Malingering by Proxy: A Literature Review and Current Perspectives

Malingering by proxy (MAL‐BP) is a form of maltreatment that involves a caregiver who fabricates or induces signs or symptoms in a child, dependent adult, or pet in pursuit of external, tangible incentives. Rarely studied, MAL‐BP has an unknown prevalence, and is a challenging diagnosis for healthcare professionals. Therefore, a comprehensive computer literature search and review was conducted. The review uncovered a total of sixteen case reports of MAL‐BP (eleven human, five veterinary). The motive for malingering was financial in all human cases and medication‐seeking in all veterinary cases. Although the strategies employed differed among the identified cases, common themes regarding the best approach to identification of MAL‐BP cases became evident. A comprehensive workup including a thorough history, physical examination, appropriate neuropsychological testing, and relevant collateral information forms the basis of an effective identification strategy. The optimal method of management is currently unclear due to a relative paucity of data and guidelines. However, management of these cases would likely include a team‐based approach with a prudent assessment of safety for the proxy and a low threshold for referral to appropriate services. Long‐term follow‐up is essential and should be approached from a biopsychosocial perspective. Attention, research, and guidance on this topic are needed to develop further evidence‐based guidelines for the identification and management of MAL‐BP.