Illness induction syndrome: Paper I—A series of 41 children from 37 families identified at the great ormond street hospital for children NHS trust

• Published in: Child abuse & neglect 1996-08, Vol.20 (8), p.655-673
• Main Authors: Gray, Jenny, Bentovim, Arnon
• Format: Article
• Language: English
• Subjects: Allergy; Biological and medical sciences; Case Studies; Child; Child Abuse; Child abuse & neglect; Child, Preschool; Children; Clinical Diagnosis; Detection; Diagnosis; England; Etiology; Fabricated illness; Failure to Thrive; Female; Foreign Countries; Hospitals; Humans; Identification of illness induction; Illness; Illness Induction Syndrome; Illnesses; Infant; London; London, England; Male; Maternal Welfare; Medical sciences; Medical Services; Mothers; Mothers - psychology; Munchausen Syndrome by Proxy; Munchausen Syndrome by Proxy - prevention & control; Nutrition; Parent Child Relationship; Poisoning; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Retrospective Studies; Victimology
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/0145-2134(96)00055-5

At the hospital 41 children from 37 families were identified as having had illness induced by a parent who in all but three cases was the mother. Their case records were reviewed. Four patterns of presentation occurred: failure-to-thrive through the active withholding of food; allegation of allergy and withholding of food; allegation and fabrication of medical symptoms; and active interference by poisoning or disrupting medical treatment. Four of the children died, two as a result of the illness induction. In 35% of the families a sibling had been previously subjected to some type of abuse. All the children had been presented with potentially serious symptoms, but post-identification only five were found to have serious medical problems requiring ongoing treatment. There were no specific characteristics of either the child or family associated with each type of presentation. Seventeen children had previously presented with failure-to-thrive, feeding problems or food allergies. All the mothers had suffered at least one of the following: privation, child abuse, psychiatric illness, or significant loss or bereavement, whereas only half the fathers had grown up in a deprived family situation and/or had earlier or current health difficulties. Forty percent of the parents had serious marital problems. A combined medical/psychosocial team identified the abuse and attempted to understand the family's belief system regarding the illness. The process of Illness Induction was conceptualized as being initiated by the parents perceiving the child to be ill and using this focus on illness as a way of solving major personal, marital, and/or family difficulties. Quarante et un enfants issus de 37 familles ont été identifiés à l'hôpital comme ayant eu une maladie induite par un parent qui était la mère dans tous les cas sauf trois. Leurs dossiers ont été analysés. Quatre formes d'expression de la maladie sont apparues: un retard de croissance à travers une restriction alimentaire acive, l'affirmation d'une allergie et la restriction alimentaire, l'affirmation et la fabrication de symptomes médicaux, et l'interférence active par l'empoisonnement ou l'interruption du traitement médical. Quatre enfants moururent: deux suite à l'interruption du traitement médical. Dans 35% des familles, un membre de la fratrie avait été préalablement soumis à l'une ou l'autre forme de maltraitance. Tous les enfants ont été présentés avec des symptômes potentiellement sévères, cependant après i