Factitious disorder imposed on another (FDIA) formerly Munchausen syndrome by proxy (MSP) is a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. What is factitious disorder imposed on another? In this mental illness, a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator has the diagnosis (FDIA) and directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age. It is considered a form of abuse by the American Professional Society on the Abuse of Children. However, cases have been reported of adult victims, especially the disabled or elderly. FDIA was previously known as Munchausen Syndrome by Proxy. People with FDIA have an inner need for the other person (often his or her child) to be seen as ill or injured. It is not done to achieve a concrete benefit, such as financial gain. People with FDIA are even willing to have the child or patient undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill and their families. Factitious disorders are considered mental illnesses because they are associated with severe emotional difficulties. The Diagnostic and Statistical Manual of Mental Disorders 5, is the standard reference book for recognized mental illnesses in the United States. It describes this diagnosis to include falsification of physical or psychological signs or symptoms, and induction of illness or injury to another associated with deception. There is no evidence of external rewards and no other illness to explain the symptoms. Fortunately, it is rare (2 out of 100,000 children). FDIA most often occurs with mothers—although it can occur with fathers—who intentionally harm or describe non-existent symptoms in their children to get the attention given to the family of someone who is sick. A person with FDIA uses the many hospitalizations as a way to earn praise from others for their devotion to the child's care, often using the sick child as a means for developing a relationship with the doctor or other health care provider. The adult with FDIA often will not leave the bedside and will discuss in medical detail symptoms and care provided as evidence that he or she is a good caretaker. If the symptoms go away in the hospital, they are likely to return when the caretaker with FDIA is alone with the child or elderly parent. People with FDIA might create or exaggerate the child's symptoms in several ways. They might simply lie about symptoms, alter diagnostic tests (such as contaminating a urine sample), falsify medical records, or induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. The presenting problem may also be psychiatric or behavioral. How common is factitious disorder imposed on another? There are no reliable statistics regarding the number of people in the United States who suffer from FDIA, and it is difficult to assess how common the disorder is because many cases go undetected. However, estimates suggest that about 1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA. In general, FDIA occurs more often in women than in men.