Attachment representations in mothers with abnormal illness behaviour by proxy.

BACKGROUND: Abnormal illness behaviour by proxy (also known as factitious illness by proxy or Munchhausen syndrome by proxy) is a type of child maltreatment, the origins of which are poorly understood.

AIMS: To describe attachment representations in a cohort of mothers demonstrating abnormal illness behaviour by proxy.

METHOD: Sixty-seven mothers who had shown this behaviour took part in a semistructured interview assessing their attachment representations.

RESULTS: Only 12 mothers (18%) were rated secure in terms of their own childhood attachments. There was evidence of unresolved trauma or loss reactions in 40 mothers (60%). Eighteen mothers (27%) gave unusually disorganised and incoherent accounts of attachment relationships in their own childhoods. The frequency of these attachment categories is higher than in normal non-clinical samples.

CONCLUSIONS: Insecure attachment is a risk factor for this type of child maltreatment. Therapeutic interventions could be offered in relation to unresolved traumatic stress or bereavement responses. Further study of similar groups, such as mothers with sick children or mothers with histories of traumatic experience, would be a useful next step.