ICD-10: F68.A

Factitious disorder imposed on another, classified under ICD-10 code F68.A, is a complex psychological condition characterized by an individual intentionally producing or feigning symptoms in another person, typically someone under their care, such as a child or an elderly relative. This behavior is driven by a desire to assume the role of a caregiver or to gain attention and sympathy from others, rather than for external incentives like financial gain.

Clinical Description

Definition and Characteristics

Factitious disorder imposed on another (FDIA) is a subtype of factitious disorder, where the perpetrator deliberately causes or fabricates illness in another person. This can manifest in various ways, including:

• Fabrication of Symptoms: The individual may create false medical histories or induce symptoms through various means, such as withholding food, administering harmful substances, or manipulating medical tests.
• Seeking Medical Attention: The caregiver often seeks extensive medical evaluations and treatments for the victim, which can lead to unnecessary medical interventions and hospitalizations.
• Psychological Motivation: Unlike malingering, where the individual has clear external incentives (like financial gain), the motivation in FDIA is primarily psychological, often rooted in a need for attention, sympathy, or a desire to be seen as a devoted caregiver[2][5].

Diagnostic Criteria

According to the DSM-5, the diagnosis of factitious disorder imposed on another requires:

1. Intentional Production or Feigning of Symptoms: The individual must intentionally produce or feign physical or psychological symptoms in another person.
2. Deceptive Behavior: The behavior must be evident even in the absence of obvious external rewards.
3. Impact on the Victim: The actions must lead to medical evaluations, treatments, or interventions that are unnecessary and potentially harmful to the victim[5][6].

Prevalence and Demographics

FDIA is relatively rare, but it can occur in various settings, including hospitals and outpatient clinics. It is more commonly observed in women and often involves a mother or primary caregiver and their child. The disorder can lead to significant medical complications for the victim, including prolonged hospital stays and invasive procedures[3][4].

Treatment and Management

Managing factitious disorder imposed on another is challenging and requires a multidisciplinary approach:

• Psychiatric Intervention: Treatment often involves psychiatric evaluation and therapy for the perpetrator to address underlying psychological issues.
• Protection of the Victim: Ensuring the safety and well-being of the victim is paramount, which may involve legal intervention or child protective services if necessary.
• Education and Support: Providing education to healthcare providers about FDIA can help in early identification and management of cases, preventing further harm to the victim[1][2].

Conclusion

Factitious disorder imposed on another (ICD-10 code F68.A) is a serious mental health condition that poses significant risks to vulnerable individuals. Understanding its clinical characteristics, motivations, and treatment options is crucial for healthcare professionals to effectively identify and manage this disorder, ensuring the safety and well-being of those affected. Early intervention and a supportive approach can mitigate the harmful effects of this condition on both the victim and the perpetrator.

Factitious disorder imposed on another, classified under ICD-10 code F68.A, is a complex psychological condition characterized by an individual deliberately producing or feigning symptoms in another person, typically a dependent, to assume the role of a caregiver or to gain attention and sympathy. This condition is often associated with various alternative names and related terms that help in understanding its nuances.

Alternative Names

1. Munchausen Syndrome by Proxy: This is perhaps the most recognized alternative name for factitious disorder imposed on another. It refers specifically to the act of a caregiver, often a parent, fabricating or inducing illness in a child or dependent to gain attention or sympathy for themselves[2][4].

2. Factitious Disorder by Proxy: This term is used interchangeably with Munchausen Syndrome by Proxy and emphasizes the factitious nature of the disorder, highlighting that the symptoms are not genuine but rather fabricated or induced[6].

3. Imposed Factitious Disorder: This term is a more straightforward description of the condition, focusing on the act of imposing symptoms on another individual[3].

Related Terms

1. Somatic Symptom Disorder: While not directly synonymous, somatic symptom disorder involves the presence of physical symptoms that cause significant distress or impairment, which can sometimes overlap with factitious disorders when individuals present with symptoms that are not medically explained[5].

2. Münchausen Syndrome: This term generally refers to individuals who feign illness in themselves rather than in others. It is important to distinguish between the two, as the motivations and implications differ significantly[4][6].

3. Psychological Manipulation: This broader term encompasses various behaviors, including those seen in factitious disorders, where an individual may manipulate situations or people to achieve a desired outcome, such as attention or sympathy[2].

4. Child Abuse: In cases where a caregiver induces illness in a child, this behavior can also be classified under child abuse, as it involves harm to a dependent individual for the caregiver's benefit[4].

Conclusion

Understanding the alternative names and related terms for ICD-10 code F68.A is crucial for healthcare professionals, as it aids in accurate diagnosis and treatment. Recognizing the nuances of factitious disorder imposed on another can help in developing appropriate interventions and support for affected individuals and their families. If you have further questions or need more detailed information on this topic, feel free to ask!

Factitious disorder imposed on another, classified under ICD-10 code F68.A, is a complex psychological condition where an individual intentionally produces or feigns physical or psychological symptoms in another person, typically someone under their care, such as a child or an elderly relative. This behavior is often motivated by a desire to assume the sick role and gain attention or sympathy.

Diagnostic Criteria for Factitious Disorder Imposed on Another

The diagnosis of factitious disorder imposed on another is primarily guided by the criteria outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and the ICD-10. Here are the key criteria used for diagnosis:

1. Intentional Production of Symptoms: The individual must intentionally produce or feign symptoms in another person. This can involve fabricating symptoms, altering test results, or even causing harm to the other person to elicit medical attention[3][4].

2. Deceptive Behavior: The behavior is characterized by deception, which is evident even in the absence of external rewards. Unlike malingering, where the individual seeks tangible benefits (like financial gain), factitious disorder is driven by the need for attention and care[5][6].

3. Symptoms in the Victim: The symptoms must be present in the person being affected (the victim), leading to medical evaluations, treatments, or hospitalizations. The individual imposing the disorder often presents the victim to healthcare providers, claiming that the victim is ill[7].

4. Absence of External Incentives: The diagnosis requires that the deceptive behavior is not better explained by another mental disorder. The individual does not have a clear external incentive for their actions, which distinguishes it from other conditions like malingering[8].

5. Duration and Impact: The symptoms must cause significant distress or impairment in social, occupational, or other important areas of functioning. This can include repeated hospitalizations or extensive medical interventions for the victim[9].

Additional Considerations

• History of Similar Behavior: Often, individuals with this disorder may have a history of similar behavior, either in their own health or in the care of others, which can complicate the diagnosis and treatment[10].
• Psychological Evaluation: A thorough psychological evaluation is essential to rule out other mental health disorders and to understand the underlying motivations for the behavior[11].

Conclusion

Diagnosing factitious disorder imposed on another requires careful consideration of the individual's behavior and the impact on the victim. It is crucial for healthcare professionals to approach this condition with sensitivity and a comprehensive understanding of the psychological factors involved. Early identification and intervention can help mitigate the harm caused to the victim and address the underlying issues faced by the individual imposing the disorder.

Factitious Disorder Imposed on Another (FDIA), previously known as Munchausen Syndrome by Proxy, is a complex psychological condition where an individual deliberately produces or feigns symptoms in another person, typically a child or dependent, to gain attention or sympathy. This disorder is classified under the ICD-10 code F68.A and presents unique challenges in diagnosis and treatment.

Understanding Factitious Disorder Imposed on Another

Definition and Characteristics

FDIA is characterized by the intentional production or feigning of physical or psychological symptoms in another person, often leading to unnecessary medical interventions. The perpetrator, usually a caregiver, seeks to assume the role of a sick person, which can result in significant harm to the victim. The motivations behind this behavior can include a desire for attention, sympathy, or a need to fulfill a psychological need for control or power over the victim's health[1][2].

Diagnostic Criteria

The diagnosis of FDIA requires careful evaluation, as it can often be confused with other medical or psychological conditions. Key diagnostic criteria include:
- The presence of falsified or induced symptoms in another individual.
- The absence of external incentives for the behavior, such as financial gain.
- Evidence that the caregiver has a history of similar behavior in other relationships[3][4].

Treatment Approaches

Multidisciplinary Team Involvement

Effective treatment for FDIA typically involves a multidisciplinary approach, including:
- Psychiatric Evaluation: A thorough assessment by a psychiatrist is crucial to understand the underlying psychological issues and to develop a tailored treatment plan.
- Medical Intervention: Addressing any medical harm caused to the victim is essential. This may involve a pediatrician or other specialists to ensure the child's health is prioritized[5].

Psychotherapy

Psychotherapy is a cornerstone of treatment for the perpetrator. Various therapeutic modalities may be employed:
- Cognitive Behavioral Therapy (CBT): This approach can help the individual recognize and change harmful thought patterns and behaviors.
- Family Therapy: Involving family members can help address dynamics that may contribute to the disorder and support healthier relationships[6].
- Supportive Therapy: Providing a safe space for the individual to express feelings and experiences can be beneficial in fostering insight and change[7].

Legal and Protective Measures

In cases where the victim is at risk, legal intervention may be necessary. Child protective services may become involved to ensure the safety of the victim, and legal action may be taken against the perpetrator if warranted. This aspect of treatment is critical, as it addresses the immediate safety concerns for the victim[8].

Long-term Management

Long-term management of FDIA often requires ongoing psychiatric support and monitoring. The risk of recurrence is significant, and continuous engagement with mental health services can help mitigate this risk. Education about the disorder for both the perpetrator and the family can also play a vital role in preventing future incidents[9].

Conclusion

Factitious Disorder Imposed on Another is a serious condition that necessitates a comprehensive and sensitive approach to treatment. By involving a multidisciplinary team, utilizing psychotherapy, and ensuring the safety of the victim, effective management of FDIA can be achieved. Ongoing support and education are essential to prevent recurrence and to promote healthier family dynamics. If you suspect FDIA in a caregiver or patient, it is crucial to seek professional help immediately to address the complex needs of both the victim and the perpetrator.

References

1. Factitious Disorder - An Overview of the Condition & ICD.
2. ICD-10-CM Official Guidelines for Coding and Reporting.
3. Factitious Disorders.
4. The ICD-10 Classification of Mental and Behavioural Disorders.
5. Essential 2025 ICD-10-CM Coding Guidelines and Key.
6. The other face of illness-deception: Diagnostic criteria for.
7. Factitious Disorder Imposed on Self (Munchausen's).
8. Factitious disorder imposed on another.
9. 2024 April 1-ICD-10-CM Guidelines.

Factitious Disorder Imposed on Another (FDIA), classified under ICD-10 code F68.A, is a complex psychological condition characterized by the intentional production or feigning of physical or psychological symptoms in another person, typically a dependent individual, such as a child or an elderly person. This disorder is often associated with significant ethical and legal implications, as it involves deception and manipulation of medical professionals and caregivers.

Clinical Presentation

Overview

Patients with FDIA typically present with a range of fabricated or exaggerated symptoms in another person, which can lead to unnecessary medical interventions. The individual imposing the disorder often seeks attention, sympathy, or validation from healthcare providers and others by portraying themselves as a concerned caregiver.

Common Signs and Symptoms

1. Deceptive Behavior: The primary characteristic of FDIA is the deliberate fabrication of symptoms. This may include:
   - Falsifying medical histories.
   - Manipulating test results (e.g., contaminating urine samples).
   - Inducing symptoms through harmful actions (e.g., administering medications or causing injuries).

2. Inconsistent Medical Findings: Healthcare providers may notice discrepancies between reported symptoms and clinical findings. For instance:
   - Symptoms that do not align with known medical conditions.
   - A lack of corroborating evidence from diagnostic tests.

3. Frequent Medical Visits: The affected individual often has a history of multiple hospitalizations or medical consultations, frequently changing providers to avoid detection.

4. Emotional and Behavioral Indicators: The caregiver may exhibit signs of emotional distress or a need for attention, which can manifest as:
   - Excessive concern for the health of the victim.
   - Dramatic presentations of the victim's condition.

Patient Characteristics

• Demographics: FDIA can occur in various demographic groups, but it is most commonly seen in:
• Mothers imposing the disorder on their children.

• Caregivers of elderly patients or individuals with disabilities.

• Psychological Profile: Individuals with FDIA may have underlying psychological issues, including:

• Personality disorders (e.g., borderline or narcissistic personality disorder).
• A history of trauma or abuse.

• Previous experiences of being a patient themselves, which may contribute to their need for attention through another's illness.

• Motivation: The motivations behind FDIA can vary but often include:

• A desire for attention and sympathy.
• A need to assume the "sick role" vicariously through another person.
• A way to exert control over the victim's life and medical care.

Conclusion

Factitious Disorder Imposed on Another is a serious condition that poses significant challenges for healthcare providers. Recognizing the signs and symptoms is crucial for appropriate intervention and management. Understanding the psychological motivations and characteristics of individuals with FDIA can aid in developing effective treatment strategies and safeguarding vulnerable patients from further harm. Early identification and intervention are essential to prevent unnecessary medical procedures and to address the underlying psychological issues of the perpetrator.