Friday, September 5, 2014

Folie à deux; False Allegations of Sexual Abuse


This is an analysis of how psychiatric problems in a family can lead to the malicious prosecution of innocent people. In the more serious, otherwise similar situation, there can be false allegations of sexual abuse, therefore this is a combined report.

Also known as a “madness shared by two” Folie à deux is a delusional disorder shared by two people; who have close emotional ties. Commonly the stronger, more dominant person develops a delusion and induces it in the other. The condition generally remits if the dominant person is treated or if the two are separated.

•Folie imposée- is where a dominant person (known as the ‘primary’, ‘inducer’ or ‘principal’) initially forms a delusional belief during a psychotic episode and imposes it on another person or persons (known as the ’secondary’, ‘acceptor’ or ‘associate’) with the assumption that the secondary person might not have become deluded if left to his or her own devices.

•Folie simultanée- describes either the situation where two people considered to suffer independently from psychosis influence the content of each other’s delusions so they become identical or strikingly similar, or one in which two people “morbidly predisposed” to delusional psychosis mutually trigger symptoms in each other

•Folie communiquée- The recipient develops psychosis after a long period of resistance and maintains the symptoms even after separation. The mental status exam may be consistent with hypervigilance, obsessive thinking, brooding, rumination, anxiety, and lack of reasoning.

•Folie induite- New delusions are adopted by an individual with psychosis who is under the influence of another individual with psychosis. The mental status exam would be similar to one of a psychotic patient, namely, paranoia; lack of reasoning, judgment, and insight; and poor relatedness. Limited eye contact, bizarre mannerisms, and magical thinking may be apparent on assessment.

Paranoid disorders and the spread of delusional ideas to family members have been in literature since the 17th century. Few people in close association with deluded individuals acquire their delusions as attested by the rarity of published cases of only 100 reports of folie a deux from 1877 to 1942 and 280 cases from 1943 to 1996. Many cases may go unnoticed because they are classified individually or because only one member of a pair is admitted. The more a hospital is oriented toward family evaluations and diagnoses, the more likely a partner in a shared psychotic disorder will be found.

Folie a deux has been implicated in such notorious or bizarre events as the serial killers Ian Brady and Myra Hindley,Fred and Rose West;mass suicides of the People’s Temple cult in Guyana (912 people in 1978),Heaven’s Gate cult recently; The League of Geniuses,the Men in Black “seen” by flying saucer watchers/alien abductees and even Adolf Hitler and the German nation. Suicide Pact in Dublin of the Mulrooney (Mullrooney in a register) family.

DSM-IV-TR Diagnostic Criteria for 297.3 Shared Psychotic Disorder

ICD-10 Diagnostic Criteria for F.24 Induced Delusional Disorder (Folie à Deux)

1.A delusion develops in an individual in the context of a close relationship with another person or persons, who have an already established delusion.

2.The delusion is similar in content to that of the person who already has an established delusion.

3.The disturbance is not better accounted for by another psychotic disorder (eg, schizophrenia) or a mood disorder with psychotic features and is not due to the direct physiological effects of a substance (eg, drug abuse, medication) or a general medical condition.

1.Two people share the same delusion or delusional system and support one another in this belief.

2.They have an unusually close relationship.

3.Temporal or contextual evidence exists that indicates the delusion was induced in the passive member by contact with the active partner.

There are marked similarities between what transpires in the developement of a folie a deux and the process of brainwashing. Three phases are present in both. The first phase may be viewed as the “disorganizing or regressive phase” and consists of the breakdown of existing defenses and resistances. In brainwashing and folie a deux, this is accomplished through social isolation, sensory and ideational deprivation. During the second phase identification with the agressor, who is viewed as the rescuer, takes place. The submissive individual identifies with the dominant person who is carrying out the operation. The brainwashee is exposed to kindness and consideration during this phase. The third phase is the reindoctrination period. Constant monoideational stimulation is maintained until the individual who is in a submissive role incorporates the ideas. The second and third phases are only possible after the first has been successful.


Not all false allegations are deliberately made. Allegations of sexual abuse may occur as part of a psychiatric illness. These individuals generally show other features of illness and will respond to treatment of the underlying condition. However, some may come to the attention of investigating authorities before the correct diagnosis is made. The division of mental illness into psychosis and neurosis, though imprecise, remains a useful distinction. As well as mental illness are the various forms of personality disorder which may exist independently of any mental illness but can cause significant impairment of social functioning. Psychosis is a mental disorder in which there is gross impairment of mental function to such an extent that insight, judgment and contact with reality are affected. The majority of sufferers experience delusions or halucinations, have conspicuous social and personality difficulties and generally do not recognize themselves as unwell.

Some custody disputes may be of this kind, in which a child takes on the delusion of the parent. Allegations involving children that were later found to be false often involve mothers with a psychotic illness. An allegation of sexual abuse is a potent weapon against a despised spouse and in cases where custody is disputed such allegations have a high probability of being false. That is not to imply that there are no true cases of sexual abuse in custody cases, merely that the context offers peculiar temptations to the adults. Divorce and disputes over custody form the background to about 50 percent of cases of false allegations of sexual abuse involving children. Typically, this kind of allegation is a deliberate manipulation by one parent to obtain custody, using the child as an instrument of directed deceipt.

Most often, the mother accuses the father of abusing the child and sometimes coaxes the child to confirm the allegation, but remember this can happen with a father against the mother. The studies in which the allegations against the mother have not yet been established in a more thorough setting, therefore this report relflects more recent studies of allegations against the father. In a study of two individual mothers the allegations were grandious and unfounded, and reflected the same results as those of a fathers.

Some children come to believe their stories, while others are simply suporting the parent. Not all accusations are as flagrantly dishonest and some arise from anxious misinterpretation of a child’s behaviour. Children who are torn between two parents frequently show signs of distress, which can be misconstrued as fear of the non-custodial parent.


Parental alienation syndrome (PAS, Gardner, 1985, 1986, 1987a, 1987b, 1989, 1992, 1998) is a disorder that arises almost exclusively in the context of child-custody disputes. In this disorder, one parent (the alienator), induces a program of denigration against the other parent (the alienated parent) or (targeted parent) However, this is not simply a matter of “brainwashing” or “programming” in that the children contribute their own elements into the campaign of denigration. It is this combination of factors that justifiably warrants the designation PAS.

When paranoia fuels PAS, the victim of the paranoid delusional system is often limited to the denigrated spouse, at least, this is the case in the early phases. With ongoing litigation, the paranoia may expand to all the people who provide support to the targeted parent. Typically, the paranoid system becomes illogical and preposterous; for example, that the targeted parent would perpetrate abusive behavior–and even sexual molestation, in front of court-ordered supervisors.

Often the PAS parent and the programmed child jointly entertain the same delusion. This is when it is referred to a folie à deux. This is a common occurrence in PAS. In such cases, the DSM-IV diagnosis of shared psychotic delusion (folie à deux) is warranted. There is probably a higher prevalence of paranoia in severe PAS indoctrinators than in the general population. Also, there is probably a higher prevalence of paranoia in abusive or neglectful parents than in the general population.

In psychosis of association, the submissive partner is being induced by the process of suggestion to accept the delusional ideas of the dominant one. Most cases of folie à deux show a pattern of dominance and submission. 90-percent of cases are reported to occur in families. The primary agent must be in close proximity, be a figure of authority or identification, and be in the early or less severe stages of psychotic decompensation in order to be in touch with reality enough to influence the other.

In addition, the secondary partner must derive some gain from adopting the symptoms. The underlying process is one of identification by the submissive party, which may be unconscious. Folie a deux is an example of a pathological relationship in which the dominant party strives to maintain a link with reality while the other fulfils dependency needs. The recipient is not necessarily entirely a submissive partner since in most cases, he or she becomes delusional after considerable resistance and this may affect the primary sufficiently to modify his or her delusions.

The secondary partner seeks to preserve the relationship with the dominant one by adopting her delusions because the threat of loss is greater than the fear of psychosis. All families share a common reality and family myths, which help the family to maintain a stable cohesiveness in the midst of internal or external threats. Criminal acts, false allegations, and parental alienation syndrome and suicide pacts can occur in shared psychotic disorder.

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