Psychological Maltreatment and Factitious Disorder Imposed on Another
Psychological maltreatment
Psychological maltreatment includes spurning, terrorizing, isolating, exploiting or corrupting, denying emotional responsiveness, and failing to provide mental health, medical, or educational support. It is often chronic and invisible; effects include attachment disorders, poor self-regulation, and developmental delay. Diagnosis rests on a pattern of caregiver behavior and the child's response, not a single episode.
Factitious disorder imposed on another
The caregiver - most often the mother - fabricates or induces illness in a child, who becomes the patient. DSM-5-TR names the caregiver's condition factitious disorder imposed on another; the broader clinical term is medical child abuse. Methods include suffocation, poisoning, unnecessary medications, and specimen tampering. Warning signs: persistent unexplained findings, discrepancy between reported and observed symptoms, symptoms only when the caregiver is present, an unusually extensive medical history, and caregiver calm or reassurance-seeking during crises.
Assessment and management
Diagnosis requires both fabrication or induction and a caregiver motivation to assume the sick role. Use a multidisciplinary approach: review all records, check laboratory results, observe without the caregiver, and coordinate with CPS. Confrontation is rarely productive and may prompt family flight. Remove the child from the caregiver for a monitored trial only with a protective plan.
Traps and rule of thumb
Traps: diagnosing FDIA from one discrepancy; confusing it with parental anxiety or over-medicalization; and missing that repeated unnecessary procedures are themselves abuse. Document everything.
Rule of thumb: symptoms that resolve when the caregiver is absent support but do not prove FDIA; the pattern, records, and multidisciplinary consensus make the diagnosis.