Munchausen by Proxy, which is now referred to as Factitious Disorder Not Otherwise Specified, includes disorders with false symptoms that do not meet the criteria for Factitious Disorder.  This is the intentional production or feigning of physical or psychological signs or symptoms in typically a child or another person who is under the adult’s care. The parent creates  or exaggerates symptoms regarding the child, associated with a feigned underlying illness in order to obtain the vicarious attention received through the child’s symptom. In doing so,  the parent seeks out unnecessary and dangerous medical treatment for the child. This is a form of child abuse that usually includes physical and emotional abuse as well as medical neglect. Some studies have found that the mortality rate of this disorder occurs in 9%  of the children subjected to this type of abuse. An examples of this abuse is a parent who alleges their infant has a serious illness because of their inability to gain weight. Typically doctors perform many tests and potentially life threatening procedures to diagnose the problem. Eventually in one such case, cameras installed in a pediatric unit found the child’s mother substituting colored water for the infant’s formula. Another example is a parent who claimed her child’s behavior was aggressive and out of control at home. The parent obtained psychiatric care for the child, requesting medication to treat the behavioral problem. The parent continued to report escalating problems of aggression. The child was eventually put on anti-psychotic medication to control the behavior. Such medication is potentially life threatening to the child. Eventually when the parent’s description of the child’s behavior was found to be inconsistent with the school’s observation of the child a report to Child Protection was made and a diagnosis of Factitcious Disorder Not Otherwise Specified was made. The child was  removed from the home and taken off all medications. The child immediately improved and demonstrated only minimal adjustment problems. In summary, as in other forms of child abuse, typically the parent vehemently denies abusing  the child and confounds well meaning professionals attempting to treat the child by his/her excessive concern for the child.  Such a parent obtains the attention they are seeking from the child’s treatment providers and the child becomes increasingly sicker as increased inappropriate medications are provided.

Pediatric condition Falsification (PCF) is a relatively new term that is being used as a diagnosis for this form of child abuse. Factious Illness assumes that the caretaker’s motivation is to use the child to gain attention for themselves. While this is true in some cases, other motives of the offending caretaker can also be to manipulate a spouse, manipulate the medical system, perpetrate fraud, or to escape an unhappy home or relationship.  Courts tend to be unwilling to remove children from their parents for this disorder. Instead, even if the parent’s behavior and medical care is found to endanger the child’s life, such parents are ususally refered to treatment that is unsuccessful, because therapists attempt to treat the more overt signs of depression. Instead of attempting to diagnose the underlying condition in the parent resulting in medically endangering the child’s life, the new emphasis is in regarding this behavior in the parent as another form of abuse. Diagnosing or explaining the motive is very difficult and unnecessary to make a diagnosis of child abuse.

The treatment of this type of parental abuse, like other forms of child abuse, is usually complicated by the perpetrator’s denial. Parents often continue to deny the abuse even when they are shown vide recordings of their actions. These parental  perpetrators appear caring, sincere, and usually able to convince familly members to believe them. When investigated, these abusing parents escalate their production of the child’s symptoms to prove to the medical community that the child’s illness is real. Throughout the course of the child’s feigned illness, the perpetrator is apt to change physicians to avoid detection.

If the probelms is admitted, psycholgoical treatment is more effective. However, long term social service involvment is usualy required to keep the perpetrator in treatment. Often the child needs to be removed from the parent and placed in another setting. Reunification is a difficult and lengthy process. Consequently, Court involvment is required to turn legal cusotody of the child over to Child Protection while the parent is receivhng treatment. Dialectical Behavior Therapy (DBT) is the most effective form of tratment for these parents. Treatment should begin in a group DBT program where the skills to control intense emotions is learned. The second stage of treatment involves individual work with the client to  address the underlying  hisotory of thier own childhood abuse. The intense trauma work is most successful when the parent  has learned how to use the treatment skills of emotional regulation.  This intense phase of treamtnet shouold be done by a therapist skilled in working with working with patients who have been diagnosed with Borderline Personality Disorder and who is also knowledgable about  DBT.

No psychological test of the perpetrating parent can make the diagnosis of Factitious Illness or Factitious Disorder Not Otherwise Specified.However, psychological testing typically uncovers a personality disorder as well as depression in such parents. Such individuals have typically experienced significant physical, sexual, or emotional abuse in their family of origin that creates depression as well as a  an enduring experience and behavior that differs markedly from the typical experience in the culture. These abusive experiences produce a distorioon of the abused child’s cognition in order to cope with the abuse. This results in the later adult misinterpreting themselves, others, and events. Secondly, the childhood history of abuse interferes wtih the adult’s ability to regulate thier emotions. Such individuals commonly experience intense feelings, and inappropriately express these feelings in unpredictable ways. Such individuals have a history of difficulty in interpersonal relationships and impulse control. This behavior results in clinical impairment in social, occupational, or other important areas of life. The onset of this behaivor can usually be traced back to adolescnece or early adulthood.

Borderline Personality Disorder is a common diagnosis seen in parents who engage in Factitious Disorder Not Otherwise Specified (NOS).  For those who suffer from a Borderline Personality Disorder, their lives  involve frantic efforts to avoid abandonment and a pattern of unstable and intense relationships alternating between idealizing the other and devaluing the other.  Impulsivity is noted in ways that are self-damaging such as over spending, sex, and binge eating. There are marked changes in mood with such individuals exhibiting  intense irritability, or anxiety. The individual experiences chronic feelings of emptiness, inappropriate and  intense anger,  difficulty controlling their anger, and at times Dissociation. The result is that the parent misinterprets the child’s behavior, has limited ability to cope with the demands of being a parent, and  resents the demands placed on the parent by the child. The parent retaliates, consciously or unconsciously, by seeking out attention for themselves. In order to do so, the parent identifies the child as “sick” and seeks out unnecessary medical attention for the child. Unfortunately such parents often abuse their children in this way for years before they are discovered. They present themselves to treating professionals as overwhelmed as a result of the responsibility of caring for such a difficult, sick child.

In summary this study indicates shared overnight care of children under four years of age had a negative impact on several emotional and behavioral regulation outcomes.  By the ages of 4-5 years, these effects were no longer evident.   The study indicates that children should achieve certain developmental milestones in order to better able to handle frequently shared overnight arrangements.    Specifically, according to the researchers, the child should be  able to self soothe and organize their own behavior.  The child should also  be capable of representational thought and anticipation.  The child should also have adequate receptive language.  Finally, the child should also  be able to anticipate and communicate about past and future events and emotional states.    These conclusions are consistent with the neurobiology of attachment.  Overnights away from the residential parent during the first year of life, when the brain’s circuits for attachment are being set up,  is different from overnights once the attachment system is up and running.  To stress a developmental system while it is organizing in the first year, will have a more negative impact than the same stress when the child is four (Schore, Siegel and McIntosh, forthcoming)…

Just as doctors use tests to determine or rule out  a diagnosis, psychologists use tests to assist them in forming a psychological diagnosis.  A psychological expert in such cases typically requests all of the prior medical, psychological, and educational  records. Then the psychological expert interviews the plaintiff to obtain a family and social history as well as to  administer psychological testing to arrive at a current diagnosis.  If diagnosed with emotional injuries, the next task of the psychological expert is to assess the etiology of such injuries.  The incident in question may or may not be the cause of the Plaintiff’s emotional injury.   The plaintiff’s emotional injury may also be the result of the incident, in combination with historical emotional injuries.  Psychological experts can assist in explaining such complexities to a jury.

Raising a Happy Child of Divorce involves knowing how to provide the most beneficial setting for your child at every stage of development–even under the adverse experience of divorce.   If you are currently going through a divorce, you are struggling (a normal response).  As a parent,  you want the best for your child.  Your child’s positive functioning means he or she is o.k., even if you are not.  Working as an adult and child psychologist for the past 30 years, I have specialized in two areas: divorce-related issues with children and adults; and workingwith children and adults who have experienced trauma.  Perhaps when you hear the word trauma, you think of trama related to combat or sexual abuse.  My experience in  clinical and forensic practice has convinced me that  Divorce is trauma for every adult and child going through the process.   This blog is an attempt to provide you with all of the current  research available to raise a Happy Child of Divorce.

There is ongoing important research being conducted that is currently trickling down to the professional community working with children of divorce.  My goal is to share that research with you NOW rather than 10 years from now when the information is made available to the public.