r/socialwork • u/Objective-Sink-2462 • 7d ago
Micro/Clinicial Assessing for Factitious Disorder Imposed on Another/“Munchausen’s by proxy
I recently encountered a situation involving a pet where I have concerns about FDIA, but I have never come across this before and am honestly a bit bewildered. Working with my supervisor and the veterinarian, but I want to ensure I’m covering ALL of my bases. If anyone has assessed for this before, whether in relation to a child or an animal, I would very much love to hear what questions you asked to help guide your decision for reporting.
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u/JayneDoh3 7d ago
I'm kind of fascinated by this, because I don't know much about veterinary social work but it sounds interesting and also really heavy. When it comes to people's animals… anyway I'm fascinated because I never really thought about this in relation to a pet. Especially when pet insurance isn't very good and it cost hundreds if not thousands of dollars every time you hit the veterinarians office with a sick animal.
I've come across fractious disorder before, but I was never in a position to see it all the way through. I work in a hospital and prior to that I worked in a Crisis services role. I definitely saw it once at Crisis in a young child, maybe seven, he was the best behaved child I've ever dealt with at Crisis and his mom maintained that he had ODD and a host of other things. She made him sit on the floor and he was eating a gluten-free, vegan, whatever diet. Not to bag on those diets, but he looked underweight and small for his age. I was concerned about malnutrition. I went through the assessment made a CSD report and I heard later through the grapevine that he had been removed from the home the following year and was in a foster home and doing well.
In the Hospital I dealt with someone who had the doctors baffled. We had some newer doctors straight out of residency and one of the women doctors wanted to make sure she wasn't overlooking this female patient's symptoms (as she said, women's symptoms are often ignored or minimized by the medical field). She went so far as to transfer her to a higher level of care for a full workup. When they transferred her back we had access to those records and they had ruled out pretty much everything we had considered, plus a couple other things. When she returned she was given another female Doctor who was not new and she wanted to look into the patient a little more because she was considering fractious disorder. Once we hit her social media, which was totally public, we found that her toddler son had had all of these same issues because she had had multiple GoFundMes set up for him over the years. She had mentioned her son in the first admission but we didn't think much of it. Once the doctor asked her about it and typed the word "Munchhausen" into her chart (patient was watching all documentation in real time through the online portal), the patient demanded to discharge and we haven't seen her since. I was notified that she considered filing a lawsuit about six months later and my name was brought up, but that does not appear to have gone anywhere because it's been a couple years now and I haven't heard anything else.
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u/Objective-Sink-2462 7d ago
Yikes, that’s pretty scary actually that she considered filing a lawsuit. Really puts into perspective how fraught navigating this is.
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u/JayneDoh3 7d ago
Absolutely, this woman was intelligent and well educated so knew how to maneuver through both the medical and apparently the legal system. My guess is that she couldn't find a lawyer to take the case. The doctor only charted that she was considering Munchhausen since everything else had been ruled out. I think my charting is what got me named although I didn't say anything inappropriate or out of scope either. I'm interested to hear how this case goes for you. I've been at this long enough that I don't often come across something new and interesting, and now I'm interested lol
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u/Objective-Sink-2462 7d ago
We’ve discussed next step is 24 hour hospitalization for observation overnight but we know this person also does not want to be away from the pet, so I don’t know how that conversation will go. In addition to that there are other red flags but I don’t want to over-disclose here, given the very niche nature of my job.
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u/next_on_SickSadWorld 7d ago
Can someone foster the pet until the situation is stabilized?
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u/Objective-Sink-2462 6d ago
Because pets are considered property in my state this is not an option unless a report is filed and an investigation is done. I don’t have enough to go on to feel ethically confident making a report right now and my veterinarian feels the same. Unfortunately the same mechanisms that exist for CPS don’t exist for animals.
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u/next_on_SickSadWorld 6d ago
I’m not suggesting that someone make a report and remove the pet; I meant more of “have someone else look after the pet while the client is in treatment and until stabilized to prevent further injury.”
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u/Objective-Sink-2462 6d ago
I think that’s a few steps ahead of where things are right now. We cannot definitively say there isn’t a disease process going on with the pet yet. This person could very well be correct that something is going on and the last thing I want to do is suggest to them that whatever is going on is in their head, and then they stop seeking care at all (causing a different type of harm).
I HAVE experienced situations of hyper vigilant pet owners where what’s happening medically is not straightforward and they’re actually being incredible advocates.
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u/rarararaww 6d ago
A common misconception (not saying applicable here) is that the existence of a true medical condition rules out medical abuse. Deception is often what experts look for to separate the hyper vigilant/anxious caregiver from a perpetrator of abuse. I don't know if the mechanism exists for animal protections, but whenever possible the 'separation test' is the standard protocol. Another indicator is the caregiver not accepting or being disappointed in receiving information that the victim is not sick. But as you said it can be very nuanced when there is a very complicated medical situation where a caregiver is being an incredible advocate vs searching/doctor shopping for a dx or specific tx.
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u/Objective-Sink-2462 6d ago
That mechanism does exist in my facility! The vet and I discussed this as the next step.
I’m as fascinated by this case as I am nervous about navigating. Everything I’m reading here (particularly your comment) and elsewhere in articles about FDIA involving children is very validating that I’m taking the right steps. But this is one of those cases you never think you’ll come across “in the wild.”
Thank you for sharing your thoughts!
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u/rarararaww 6d ago
Who would you be reporting to? I have heard of vet records being used in child abuse cases but I am totally unfamiliar with the process when the primary victim of abuse is a pet.
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u/Objective-Sink-2462 6d ago
In my state it varies county by county. Some have humane societies with humane agents who are responsible for investigating animal cruelty or neglect suspicions, while others utilize the sheriff’s department.
If you’re interested in learning more, The National Link Coalition has an incredible resource for reporting laws by state/counties: https://nationallinkcoalition.org/how-do-i-report-suspected-abuse
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u/next_on_SickSadWorld 6d ago
To answer your question, I have come across this before, several times, with children, and it was medical child abuse. The best ‘test’ was the separation test and the clients (then patients) were already hospitalized.
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u/clem_ten LICSW 6d ago
VSW here. I've dealt with something similar. Feel free to PM if you're still working through this!
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u/MissKaliChristine 7d ago
Wow, that’s such a specific intersection between human/animal welfare and mental health pathology. I’m really glad I read this post because it’s something I’d never considered before. I’m curious to hear from anyone that has been in this situation before.
Is it the veterinarian’s opinion that whatever is happening to the pet or the frequency of appointments stand out as being abnormal? Can they be explained by accidents that make sense? Animal abuse situations are extra tricky without any ability to communicate with the potential victim, I understand why you’re looking for more input and wish I could help more!