A high index of suspicion is necessary to detect factitious disorder imposed on another (Munchausen syndrome by proxy [MSBP])—for example, on the basis of the level of dishonesty a patient exhibits. A diagnosis of MSBP is considered only after physical illnesses in the child are ruled out. The child’s medical history and the family history should be reviewed to look for a history of MSBP in the patient. The adult, not the child, is the patient to whom the diagnosis of MSBP is applied. Video surveillance may assist in confirming the diagnosis.
In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:
Real medical illnesses
Normal variability between illnesses
Illnesses resulting from discontinuation of medicines
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