. The most commonly reported falsified or induced conditions were fevers, ketoacidosis, purpura, and infections, and the fabrications ranged from false symptom-reporting to active injections, bruising, and ingestions. The mean duration of the falsifications was almost 16 months before detection. Many of the children admitted to their deceptions when confronted, and some had positive outcomes at follow-up. The descriptions of some of these children as bland, depressed, and fascinated with health care were remarkably similar to adults with factitious disorders.
Conclusions:
Medical conditions fabricated by children may go undetected for a variety of reasons, or diagnosed as somatization. Further study of children who falsify symptoms may in some cases help identify earlier experiences of Munchausen by proxy abuse or covert parental coaching of illness falsification, and provide more effective interventions. Better understanding and identification of these children is likely to help prevent the development of more chronic adult factitious disorders.