Factitious Disorder by Proxy, Parent Alienation, and the Argument for Interrelated Multidimensional Diagnoses

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. Public Significance Statement For well over forty years practitioners in the field of behavioral health and other professionals in legal as well as medical settings have struggled to understand and identify complex interactions between people, families and institutions. In this article the term Interrelated Multidimensional Diagnosis (IMD) has been proposed to capture these complex interactions and offer a new diagnostic framework to describe phenomena such as Munchausen's Syndrome by Proxy, Factitious Disorder by Proxy, and Parental Alienation. IMDs describe how individuals and systems interact to create pathological dynamics that prove harmful and even lethal to children.