Factitious Disorder by Proxy and Interrelated Multidimensional Diagnoses

In 2009 it was proposed that disorders such as Factitious Disorder by Proxy (FDBP) or the like "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" (Bütz, Evans and Webber-Dereszynski), At that time, this author considered the concept of what would eventually be described by the term IMD to address conceptualizations such as FDBP. This chapter follows the hopeful clarity supplied by Chapters 3 and 4, noting the background and history of FDBP and the proposal of an Interrelated Multidimensional Diagnosis. Based on the literature that was approached inclusively using all of the terms described under FDBP in Chapter 3, the case is made dimension by dimension for FDBP as an IMD. Tables based on repeated descriptions in the literature are assembled to meaningfully describe background; individual, system, and subdynamic characteristics, and symptoms in an interrelated fashion. Corrections from earlier conceptualizations are offered (Bütz et al., 2009) and replaced with more accurate tables and descriptions of the phenomenon. Using variable criteria, FDBP is differentiated from other conditions and symptom presentations as a unique IMD plainly different from, for example, the proposed diagnosis by Rogers (2004; Velsor & Rogers, 2018) of Malingering by Proxy. Based on these analyses and the descriptions in Chapter 4, a new way of approaching the diagnosis of FDBP as an IMD is proposed including both the stages of suspicion and further study as well as a method for making such determinations at the level of proof that is more probable than not. This chapter follows background and history of Factitious Disorder by Proxy (FDBP) and the proposal of an Interrelated Multidimensional Diagnosis. This set of diagnostic symptoms has remained elusive and unclear, and the point of considerable debate in professional literature and national policy. Still, healthcare providers and courts frequently make important decisions based on these diagnoses as if this phenomenon enjoyed agreement and unified terminology. In this author and colleagues' article from 2009, a list of FDBP characteristics that appeared frequently in the literature was provided for direct comparison between an alleged perpetrator diagnosis and what at the time was referred to as the FDBP-Child Maltreatment Dynamic. With the further conceptual shift to an IMD, the a