Could His Mother Be Causing His Illness?

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Reader’s Question

My boyfriend, who has a 16-year-old son, got divorced about a year and a half ago. For the last 6 months or so his son has been very ill. He has a 100-103 degree fever and is vomiting. We have him every other weekend and oddly enough, when he is with us nothing seems to be wrong — no fever and little sick feeling. The day he returns to his mother this fever magically spikes again. His mother is on anti-depressants and is constantly calling her ex-husband and wanting to talk to him. She is also constantly taking her son to different hospitals to figure out what is wrong. I am worried that she is somehow causing the fevers and sickness in her son to try and get her ex-husband back. Is it possible to give a child a fever without his knowledge? Could she be doing this?

Psychologist’s Reply

There is a type of psychological disorder in the DSM-IV-TR called factitious disorder, which involves some dishonesty regarding physical or psychological symptoms. Two disorders that could be classified as factitious disorders are Munchausen Syndrome and Munchausen Syndrome by Proxy (MSP). Munchausen Syndrome is when someone feigns or causes his or her own illness. Munchausen Syndrome by Proxy is when a caretaker or parent causes or falsely reports illness in his or her child. Both of these disorders are rare, although exact prevalence is not known.

Munchausen Syndrome by Proxy (MSP) is characterized by a particular cluster of elements. Most typically, it involves the biological mother, and she is usually knowledgeable about the medical or healthcare system, either through her own exposure or perhaps based on her background as a medical professional. The mother presents the child at multiple doctors or hospitals (i.e., ‘doctor shopping’) for tests or treatments. She typically appears to be an excellent caregiver for her child and is cooperative and well-liked by the doctors and hospital staff members.

The tricky thing about this is that the above picture could also describe a knowledgeable, concerned parent who wants the best care and treatment for her child. From the information in your post I certainly am not able to determine this. In fact, it can be difficult in general to detect when a parent is feigning or causing a child’s illness.

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If it is indeed MSP, there would likely be inconsistencies among the reported clinical history, lab tests, and symptoms, and the symptoms might disappear at the hospital but reappear at home. Also, with MSP, the child’s symptoms do not fit with the classical picture of typical illnesses or do not fit together well.

Because it can include parents actually causing illness in their children or presenting them for repeated, potentially invasive medical treatments, MSP is considered a form of child abuse.

As with any hypothesis, it is a good practice to consider alternative explanations. Maybe there is actually something that is causing him to feel ill that is present in the environment at his mother’s house. Maybe he is having difficulty coping with the divorce and is experiencing anxiety, which can cause both stomachaches and nausea. Open discussions with your boyfriend’s son regarding how he is feeling, both physically and emotionally, could be a first step in determining the how, what, and why of his illness.

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