Symptom coaching: Factitious disorder by proxy with older children

This paper proposes the idea that the story of factitious or exaggerated illness is coauthored or that symptoms may be coached through the dynamics of the family. The physician is unwittingly engaged as a coauthor by performing diagnostic tests and treatments. Children and family members may be invited to coauthor or collude in the presentation of false symptoms as well. The importance of assessing the participation of family members in illness presentation was discussed as well as the difficulty in determining intentionality of symptom production. Four cases are presented including test data which indicate that the more “active” the family may be in presentation of symptoms, the more likely they are to present a cohesive family picture and to seek outside support and the less likely they are to report Stressors. Treatment ideas include acknowledging the possibility of both conscious and unconscious production of symptoms by family members in the creation of a story of illness. Treatment suggestions included the promotion of an alternative story to illness.