SYMPTOM COACHING - FACTITIOUS DISORDER BY PROXY WITH OLDER CHILDREN

This paper proposes the idea that the story of factitious or exaggerat ed illness is coauthored or that symptoms may be coached through the d ynamics of the family. The physician is unwittingly engaged as a coaut hor 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 like ly they are to present a cohesive family picture and to seek outside s upport and the less likely they are to report stressors. Treatment ide as include acknowledging the possibility of both conscious and unconsc ious production of symptoms by family members in the creation of a sto ry of illness. Treatment suggestions included the promotion of an alte rnative story to illness.