Some Kids Cry Out in Language of Illness
Feb. 14, 2000 (Atlanta) -- Qualified doctors can't be fooled by a child --
or can they? The sad and surprising answer, according to an article in the
journal Pediatrics, is that children as young as 8 can convince their
caregivers that they suffer from chronic illness.
One case -- a 12-year-old girl -- was thought to suffer from a mysterious
fever until she was 17, when her doctors finally realized that she was faking
thermometer readings. In other cases, children and adolescents inflicted
serious harm upon themselves or fooled doctors into prolonged hospital stays
and even repeated operations. Cases are rare, but early detection and treatment
are crucial to preventing long-term harm to the child. Study author Judith A.
Libow, PhD, tells WebMD that untreated children could go on to become adults
who repeatedly fake illness -- a diagnosis known as factitious disorder,
commonly called Munchausen syndrome.
"Most cases of adult factitious disorder seem to be traced to early
adulthood if not adolescence," says Libow, coordinator of psychological
services at Children's Hospital in Oakland, Calif. "These kids look like
the adult patients in their bland indifference to the number of procedures and
hospitalization, their fascination with health care, their denial and flight
from psychotherapy. It is logical ... that many of these patients begin early
in life and don't get picked up on until much later," she says.
In an interview to provide objective comment, Marc D. Feldman, MD, an expert
on factitious disease, agrees with Libow. "If children have experienced the
misuse of illness to draw attention, they are more likely to do this as
adults," he tells WebMD.
Libow also cites disturbing evidence that some children who make themselves
sick may previously have been victims of the form of child abuse known as
Munchausen by proxy (MBP), in which a parent inflicts disease symptoms on a
child in order to get attention and sympathy. "Many of these children may
have been victims of MBP," she says. "Some victims do go on to either
collude with the illness falsification by the parent or to go on to develop
Louisa J. Lasher, an Atlanta-based expert consultant on MPB maltreatment,
confirms Libow's assessment. "I can say that I have dealt with several
older children -- Munchausen by proxy victims -- who at the time I saw them
were themselves exhibiting symptoms of factitious disorder," she tells
Feldman, medical director of the University of Alabama at Birmingham Center
for Psychiatric Medicine, suggests that a small minority of MBP victims may
grow up to become MBP perpetrators themselves. "We know that parents who
engage in [MBP] very commonly have their own previous histories of factious
disorder," he says. "They are at a heightened risk of becoming MPB
perpetrators. The most powerful finding of MBP perpetrators has been Munchausen
syndrome or some other preoccupation with health."