Beyond collusion: active illness falsification.

OBJECTIVE: This article explores the relationship between factitious disorder by proxy victimization and the genesis of factitious disorder in young people. It is hoped that this will aid in our understanding of how some illness falsification behaviors may be learned and transmitted within the family system. METHOD: A discussion of the origins of adult factitious disorder and recent findings on the phenomenon of illness falsification in children and adolescents is integrated with some of the more ambiguous or "blended" cases which combine primary falsification by the youngster with caregiver collusion. Those less easily classified cases of factitious illness which fall in the gray areas, containing elements of both independent illness falsification by a child or adolescent with an earlier history of collusion with a parent's Munchausen by Proxy disorder, are proposed as a type of transitional case which may help us better understand the process by which illness falsification is learned. RESULTS: The literature on illness falsification in adults supports the possibility that adult factitious disorder may have its origins in adolescence or perhaps even earlier. Several cases are identified which suggest that some youngsters independently falsifying illness may have had earlier experiences of Munchausen by Proxy victimization or perhaps experienced the modeling or encouragement of illness falsification by a caregiver. Certain elements of the child victim experience, including efforts to overcome feelings of powerlessness, chronic lack of control, and disappointment in the physician are suggested as possible dynamics in the eventual development of independent illness falsification behaviors. CONCLUSIONS: The many unanswered questions in our understanding of the development of factitious illness in children and adolescents suggest avenues for further research. It is hoped that increased understanding will eventually allow more rapid, reliable identification of these patients and more effective interventions within the family system, with positive implications for future generations.

Three forms of factitious illness in children: when is it Munchausen syndrome by proxy?

Examples of fabrication of illness in children are described. Primarily uncomplicated cries for help are differentiated from two major subtypes (the Active Inducer and the Doctor Addict) which define the spectrum of Munchausen syndrome by proxy. Primary differences involve the form of deception, age of the victim, and maternal affect. Five histories are presented and it is suggested that doctor addiction is more common than has thus far been recognized.

An exploratory approach to self-blame and self-derogation by rape victims.

Quantitative and interview data on rape victims' self-evaluation and attributions of personal responsibility were studied to explore the relevance of theories of "defensive attribution" and maintenance of belief in a "just world." Clinical implications of the findings for adjustment of victims, counseling, victim compensation, and the legal system are discussed.