Fabricated or Induced Illness by Carers: severe and silent abuse

Abstract

Fabricated or induced illness by carers, also known as Munchausen Syndrome by Proxy, is a severe form of abuse, in which a carer (usually the child's biological mother) exaggerates or deliberately causes symptoms of illness in the child, making its diagnosis very difficult. The perpetrator can use different methods to produce signs and symptoms that are, to a great extent, compatible with the diseases observed at this time of life, making the syndrome even harder to recognize. The consequences of diagnostic failure are numerous, including physical and emotional distress resulting from the diagnostic methods used and adverse events due to unnecessary medication. The aggressor frequently uses insulin to trigger epileptic seizures of metabolic etiology and antiepileptic medication to induce motor and cognitive disorders. This study aimed to report the case of a boy diagnosed with epileptic encephalopathy, in which the disease’s signs and symptoms were produced by the mother through the administration of insulin, phenobarbital and carbamazepine. The importance of this issue is related to the need for doctors to be alert to this possible diagnosis. Some criteria can be considered in the search for the correct diagnosis.