The Abuse You Might Be Missing: When Illness Is Fabricated in Veterinary Patients

A new study published in PLOS ONE (van Herwijnen et al., 2026) shines a light on a rarely discussed—and deeply uncomfortable—topic in veterinary medicine: Animal Abuse by Falsification (AAF). While the profession has made strides in recognizing physical abuse and neglect, this paper suggests a more insidious form may be hiding in plain sight—one that hinges not on obvious injury, but on deception.

AAF, conceptually similar to factitious disorder imposed on another in human medicine, involves a caregiver fabricating or inducing illness in an animal to gain attention or sympathy. Though well-documented in pediatric settings, its veterinary counterpart remains poorly understood, under-researched, and—critically—under-recognized.

This exploratory Dutch survey of 88 veterinary professionals reveals a striking paradox. Despite only 12% of respondents reporting any formal education on AAF, more than 80% said they were familiar with the concept. Even more concerning, over half believed they likely encounter such cases in practice.

That disconnect—high perceived awareness but low formal training—sets the stage for inconsistent recognition and, ultimately, underreporting.

What veterinarians seem to recognize most readily are not the animal’s clinical signs, but the client’s behavior. Participants consistently rated red flags such as frequent clinic visits, inconsistent histories, and attention-seeking patterns as more indicative of AAF than medical abnormalities in the patient itself. In open-ended responses, vague or unverifiable complaints and repeated presentations with “unexplained” symptoms dominated the narrative.

This reflects a clinical reality many practitioners will recognize: the case that doesn’t quite add up.

However, relying primarily on client behavior creates its own diagnostic blind spots. Medical indicators—such as discrepancies between history and clinical findings, unusual disease progression, or failure to respond to appropriate treatment—were less prominently identified, despite being central to many documented AAF cases. The risk here is clear: without integrating both medical and behavioral red flags, cases may be dismissed as merely complex, rather than suspicious.

The study also highlights just how rarely AAF is formally addressed. An overwhelming 92% of respondents reported never having documented or reported a suspected case as animal abuse. This is not necessarily due to lack of concern—but rather a lack of clarity.

Participants cited three major barriers: insufficient knowledge of available resources, lack of standardized criteria for identifying AAF, and concerns about breaching client confidentiality. In other words, even when veterinarians suspect something is wrong, they often don’t know what to do next—or whether they’re justified in acting at all.

That uncertainty is compounded by the complexity of AAF itself. The condition exists on a spectrum, ranging from exaggeration of symptoms to active induction of disease. Presentations may mimic legitimate medical conditions, and in some cases, animals may even improve when separated from the owner—an observation that is difficult to verify in routine clinical practice.

Adding another layer of concern, the study reinforces links seen in human healthcare: abuse by falsification may not occur in isolation. Previous reports have documented overlap between animal-directed and child-directed abuse in the same household, raising the stakes far beyond individual patients.

For veterinarians, this positions AAF not just as a welfare issue, but as part of a broader safeguarding responsibility.

So where does the profession go from here?

The authors argue—and the data strongly support—that education is the most immediate need. Not just awareness that AAF exists, but practical, clinical guidance: how to recognize patterns, how to document concerns, and how to navigate reporting pathways. Respondents themselves called for clearer protocols, decision-making frameworks, and interdisciplinary collaboration, including partnerships with human healthcare and legal systems.

In many ways, AAF sits at the intersection of medicine, ethics, and psychology—territory that veterinary curricula have historically only touched on lightly. But as this study makes clear, ignoring it is no longer an option.

Because the most dangerous cases aren’t always the ones with the clearest symptoms.

Sometimes, they’re the ones that seem just a little too confusing—and get explained away.

Read full article here: 10.1371/journal.pone.0345067