Factitious Disorders
Diagnosing a Factitious Disorder is challenging. It requires identifying something that is NOT there. It’s a false disorder.
A classic symptom for a factitious medical disorder imposed on another is a huge-huge patient medical record with no clear cause or diagnosis for the symptoms. That’s the first tip-off for doctors of possible FDIA – a huge-huge chart with no clear diagnosis.
It takes a long time to diagnose a Factitious Disorder because we must first rule-out all the real disorders as possible causes. It’s a diagnosis by rule-out – a diagnosis of something that’s not-there – it’s a diagnosis of a non-disorder.
That’s because no one expects a Factitious Disorder. Who creates pathology, who WANTS to be pathological, so much so that they’ll fake being sick? No one does that. No one wants ADHD or depression, no one wants a disorder… some people do.
It’s for something called “secondary gain” – that’s the motivation, the secondary gain, the reward – it could be money (fraud) – it could be the attention received from doctors – it could be gratifying some pathological need within – but there’s a hidden reward that the person is receiving in creating a false pathology.
Are they doing it on purpose? Are they aware of the secondary gain they receive? Or are they creating the false pathology from unconscious motivations, needs for attention or to be seen as the ever-giving “all-wonderful” parent who is nurturing their child’s needs?
It typically takes a long time to diagnose a Factitious Disorder Imposed on Another (FDIA; DSM-5 300.19) because everyone starts off by believing the false disorder – no one expects a false disorder. Who creates a false disorder? That’s a pathological human, and everyone expects normal-range as being typical.
It’s only over time as they administer one set of tests after another without finding the cause, they try this treatment and that looking for some possibility, but nothing solves the symptoms. Only after lots of time and effort does it occur to the doctors that – you know… I don’t think this is real. I think the parent’s inducing the disorder in their child.
It takes time to diagnose a false disorder because no one expects a Factitious Disorder – who does that? Who creates pathology in the child for secondary gain? A severely pathological parent.
Yep.
In the family courts surrounding child custody conflict, the secondary gain for false allegations and creating false pathology in the child is huge and immediate. In the family courts, FDIA should be a primary initial rule-out diagnosis.
Is the child’s attachment pathology real or induced by the pathogenic parenting of a severely abusive pathological parent?
Who does that? Who creates pathology in their own child? No one. It’s a rare disorder – but not as rare as one might think. A dark personality is highly manipulative – Machiavellian levels of manipulation – off-the-chart manipulative… they’ll create pathology in an instant for the secondary gain it provides.
They win the custody conflict immediately. They’re determined to be the “better parent” automatically just by the allegation. They control the narrative by creating the pathology in the child – the supposedly “victimized” child.
The secondary gain in the family courts to making false allegations of abuse and for inducing a false attachment pathology in the child, a shared (induced) persecutory delusion about the other parent, is huge. It confers absolute power to the pathological parent for child custody.
It allows the pathological narcissistic-borderline-dark personality parent to punish the other spouse forever as the normal-range parent fights back against the false allegations, defamation, and slander to their reputation.
The pathological parent wins from the start. Who creates pathology in their child, who destroys their own child’s life to meet the needs of a parent? No one… except a few.
False allegations of abuse immediately win the custody case for the pathological parent based on the child protection concerns that are present while the allegations of abuse are investigated. The courts are made irrelevant by the false pathology induced in the child.
The symptom confers power.
In the family courts, FDIA created by a manipulative narcissistic-borderline-dark personality parent should be expected, it should be an initial rule-out. While no one else expects a Factitious Disorder Imposed on Another, for court-involved clinical psychologists it should be expected, it should be a primary rule-out.
Rule-Out 1: Authentic child abuse
Rule-Out 2: FDIA; a shared (induced) persecutory delusion and a false (factitious) attachment pathology imposed on the child by a narcissistic-borderline-dark personality parent for the secondary gain of manipulating the court’s decisions regarding child custody.
It’s time to talk about FDIA. I’ve explained cross-generational coalitions, I’ve explained shared persecutory delusions. I should describe a Factitious Disorder Imposed on Another – this.
Look around at the situation… this… is the explanation. This is the pathology of a factitious attachment disorder being imposed on the child by the pathogenic parenting of a pathological parent. Do you want an example of FDIA… this.
There is the personality pathology of the pathological parent – narcissistic-borderline-dark – creating the deeply pathological needs of the parent… the motivation. There’s the reward – the secondary gain. The child’s false pathology confers power.
FDIA should always be a prominent rule-out diagnosis in court-involved custody cases.
Rule-out authentic child abuse. Rule-out FDIA.
Let’s talk about FDIA over coffee this Sunday here on Facebook Live at 8:00 Pacific.
Craig Childress, Psy.D.
Clinical Psychologist, CA PSY 18857
GreatCosmicMothersUnite 