Malingering by Proxy: A Literature Review and Current Perspectives

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.