Malingering by Proxy: A Literature Review and Current Perspectives

J Forensic Sci. 2016 Jan;61 Suppl 1:S171-6. doi: 10.1111/1556-4029.12977. Epub 2015 Nov 13.

Abstract

Malingering by proxy (MAL-BP) is a form of maltreatment that involves a caregiver who fabricates or induces signs or symptoms in a child, dependent adult, or pet in pursuit of external, tangible incentives. Rarely studied, MAL-BP has an unknown prevalence, and is a challenging diagnosis for healthcare professionals. Therefore, a comprehensive computer literature search and review was conducted. The review uncovered a total of sixteen case reports of MAL-BP (eleven human, five veterinary). The motive for malingering was financial in all human cases and medication-seeking in all veterinary cases. Although the strategies employed differed among the identified cases, common themes regarding the best approach to identification of MAL-BP cases became evident. A comprehensive workup including a thorough history, physical examination, appropriate neuropsychological testing, and relevant collateral information forms the basis of an effective identification strategy. The optimal method of management is currently unclear due to a relative paucity of data and guidelines. However, management of these cases would likely include a team-based approach with a prudent assessment of safety for the proxy and a low threshold for referral to appropriate services. Long-term follow-up is essential and should be approached from a biopsychosocial perspective. Attention, research, and guidance on this topic are needed to develop further evidence-based guidelines for the identification and management of MAL-BP.

Keywords: Munchausen; behavioral sciences; child abuse; disability; factitious; forensic science; malingering; proxy.

MeSH terms

  • Adult
  • Child, Preschool
  • Humans
  • Malingering*
  • Munchausen Syndrome by Proxy*
  • Neuropsychological Tests
  • Prevalence
  • Referral and Consultation