Information and Resources

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 factitious illnesses."

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 WebMD.

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."