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Malingering by Proxy: A Literature Review and Current Perspectives

Adam Amlani1, Gurinder S Grewal1, Marc D Feldman2

  • 1The University of Alabama Tuscaloosa, AL c/o 2609 Crowne Ridge Court Birmingham, AL, 35243-5351.

Journal of Forensic Sciences
|July 13, 2016
PubMed

Insights

Malingering by proxy (MAL-BP) involves caregivers fabricating illness in others for personal gain. This rare condition requires thorough medical workups for identification, but management strategies need further research.

Area of Science:

  • Medical Ethics
  • Child Abuse
  • Veterinary Medicine

Background:

  • Malingering by proxy (MAL-BP) is a rare form of maltreatment where a caregiver fabricates or induces symptoms in a dependent individual or pet.
  • This condition presents diagnostic challenges for healthcare professionals due to its infrequent study and unknown prevalence.

Purpose of the Study:

  • To review existing literature on malingering by proxy.
  • To identify common themes in identification strategies and propose a framework for management.

Main Methods:

  • A comprehensive computer literature search and review was conducted.
  • Analysis of sixteen case reports (eleven human, five veterinary) of MAL-BP.

Main Results:

  • Financial gain was the motive in all human MAL-BP cases, while medication-seeking was the motive in veterinary cases.
  • Effective identification relies on a comprehensive workup: thorough history, physical examination, neuropsychological testing, and collateral information.
  • Common themes in identification strategies emerged despite differing tactics.

Conclusions:

  • Further research and guidance are needed to develop evidence-based guidelines for MAL-BP identification and management.
  • Management likely requires a team-based approach, safety assessment for the proxy, and timely referral to appropriate services.
  • Long-term follow-up from a biopsychosocial perspective is essential.
Keywords:
Munchausenbehavioral scienceschild abusedisabilityfactitiousforensic sciencemalingeringproxy

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