Factitious Disorders Not Otherwise Specified

Clinical Findings
Factitious disorder not otherwise specified is reserved for individuals who do not meet the criteria for other factitious classifications. In fact, they can more suitably be called perpetrators. The most common entity in this classification is the individual with MSP. Meadow first used the term MSP in 1977, and it has become widely recognized in pediatric settings. The most common presentation is that of a mother who produces signs or symptoms of disease in one or more of her infants or toddler-age children. In some of these instances, the mother also may produce a factitious disorder in herself. In rare cases, an adult will produce an illness in another adult.

The most frequently seen factitious conditions in children include bleeding, seizures, apnea, diarrhea, vomiting, fever, electrolyte disturbance, or skin lesions. Mothers have been observed in a wide range of behaviors, ranging from smothering their child with a pillow to produce hypoxic seizures to chronically administering ipecac syrup to simulate gastrointestinal disorders. Usually the mothers repeatedly bring their children to pediatricians' offices and emergency rooms. Although the syndrome is most commonly focused on one child at a time, older siblings may have had similar disorders that were medically unexplained. Substantial mortality is associated with the syndrome: Rosenberg (1987) reported a mortality rate of 9%. Based on a survey of pediatric neurologists and gastroenterologists, Schreier and Libow (1993b) noted that the true prevalence of the disorder is difficult to ascertain but probably is greater than generally estimated because of significant underreporting.

Etiology
Authors have focused on different psychological explanations for MSP. Schreier (1992) hypothesized that the mothers were attempting to develop a relationship with a physician to compensate for early childhood deprivation and abandonment. In his scenario, the child becomes a dehumanized object that the mother manipulates to control the relationship with the physician. Griffith (1988) focused on disturbed family dynamics, often observing an enmeshed family structure in which the mother has a history of somatization and the family has a history of exploitation of children. In most reports, the mother has been described as having a severe personality disturbance. In these cases, the mother may be acting out sadistic impulses toward herself or others that are displaced onto the child.