"Factitous Disorder by Proxy" - First Case Law in Canada

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EW (Re), 2012 SKQB 1 (CanLII)
Date: 2012-01-03
Docket: F.S.M. 93/2010
URL: CanLII - 2012 SKQB 1 (CanLII)
Citation: EW (Re), 2012 SKQB 1 (CanLII)

[1] On September 23, 2010, the Minister of Social Services made an application for a protection hearing involving a child, E. W., who was born two years earlier, that is on […], 2008. The mother of E.W. is R.W. E.W. was apprehended on September 22, 2010. R.W. had previously been charged with attempting to endanger the life of E.W. by administering a noxious substance and with aggravated assault upon the child arising from the same circumstances.

[2] Medical personnel involved with the facts leading to the apprehension of E.W. suspected that R.W.’s behaviour, in attempting to smother E.W. and by administering harmful medication and tobacco to E.W. in her bottle feeding, appeared to have been to feign medical problems and signs in E.W. with the actual motive appearing to be to seek help and attention for herself and not for any other external incentive or gain. Such behaviour is referred to as Factitious Disorder by Proxy.

Will be following this one as it unfolds. The recognition and proper identification of "factitious disorder by proxy", a complex form of child abuse, is often miss understood before the courts in Canada. Often, only the most extreme forms of this pattern of behaviour is white-washed as "parental anxiety" and these cases are some of the most complex to sort out.

Louisa J. Lasher

When I think back about MBP cases with which I have been involved, I often think of the teenager who had lived her life as a dying child because of deliberate falsification activities by her mother from the time she was an infant; the seven year old child with a colostomy bag whose grandmother prayed with him and their minister to accept imminent death due to nonexistent celiac disease she had fabricated; and the two little ones whose graves I visited after a young woman induced severe breathing problems with regard to her own child, as well as children for whom she babysat. These are not rare examples, and all could have been avoided had involved professionals had and acted upon basic education regarding MBP.

Correct, skills-based education is the foundation of working appropriately with suspected and confirmed cases. Throughout the world, efforts must be made to convince those who have decision-making power that MBP maltreatment is real, that it is not rare, that it should be included in legal statutes as a separate kind of abuse/neglect, that polices and procedures relevant to MBP must be revised, and that comprehensive professional training must be offered. I challenge the readers of this editorial to become part of this effort.

Good Luck!
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[hadenough]

Factitious or Fictitious?? Isn't that like Munchausensen's Syndrome by proxy??

Indeed it is FACTITIOUS
http://en.m.wikipedia.org/wiki/M%C3%BCnchausen_syndrome

[hadenough]

Was too late to "edit" but I totally butchered the spelling of Munschausens - still not sure if I've spelled it correctly. It is a topic/condition/disorder that seldom comes up.

[Tayken]

Factitious or Fictitious?? Isn't that like Munchausensen's Syndrome by proxy??

Indeed it is FACTITIOUS
Münchausen syndrome - Wikipedia, the free encyclopedia

There are many names, part of the problem with identification:

Munchausen by Proxy (MBP)
Factitious Disorder by Proxy (FDP)
Malingering by Proxy
Pediatric Condition Falsification (PCF)
Medical Child Abuse
Fabricated or Induced Illness
Factitious Disorder
Munchausen Syndrome

Child or adult maltreatment (abuse or neglect) through deliberate problem falsification/deception is simply my generic, descriptive, informal term for a particular pattern of behavior that includes one or a combination of the following behaviors described below. I use this overall, umbrella term because of so many terms being used throughout the world – some mean the same thing – some don’t mean the same thing depending on the concept used, and the terms, meanings, and criteria change, depending on the individual using the particular term. “Terminology confusion” continues to evolve.

All terms used include perpetration of one or more of the following behaviors. One or more of these falsification behaviors constituting child or adult maltreatment must first be established – prior to attempts to determine “the why” of the behavior, and to use any of the sub-terms.

Exaggerate:
The perpetrator embellishes a genuine physical and/or psychological-behavioral-emotional-mental health problem.

Fabricate:
(A) The perpetrator makes up/concocts a physical and/or psychological-behavioral-emotional-mental health problem story – AND/OR (B) makes it look as if a problem exists when, in fact, the problem does not exist.

Induce:
The perpetrator causes/creates/exacerbates a physical and/or psychological-behavioral-emotional-mental health problem.

Very confusing ontology (terminology) to FDP (aka MBP/MBPS). Even the DSM for FDP is a mess when defining "what" exactly outlines this form of neglect/maltreatment - child abuse.

Good Luck!
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Factitious illness: recognition and management
D M Eminson, R J Postlethwaite

http://adc.bmj.com/content/67/12/1510.full.pdf

This paper is interesting as they present a spectrum of normal parental behaviours. (Second page)

(Not a fan of the gender identifying in the paper to "mothers" but, if you read it without the label there are some interesting observations. Read "parent" where they explicitly use "mother".)

Characteristics of mothers

The mothers we have engaged in psychiatric treatment, themselves only a small percentage of those who are seen by the child psychiatrist, are
a disturbed group of women in terms of parenting abilities (in the broadest sense), personality functioning, and ability to form relationships. All have had early experience that was abusive at an emotional or physical level,
although on occasion this is suggested rather than actively acknowledged. Although these mothers' capacity to cope with current difficulties without presenting their child for paediatric care can be supported, their own concurrent psychiatric difficulties treated, their child helped to independence of maternal symptom production, and they themselves helped to find ways in which some personality maturation may take place, they remain highly vulnerable to using this method of meeting their own needs. Even so, we believe strenuous efforts to engage these families in treatment are worthwhile in terms of the quality of life for the children, even before considering the savings in unnecessary hospital stays and investigations. The children who stay within families where factitious illness is common have not been studied extensively. Retrospective studies of adults with abnormal illness behaviour would suggest that this may be one of the outcomes. The extent to which it is proper to generalise from less unusual health care seeking parents (for example parents with psychosomatic illness or anxiety) to examine the results for families with greater parental health care seeking behaviour and less ability to distinguish their child's needs is unknown.

Good Luck!
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[murphyslaw]

Would a parent deliberately and continuously trying to put children in harms way, be a form of this?Especially if that parent has a continous need for attention, or would that be leaning more towards Münchhausen ?.Im not talking about just being a neglectful parent ,rather towards effort put in make a crisis situation, which thankfully was thwarted on ever turn.

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Would a parent deliberately and continuously trying to put children in harms way, be a form of this?Especially if that parent has a continous need for attention, or would that be leaning more towards Münchhausen ?.Im not talking about just being a neglectful parent ,rather towards effort put in make a crisis situation, which thankfully was thwarted on ever turn.

Fabrications of all sorts of things can be "factious" in nature. If the parent in question is continually calling the CAS and reporting emotional abuse and other factitious things and by proxy blaming the other parent it *could be* related to the person's need for attention. Constantly seeking out someone to "believe" the factitious (lies) statements against someone else in relation to the child (the false victim) *could* be a factitious disorder by proxy. The parent making the constant allegations may be expressing an emotional state where by their are not putting the child's "best interests" first and their "best interests" only.

This is often white-washed by many professionals as "over anxious" parenting but, when third party professionals (doctors, lawyers, social workers, CAS, courts, etc...) become involved... They *may* be attempting to gain attention by proxy through these third parties to create a distortion campaign against the other parent.

This is why, in my opinion, more research and study in Canada needs to go into better understanding FDP as a whole. The "tax" these possible people have on the medical/legal/law enforcement agencies is incredible. I have been searching to see what the public costs of someone exhibiting these patterns of behaviour cost public tax payers.

FDP in Canada generally requires the parent to try and induce an illness and the weighting is all based on the parent "inducing" the illness. For example, a parent who puts their child on a special diet for an allergy they don't have, goes to different clinician's "shopping" this illness etc... would be by general definition an "over anxious" parent. They may have even been told by these clinicians that the child does not have the condition but, maintain it publicly so they can feel like a "good parent". Even though they have exaggerated and even fabricated (lied about clinical diagnosis that don't exist) the expectation of clinicians generally (in Canada) is that they have to "induce" the illness. One would question if changing a child's diet, often seen as not "dangerous" is a pattern of "induction"?

This is also white washed as "over anxious" parenting when the person constantly logs the child's weight, records their movements (color, size, amount) and dietary intake. At what point does anxiety become a "belief" in light of medical advice contrary to what has been provided by clinicians become "induction"? The child is told they have an issue, they can't eat specific foods or it will harm them (even though it won't). This in my opinion, although not clinical, would be the induction of a mental health condition in the child.

PS: Due to the rash of parents who "believe" their child may have celiac spruce disease and the popularity of "gluten free" in the public media many health authorities are giving parents pamphlets which contain photographs of normal stool and rashes with their common diagnosis as it has been recognized that a gluten free diet, if not managed and monitored by a clinician (doctor/nurse/dietitian) can pose a danger if done improperly and for reasons that are not truly medical. (Health authority in the Greater Sudbury Region is now providing this to new parents.)

PPS: This *may* be driven by the fact that family doctors, who prior to 2005 never saw parents for "gluten intolerance" are now having loads of parents coming in and filling up their appointment books now. This *may* be done to assist in curbing the false information being propagated on the internet about "gluten sensitivity", for which no clinical definition exists.

Good Luck!
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[hadenough]

Medscape: Medscape Access

Re: Pediatric Cases, as well discusses both genders as the perpetrators

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Update on CanLII regarding the above mentioned case law:

Saskatchewan (Social Services) v RW, 2012 SKCA 75 (CanLII)
Date: 2012-08-07
Docket: CACV2214
URL: CanLII - 2012 SKCA 75 (CanLII)
Citation: Saskatchewan (Social Services) v RW, 2012 SKCA 75 (CanLII)

Appeal to the restriction of the medical report.

[4] The Child was born in 2008. In the spring of 2010, there were incidents involving calls by the Mother to Emergency Medical Services because the Child had stopped breathing.

[5] Medical personnel expressed concern that the Child was being smothered and, as a result, surveillance cameras were installed in the Child’s hospital room. The Mother was observed putting something in the Child’s food and, on another occasion, was observed opening capsules and adding their contents to the Child’s baby bottles.

[6] The Mother was interviewed and, according to material filed by the Ministry, disclosed that she had three times smothered the Child until the Child had stopped breathing and, as well, had attempted to administer adult hypertension medication to the Child.

[7] On April 15, 2010, the Mother was charged with aggravated assault and with administering a noxious substance. These charges have not been resolved.

[8] The Child was placed with the Mother’s cousin and her husband (the “Cousins”) pursuant to a six month agreement as per s. 9 of the Act. Section 9 allows a parent who cannot care for a child because of special circumstances to enter into an agreement concerning the provision of residential services for the child.

[9] The Mother was interviewed by mental health experts and, in early September of 2010, advised Ministry officials that she was having “bad thoughts” about hurting the Child again.

[10] The residential services agreement was cancelled in September of 2010 and the Child was apprehended by the Ministry. The Ministry told the Mother that it would be seeking a permanent wardship order for the Child. This did not affect the Child’s living arrangements as she continued to reside with the Cousins.

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JMT v JEB, 2012 SKQB 373 (CanLII)
Date: 2012-09-12
Docket: F.L.D. No. 79 of 2003
URL: CanLII - 2012 SKQB 373 (CanLII)
Citation: JMT v JEB, 2012 SKQB 373 (CanLII)

1) Jane is nine year old “Michelle’s” psychological parent. Jane also suffers from factitious disorder by proxy (previous known as Münchausen by proxy). She will not admit it, but she does. Jane’s life focus is to be the best mother possible to Michelle but she is hindered by her psychological problems. The primary issue before me is to determine whether, despite her mental illness, Jane can provide the care that is in Michelle’s best interests or whether Michelle would be better off with her father, Jerrod.

...

13) There was a great deal of turmoil in 2011 when Social Services became involved and expressed a concern about the frequency with which Jane was taking Michelle to doctors and hospitals. That led to a psychological assessment of Jane and the diagnosis that she had factitious disorder by proxy. Jerrod brought a successful application last summer, changing primary residence to him. Jane has moved to Saskatoon and has supervised parenting time with Michelle.

14) Michelle has no health issues of note and never has. Michelle’s teachers, Jane’s parents, Jerrod, Shannon – and Jane – described Michelle as a healthy, happy child. Even so, Jane took Michelle to hospitals and doctors more than 130 times over an eight and one-half year period. Michelle has been to a doctor only once in the year she has lived with her father. Michelle missed more than 30 days of school in each of Grades one, two and three because her mother said she was sick. Michelle has not missed a single day of school since moving in with her father.

15) The degree of Jane’s concern with Michelle’s health brought Jane’s mental state into issue in this trial. Indeed, it was the focal point. Psychologist Dr. Brian Chartier testified that Jane suffers from “factitious disorder by proxy”. He wrote in his report:


... diagnostic criteria for this disorder include: the intentional production or feigning of physical or psychological signs or symptoms, the motivation for the behaviour is to assume the sick role and external incentives for the behaviour are absent. In other words, it seems that [Jane] has been feigning her daughter’s sickness and injury....

This is just ground breaking case law in our country. Wow.