Attachment Representations and Factitious Illness by Proxy: Relevance for Assessment of Parenting Capacity in Child Maltreatment

• NCJ Number: 194426
• Journal: Child Abuse Review Volume: 10 Issue: 6 Dated: November-December 2001 Pages: 398-410
• Author(s): Gwen Adshead; Kerry Bluglass
• Date Published: 2001
• Length: 13 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United Kingdom

Annotation

This paper suggests that attachment theory offers a useful way of conceptualizing how parents' own experience of being cared for as children by their own parents may influence their capacity to parent their child; to test this model, data are presented from a British pilot study of attachment representations in mothers who exhibited Munchausen's syndrome by proxy, or factitious illness by proxy (FIP).

Abstract

Attachment theory suggests that the normal caregiver, who has a balanced, coherent, and flexible pattern of caregiving, responds to a child's situations of distress with increased caregiving behavior; and the securely attached dependent care receiver (the child) increases care-eliciting behavior. Maltreating parents, on the other hand, tend to interpret a child's distress as a threat to the caregiver. Using this model, the authors posit that FIP behaviors might be better understood as abnormal caregiving behavior and that attachment theory might offer a useful perspective. To test this concept, the authors administered the Adult Attachment Interview (AAI) protocol to 26 mothers referred for medicolegal assessment in the context of child-care proceedings. The AAI is a semi-structured interview that invites the subject to provide a narrative about his/her early attachment experiences as he/she remembers them. The referred mothers had exhibited a range of FIP behavior, from excessive consultation with the family doctor to poisoning or smothering behaviors toward their children. The study found a high proportion of insecure attachment style among the mothers (88 percent). Of this insecure group, the most common pattern was the dismissing pattern, which occurred in 77 percent of the sample. The authors conclude that it is useful to view child maltreatment, at least in part, as a failure of caregiving in the parent as a result of parental insecurity of attachment. 34 references