Factitious disorder by proxy, parent alienation, and the argument for interrelated multidimensional diagnoses.

Abstract

Bütz, Evans, and Webber-Dereszynski (2009) proposed that disorders such as factitious disorder by proxy (FDBP) “. . . may collectively be a forerunner of the more sophisticated practice of wedding individual diagnoses and group, social, family, and legal dynamics together into an integrated, coded conceptualization” (p. 37). This article expands this recommendation, offering the term interrelated multidimensional diagnoses (IMDs) to better describe phenomenon such as FDBP and parental alienation (PA). In turn, this article articulates a definition for IMDs and makes the argument that FDBP and PA are examples of more sophisticated next generation diagnoses, which integrate the characteristics, interactions, and symptoms of individuals and systems dimensionally with greater explanatory power than other diagnoses alone. Implications for clinical and forensic identification and practice are discussed.

Weaponizing Clinical Mental Health in Family Justice Courts: Ethical and Legal Minefields

“…Houchin et al (2012) aptly summarized that the legal argument that parental alienation has "arisen from emotions emanating from custody battles, publicity, and economics rather than sound, scientific study" (p. 127). Long before its propagation, the fabric of custody and child protection cases revealed parents manipulating children's loyalty, mental health or addiction struggles, interpersonal violence, and the sexual abuse and emotional and physical neglect of children (Bütz & Evans, 2019). Likewise, adultification, parentification, and enmeshment are present in conflicted family systems due to complex dynamics (Garber et al, 2022).…”

Child Maltreatment in Medically Fragile Children

“…Factitious disorder inflicted by another may also be the cause of medical fragility (Durr, 2018). Butz and Evans (2019) discuss the interrelatedness between factitious disorder inflicted by another and parental alienation. It may seem counterintuitive, as often the presentation is of an overly involved parent as opposed to an alienated one.…”

Parental Alienation: In the Child’s Worst Interest

“…Some authors claim PA can only occur in high-conflict divorces [15,19], while others claim that although divorce and post-divorce parental disputes are the most common scenario, PA can also occur within intact and separated families [20,21]. Regardless of the divorce status, it is commonly accepted that PA results from the strain that a family system endures because of the pathological dynamics born from impaired relationships between its members [19,22].…”