Composition Vendor Newgen KnowledgeWorks (P) Ltd. PLoS One plos plosone PLOS One 1932-6203 Public Library of Science San Francisco, CA USA 10.1371/journal.pone.0345067 PONE-D-25-67684 Research Article Medicine and health sciencesEpidemiologyMedical risk factorsTraumatic injury risk factorsChild abuse Medicine and health sciencesPublic and occupational healthTraumatic injury risk factorsChild abuse Social sciencesSociologyCriminologyCrimeChild abuse Medicine and health sciencesPediatricsChild abuse Medicine and health sciencesClinical medicineSigns and symptoms Biology and life sciencesVeterinary scienceVeterinary medicine People and placesPopulation groupingsProfessions People and placesPopulation groupingsProfessionsVeterinarians Biology and life sciencesPsychologyBehaviorAnimal behavior Social sciencesPsychologyBehaviorAnimal behavior Biology and life sciencesZoologyAnimal behavior Biology and life sciencesImmunology Medicine and health sciencesImmunology Medicine and health sciencesPharmaceuticsDrug therapyNeurological drug therapy Animal abuse by falsification–Recognition amongst the veterinary profession in The Netherlands Animal abuse by falsification https://orcid.org/0000-0003-0824-8089 van Herwijnen Ineke R. Conceptualization Formal analysis Methodology Writing – original draft Writing – review & editing * van Helvoort Daphne G. L. Conceptualization Investigation Methodology https://orcid.org/0009-0006-4039-6291 Reinders Nadieh Writing – review & editing https://orcid.org/0000-0002-3271-6535 Vinke Claudia M. Writing – review & editing Division of Animals in Science and Society, Faculty of Veterinary Medicine, Department of Population Health Sciences, Utrecht University, Utrecht, The Netherlands Alarape Selim Adewale Editor University of Ibadan, NIGERIA

The authors have declared that no competing interests exist.

 * E-mail: i.r.vanherwijnen@uu.nl 842026 2026 21 4 e0345067 27122025 2722026 2026 van Herwijnen et al This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Presently, Animal Abuse by (condition/ illness) Falsification (AAF), has received little scientific attention. Feigning illness in children for attention purposes has been studied, indicating that the involved children can suffer serious consequences. Although to date little is known about AAF, perplexing presentation has been mentioned. We aim to add to scientific information on veterinary awareness of AAF. Our exploratory survey-based research addressed veterinarians and vet technicians/ assistants, asking questions on their awareness of AAF and recognition of possible AAF signs. We found that only 12% of our 88 participants, who mainly treated companion animals, had previously received education on AAF. Despite this, 83% reported familiarity with the phenomenon of AAF. Half of the participants (51%), indicated to likely see AAF cases in their veterinary clinic, 5% indicated to see them with certainty (unsure: 32%; not to see such cases: 12%). Most often dogs and cats were indicated as a proxy (other animals: rabbits, rodent, horse). When asked how likely a participant would regard a sign/ symptom indicative of AAF, participants scored higher likeliness for those signs/ symptoms regarding client behaviours than animal/ medical aspects. Reporting of AAF in this sample was low: 92% indicated to have never reported AAF as animal abuse. Barriers to reporting AAF included a lack of knowledge on AAF and how to identify clients suffering from the condition. Our study engaged a limited number of participants in only one country, but indicates that knowledge on AAF may facilitate the recognition of this form of animal abuse.

 The author(s) received no specific funding for this work. Data Availability All relevant data are within the paper and its Supporting Information files. Introduction

Abuse by (Paediatric Condition) Falsification is related to serious and life-long outcomes [1]. It regards the infliction of harm to a child as to feign its illness and thus get attention and/ or sympathy from people, including medical personnel [2,3]. Outcomes may include physical and mental trauma, e.g., undergoing unnecessary and often repeated surgeries, suffering malnutrition and developing distrust of important others [3–5].

The condition of people feigning illness for attention purposes, is known under different names, such as fabricated or induced illness disorder, factitious disorder, fictitious illness, illness fabrication, illness falsification and Munchausen [3,6–8]. People who suffer from the condition seemingly need attention from people (medical personnel). To get this attention they may either be dishonest about illness symptoms (‘fabricated’), create these symptoms (‘induced’), or both [4]. Among the suggested causes of the condition arising in a person, are those of early life experiences or a lack thereof, such as of repeated medical treatments during childhood or inadequate care provision [9]. The condition may present itself as harming oneself, or it can be ‘imposed on another’, a ‘proxy’, such as a child [1,10].

Like children, animals are expected to be a possible proxy. Animal Abuse by (Condition) Falsification (AAF) has been indicated in animals under human care [2,11–13]. Alternatively, at the least, the perplexing presentation has been indicated [7,14]. Perplexing presentation regards clinically noted signs that can be explained by multiple causes, including AAF as a causation. Perplexing presentation may be a starting point to assess if AAF underlies a case. Alternatively, it may be the only label that can validly be given, as the assessment of Abuse by (Condition) Falsification is both complex and challenging [7,14]. The complex and challenging assessment of this form of abuse, likely affects studying its incidence or prevalence. A USA-based study indicated that the true incidence or prevalence of AAF is unknown [2]. The few available scientific studies on the topic, often present cases and do not provide epidemiological data [2]. An example is a UK-based study including six cases identified by veterinarians and three cases included by the researchers as possible AAF cases [13]. In this total of nine cases, signs were noted in the animals, that corresponded with signs in child abuse cases. The respective signs regarded the animal owner’s attention seeking behaviour, recovery of the animal upon owner-separation, serial incidents, real and likely factitious clinical signs, abnormal biochemical profiles, deliberately inflicted injury, tempering with surgical sites and changing one’s veterinary clinic [13]. Thus, a similarity may exist in signs of AAF and Abuse by (Paediatric Condition) Falsification.

To date few scientific studies are available on AAF. Interestingly, one study made a distinction between feigning illness for attention purposes and malingering [12]. Generally, malingering differs from illness falsification, by the perpetrator having instrumental purposes, such as feigning illness to avoid work, or to obtain medications of abuse [15]. Obtainment of medications of abuse in the veterinary clinical setting has been studied, resulting in the reporting on five veterinary cases of suspected or confirmed malingering with this purpose [12]. This instrumental purpose is obviously also of high importance to the veterinary profession, but out of scope of our study.

In our study we aim to add to scientific information on veterinary awareness of AAF, following the conclusion from Oxley & Feldman [2], that there is a need for studying the phenomenon. AAF can cause prolonged suffering in animals, their deaths and serial cases have been described, indicating that a perpetrator can cause serious harm to multiple animals [11,13]. Hence, our aim is to create insight into awareness of the condition amongst the Dutch veterinary profession. Theoretical relevance is in identifying a scientific questionnaire approach that can aid in assessing awareness levels in a profession that has a high responsibility regarding the recognition of signs forewarning AAF. Practical relevance is in assessing which awareness is present or lacking as to improve present day education to students of veterinary science. This exploratory research addresses the awareness of AAF in the veterinary profession in The Netherlands and the extent to which signs and symptoms are recognised as likely indicators of AAF.

 Methods Ethical considerations

We approached Dutch veterinary professionals via email and internet platforms where they professionally reside, asking them to participate of their own free will, after reading information on the study and providing informed consent in the survey module by clicking a survey button that indicated ‘I consent’, before continuing to the survey. The topic of this study regards an emotionally burdening topic, which we specifically addressed in the participant information. No minors were included in the study. We sought and received ethical approval from the Science-Geosciences Ethics Review Board of Utrecht University for involved human participants on August 18th, 2025 (ERB Review Science-25–0080). The survey was accessible from September 22th, 2025 to October 18th, 2025.

 Participants recruitment and survey

We recruited Dutch veterinary professionals, that is veterinarians and vet technicians/ assistants via email, and internet platforms where they professionally reside. A Faculty of Veterinary Medicine digital newsletter going out to 4,900 veterinary professionals, a Facebook group for veterinarians with 2,000 members, a Facebook group for vet technicians/ assistants with 2,900 members and a Facebook group for veterinary professionals with 4,700 members published a short notice asking participants to fill out the study survey.

Participants were asked to fill out a survey with general questions on AAF to assess awareness and experience with the phenomenon, assess reporting of AAF and barriers to reporting. We presented our participants with the barriers to reporting, as listed by Williams et al. [16] and endorsed by at least a third of their study sample of N = 215 veterinarians completing survey items on general animal abuse. Amongst their survey items were items on barriers to the reporting of animal abuse cases. The barrier items received 1,024 item endorsements and were presented in their article as a percentage of the 215 participants, followed by the number of item endorsements. We present our responses similarly as a percentage of participants, followed by the number of item endorsements. We adapted the original items from Williams et al. [16], by replacing ‘fear’ for ‘concern’ in four of the nine items, to increase suitability for the Dutch veterinary profession.

After the survey items on reporting of AAF, our second survey section followed. This second section was construed of a list of possible AAF signs and symptoms. For each of these signs and symptoms we asked participants to indicate the likeliness of pointing at AAF, on a five-point Likert scale ranging from highly unlikely (1) to highly likely (5). The signs and symptoms were derived from two AAF articles [2,13] and four articles from human child literature, which were selected for their specific listing of signs and symptoms of Abuse by (Paediatric Condition) Falsification [1,3,4,6]. S1 File presents the full survey and S2 Table indicates our choices for signs and symptoms and the appearance of similar signs and symptoms in the sources we used to base this list on. After presenting our participants with the single signs and symptoms, this section also questioned how participants would regard combinations of signs and symptoms.

In the third and final survey section our participants answered questions on the background of the participants and their veterinary clinics. (See S1 File for all questions and S1 Data for the data file).

 Data preparation and statistical analysis

Data from Qualtrics® was gathered in Microsoft® Excel. Statistical analysis of the data was performed with SPSS® for Windows®, version 29 (SPSS Inc, Chicago, USA).

For the two open questions ‘Which signs would make you think of AAF?’ and ‘What would help you to report AAF?’, the answers were coded and categorised manually, through thematic analysis and using description focused coding.

We assessed how likely the participants felt signs and symptoms indicative of AAF in two blocks. The first block regarded animal and medical aspects, the second block regarded client behaviours on a five-point Likert scale ranging from highly unlikely (1) via moderately unlikely (2), neutral (3), moderately likely (4) to highly likely (5). The same five-point Likert scale was then used to assess if the number of present signs and symptoms affected AAF likeliness ratings, asking ‘How likely would you rate a combination of signs as indicative of AAF?’ and assessing each of these three options: two signs, three to five signs, more than five signs. We present median (range) for each of the Likert scale items.

Finally, we tested with Wilcoxon tests, if a difference in likeliness scores existed between two subsamples of the participants, for the signs/ symptoms regarding animal/ medical aspects and the client behaviours. The subsamples regarded: a) those participants indicating a (certain/ likely) occurrence of AAF in their veterinary clinic and b) those participants that indicated AAF not to occur in their clinic, or being uncertain if it did. We regarded P-values <0.05 as significant.

 Results Participant characteristics

Our study sample of 88 participants consisted mainly of females (90.9%, N = 80; males: 9.1%, N = 8) and the majority were veterinarians (68.2%, N = 60; vet technicians/ assistants: 31.8%, N = 28). The majority worked in a veterinary clinic providing service to companion animals and their owners (88.6%, N = 78; mixed companion animals and other animals: 8.0%, N = 7; horses: 3.4%, N = 3). See S3 Table for all details on gender, ages and the professional/ clinic background.

The participants indicated mostly to have never received education on AAF (88.6%, N = 78; with 11.4%, N = 10 indicating they had followed some form of education on the topic).

 AAF awareness in the veterinary profession in The Netherlands

When asking participants if they were familiar with one or both of the terms ‘animal abuse by fabricated or induced illness’ and ‘Munchausen syndrome by Proxy’ the majority answered that they were familiar with one or both terms: 89.8% (N = 79). 8.0% (N = 7) indicated they were not and 2.3% (N = 2) indicated not to know. Next, we presented a definition of AAF, namely: ‘An induced/ fabricated condition in an animal which has been induced/ fabricated by a caretaker, such as the owner. This caretaker has a sickly (morbid) need for attention by making an animal ill or pretending such illness.’ We asked if participants were familiar with this phenomenon. Here too, the majority answered positively: 83.0% (N = 73). 14.7% (N = 13) indicated not to be familiar with the phenomenon and 2.3% (N = 2) indicated ‘Don’t know’.

 Experience with suspected AAF cases in Dutch veterinary clinics

To assess participant experience with the phenomenon, we asked if they see AAF cases in their veterinary clinic. 51.2% (N = 45) indicated to likely see cases. 4.6% (N = 4) indicated to certainly see cases, 12.5% (N = 11) indicated to certainly not see cases in their clinic. A relatively high percentage of 31.8% (N = 28) indicated ‘don’t know’. When we asked participants to indicate a yearly average of cases that they suspected of AAF, most indicated none (84.1%, N = 74). Of those that indicated a yearly average of cases, the range of yearly cases was one to three cases. One case a year was indicated by 10.2% (N = 9), with one of these participants indicating that ten animals were involved in the one case. 2.3% (N = 2) indicated two cases per year. 3.4% (N = 3) indicated three cases a year. Participants could indicate which animals were proxy in the suspected cases. Most mentioned dogs (N = 16) and cats (N = 12). Other mentioned animals were rabbits (N = 4), a rodent (N = 1) and a horse (N = 1).

 Recognition of AAF signs and symptoms

Thematic analysis of 173 label indications by 72 participants answering the open question ‘Which signs would make you think of AAF?’, rendered 38 different labels in 6 categories, listed in Table 1. See S4 Table for all entries.

10.1371/journal.pone.0345067.t001Categories and labels distilled from 72 participants regarding signs that would make one think of AAF.
Category Label % (N of N = 173)
Animal keeping characteristics Multiple animals 1.2% (2)
Rehoming/ relinquishment of animals 0.6% (1)
Request for euthanasia at relatively young age 0.6% (1)
2.3% (4)
Disease and condition characteristics Inexplicable injuries/ uncommon fractures 5.8% (10)
Signs of diarrhoea/ GI and/ or starving – famished animal 2.9% (5)
Signs of itchiness, allergy, relating to the immune system 1.2% (2)
Signs of lameness 1.2% (2)
Signs of poisoning 1.2% (2)
Sign PU-PD (PolyUria-PolyDipsia) 0.6% (1)
12.7% (22)
Complaint characteristics Vague or inexplicable complaints – difficult to check or confirm medically 20.2% (35)
(Unlikely) repeatedly new or changing symptoms, multiple problems 6.9% (12)
Repetitive small complaints/ visits with a healthy animal 6.9% (12)
Clinical abnormality absence upon medical/ laboratory/ additional checks 2.3% (4)
High frequency of complaints 2.3% (4)
Complaints that disappear upon clinical admission 1.2% (2)
Mentioning symptoms in the manner that a disease is described 1.2% (2)
Owner diagnosed animal before appointment 1.2% (2)
Uncommon seriousness of complaints 0.6% (1)
42.8% (74)
Treatment course characteristics Incorrect administration of medication/ no improvement on medication 2.3% (4)
Slowed healing/ recovery or even worsening despite treatment 2.3% (4)
Self-medicating (doctoring) the animal 1.2% (2)
Animal is reportedly ill, when owners visit no clinical findings at first, but clinical findings present at a second visit 0.6% (1)
6.4% (11)
Contact characteristics Recurrent contact moments/ visits with one or multiple professionals 18.5% (32)
High concern ventilation by owner and/ or lengthy in conversations 3.5% (6)
Unwilling to take advice from a veterinarian/ no interest in solutions that will aid quick recovery 2.9% (5)
Asking for medication by phone, insisting on medication prescription, or ordering it via internet by themselves 1.7% (3)
Conversations by client on medical issues of others than animal, e.g., relatives, self, other animals than patient 1.2% (2)
Insisting, being friendly but also complaining 1.2% (2)
Requests for unnecessary (invasive) examination 1.2% (2)
Asking specifically to talk to the veterinarian 0.6% (1)
Being in close contact with personnel 0.6% (1)
Blaming the veterinarian if the animal does not recover and/ or claiming that no one can help the animal 0.6% (1)
Challenging the diagnosis 0.6% (1)
Deviant behaviour of owner(s) upon discussion of possible causes of a condition 0.6% (1)
Insisting on hospitalisation or longer hospital admission 0.6% (1)
Social media behaviour 0.6% (1)
34.1% (59)
Client characteristics Client with personality disorder (characteristics)/ deviance in mental health state 1.2% (2)
A profession in (health)care of client 0.6% (1)
1.7% (3)

The category of ‘complaint characteristics’ (42.8%, N = 74) and ‘contact characteristics’ (34.1%, N = 59) held high numbers of labels and had high label counts. For the first category the label ‘vague or inexplicable complaints - difficult to check or confirm medically’ had the highest percentage of occurrence (20.2%, N = 35). For the second category ‘recurrent contact moments/ visits with one or multiple professionals’ had the highest percentage of occurrence (18.5%, N = 32). Not all participants answered this facultative question. One participant wrote: ‘None. I know that it [abuse by falsification] exists in humans, but never considered that people do this to animals. I’d rather think of abuse, but not with the objective to gain attention’.

After asking the open question on AAF recognition on which we presented the results above, we presented the two blocks of signs and symptoms indicative of AAF. We present median and ranges in Table 2. We assessed with Wilcoxon tests if there was a difference between the N = 49 participants that indicated that AAF (certainly/ likely) occurred in their clinic and the N = 39 who indicated this not to be the case or being uncertain. We found a difference for three signs/ symptoms. For each of these, the likeliness scores were higher for participants that indicated AAF occurred in their clinic: ‘Incompatibilities between medical history and clinical findings’, ‘Difficulty of diagnosis, rare or unsuspected disease pattern’, and the client behaviour: ‘Relatively often visiting the clinic with this or multiple animals’ (all P < 0.05 and the table indicates the Wilcoxon Z-values).

10.1371/journal.pone.0345067.t002Likeliness indication (median, range) for AAF signs and symptoms in the N = 88 participants and Wilcoxon Z-values and P-values for the difference between the subsample indicating AAF (certainly/ likely) occurred in their clinic (N = 49) and those indicating it did not/ were uncertain (N = 39).
Signs and symptoms regarding animal and medical aspects Median (range) Wilcoxon Z-value P-value
Difficulty of diagnosis, rare or unsuspected disease pattern 4 (1–5) −2.117 0.034
Erratic or toxic drug blood levels 4 (1–5) −1.539 0.124
Gastro intestinal complaints for more than two weeks without a definitive diagnosis 4 (1–5) −0.546 0.585
Incompatibilities between medical history and clinical findings 4 (1–5) −2.603 0.009
Inexplicable medical symptoms 4 (1–5) −0.782 0.434
Neurological complaints, e.g., epileptiform activity, lesser alertness (incl. coma) 4 (1–5) −1.417 0.157
Persistent or recurrent illnesses for which a cause cannot be found 4 (1–5) −0.022 0.982
Recovery of animal/ symptoms when hospitalized 4 (1–5) −1.614 0.106
Recurrent illnesses in which poisoning may factor in 4 (1–5) −1.106 0.269
Repeated hospitalisations and vigorous medical/ veterinary evaluations of victim without definitive diagnoses 4 (1–5) −0.399 0.690
Unlikely medical history 4 (1–5) −0.233 0.816
Relatively many animals deceased with client 3.5 (1–5) −1.315 0.189
Inexplicable intolerance of treatment or poor response to treatment 3 (1–5) −1.857 0.063
Physiologic or laboratory parameters are noticeable or not fitting with patient profile 3 (1–5) −0.758 0.449
Poor recovery if animal is with client 3 (1–5) −0.960 0.337
Recurrent illnesses in which nutrition, nutritional absorption, nutritional state may factor in 2 (1–5) −0.292 0.771
Recurrent illnesses in which suffocation may factor in 2 (1–5) −0.395 0.693
Signs and symptoms regarding client behaviours
Much knowledge of the presented illness or generally of the medical/ veterinary field 4 (2–5) −0.101 0.920
Relatively often talking about own illness or illness of relatives 4 (1–5) −0.650 0.516
Relatively often visiting the clinic with this or multiple animals 4 (1–5) −2.868 0.004
Unexpected response in communication, such as anger upon referral 4 (1–5) −0.064 0.949
Expression of concern by relatives or other professionals 3 (1–5) −0.489 0.625
Little concern expressed over painful examinations/ surgery 3 (1–5) −1.430 0.153
Perpetrator is known to have provided false information 3 (1–5) −0.167 0.867
Relatively often talking about care burden or death of animal(s) 3 (1–5) −1.638 0.101
Relatively often talking about illness in this or multiple animals 3 (1–5) −1.144 0.253
Repeatedly presenting animal at various clinics 3 (1–5) −0.432 0.666
Resistance of client to (possibly effective) therapy suggestions 3 (1–5) −1.166 0.244
Sudden withdraw from treatment or staying away from clinic 3 (1–5) −1.783 0.075

The number of present signs and symptoms affected how likely participants thought a case to regard AAF, with the median for two signs: 2 (1–4), three to five signs: 4 (1–5), more than five signs: 5 (1–5).

 Reporting of AAF signs and symptoms

With regard to reporting of AAF, we asked participants a) if they ever reported AAF as animal abuse, b) if they worked with a network partner, such as the police and c) which barriers to reporting they experienced and what would help them to report a suspected AAF case. The vast majority of the participants indicated to have never reported AAF as animal abuse (92.1%, N = 81). 4.5% (N = 4) reported AAF as animal abuse, 3.4% (N = 3) didn’t know. Of the 4.5% (N = 4) participants that reported AAF as animal abuse, 3.4% (N = 3) did so in cooperation with a network partner such as the police, 1.1% (N = 1) did so independently.

We assessed barriers to reporting, following Williams et al.’s [16] list of barriers that veterinarians experienced to reporting general animal abuse. Our 88 participants scored the barriers to reporting AAF a total of 253 times, as multiple barriers could be indicated by one participant. Table 3 indicates how in our sample the highest frequencies were for ‘Lack of knowledge of available resources’ (56.8%, N = 50), ‘Lack of accepted standards in identification’ (53.4%, N = 47) and ‘Concerns about breaking client confidentiality’ (46.6%, N = 41). The first two items were indicated in our sample at similar percentages as in the study by Williams et al. [16]. The other barriers were indicated at relatively lower percentages in our sample.

10.1371/journal.pone.0345067.t003Barriers to reporting (suspected) AAF cases as mentioned by our 88 participants and barriers to reporting <italic>general</italic> animal abuse by 215 veterinarians in the study by Williams et al. [<xref ref-type="bibr" rid="pone.0345067.ref016">16</xref>].
Regarding AAF cases in this study% (N of 253 indicated reasons) Regarding animal abuse in Williams et al. [16]% (N of 1,024 item endorsements)
Lack of knowledge of available resources 56.8% (N = 50) 54% (N = 117)
Lack of accepted standards in identification 53.4% (N = 47) 54% (N = 116)
Concerns about breaking client confidentiality 46.6% (N = 41) 69% (N = 148)
A perception no action will be taken 33.0% (N = 29) 47% (N = 100)
Inexperience in dealing with misleading information provided by client 33.0% (N = 29) 47% (N = 102)
Concerns on litigation 26.1% (N = 23) 52% (N = 111)
Concern that reporting may compromise safety of victim 18.2% (N = 16) 62% (N = 133)
Concern on physical retaliation by perpetrator 11.4% (N = 10) 35% (N = 75)
Concern that client will leave the clinic 9.1% (N = 8) 42% (N = 90)

Thematic analysis of 93 label indications by 63 participants answering the open question ‘What would help you to report AAF?’, rendered 22 different labels in 4 categories, listed in Table 4. See S5 Table for all entries.

10.1371/journal.pone.0345067.t004Categories and labels distilled from 63 participants regarding what would help to report AAF.
Category Description (label) % (N of N = 93)
Information More knowledge on topic and owner identification 18.3% (17)
More information 9.7% (9)
Knowing whom to contact for help/ knowing how the process of reporting works 6.5% (6)
Experience and familiarity with the condition 2.2% (2)
More knowledge on signs 1.1% (1)
Knowledge on consequences 1.1% (1)
38.7% (36)
Support & Assurance Certainty of recognition/ no trust breach/ no false accusation risk 6.5% (6)
Opportunity to consult psychologist/ physician of client 5.4% (5)
Support from colleagues/ employer 3.2% (3)
Low time investment/ financial support for additional examination 2.2% (2)
Knowing that action is taken upon reporting 2.2% (2)
No need to discuss with client yourself 1.1% (1)
Assistance on recognition as to not incorrectly accuse a person 1.1% (1)
More support 1.1% (1)
22.6% (21)
Guidelines and protocol (Easy access to) reporting centre/ disclosure office 12.9% (12)
Guidelines/ protocol 10.8% (10)
(Knowing) where to report 5.4% (5)
Clarity on roles in the process and consequences for the involved 1.1% (1)
30.1% (28)
Clarity on condition (recognition) Flow chart for near certain diagnosis/ guide for documentation of signs and symptoms/ list of signs of the condition 4.3% (4)
Better definition 2.2% (2)
Examples of what people with the condition do to animals 1.1% (1)
A clear diagnosis (opportunity) 1.1% (1)
8.6% (8)

The category ‘Information’ (38.7%, N = 36) and ‘Support and assurance’ (22.6%, N = 21) held high numbers of labels and had high label counts. For the first category the label of ‘More knowledge on topic and owner identification’ had the highest percentage of occurrence (18.3%, N = 17). For the second ‘Certainty of recognition/ no trust breach/ no false accusation risk’ had the highest percentage of occurrence (6.5%, N = 6). Not all participants answered this question.

 Discussion

We aimed to assess awareness on Animal Abuse by (Condition) Falsification (AAF) in the Dutch veterinary profession and found that over eighty percent indicated familiarity with the phenomenon, although under fifteen percent indicated previous education on AAF. Half of the participants indicated to likely see AAF cases in their veterinary clinic. Five percent indicated to see such cases with certainty, with often mentioned proxies being dogs and cats. Of the possible signs and symptoms indicative of AAF, signs and symptoms referring to client behaviours were reported spontaneously more so than signs and symptoms referring to animal/ medical aspects. The first were also rated higher likeliness of indicating AAF.

Generally, we demonstrate in this study that an awareness of the existence of AAF may be present in the Dutch veterinary profession. In the open answers regarding the participants’ recognition of AAF, we may even find an indication that the difference made in child abuse cases between fabricated and induced symptoms (e.g., [4,8]), may also be recognised by the veterinary profession. Our participants reported on the one hand a possible dishonesty (‘fabrication’) without induction of illness and on the other hand the induction thereof. Examples of fabrication are recognisable in ‘vague or inexplicable complaints – difficult to check or confirm medically’, and ‘repetitive small complaints/ visits with a healthy animal’. Examples of induction are recognisable in ‘uncommon seriousness of complaints’ and ‘slowed healing/ recovery or even worsening despite treatment’.

The existence of variants of abuse by falsification is only one aspect of the complexity of the phenomenon. Also, on the perpetrator side complexity exists: the condition that leads a person to abuse a proxy by condition falsification, is recognised as a spectrum disorder [8,17]. Due to the existence of variants of the phenomenon, just like in child abuse cases [14], diagnosing AAF in animal abuse cases will be challenging. It is therefore logical that our participants indicate the need for more knowledge on AAF, and on support when dealing with suspected AAF cases. Collaboration opportunities are flagged as important, involving not only colleagues, but also professionals in the human care domain. Such a support need was also indicated in an Italian survey amongst more than 500 paediatricians when suspecting child abuse by falsification [18]. The participants to this survey indicated to more likely discuss a case with another specialist (or the parent of the victim), than to refer the case to the authorities [18]. As time may be of the essence in cases of abuse by falsification [19], further studying of how reporting can be facilitated seems of relevance to animal welfare. Possible suggestions from this study may be offering knowledge in a certain format, such as flow chart, and facilitating reporting via an (easily accessible) reporting centre/ disclosure office. Furthermore, guidelines on the assessment and management of AAF are warranted. Such guidelines could build on more general animal abuse veterinary medicine guidelines [20,21]. Creating AAF guidelines would follow their existence in human medicine, where such guidelines have been written, although not yet for all subsamples, such as adolescents [19,22].

The limitation of our study primarily regards the limited number of participants. Despite our efforts to involve a large number of veterinary professionals in The Netherlands, we managed only to include 88 participants. This may have been due to the longer length of the survey, that presented the participants with AAF signs/symptoms from human medicine, which we deemed a starting point for assessing AAF in another proxy. Another study limitation may be the unintentional involvement of higher numbers of topic-engaged participants. Consequently, the found percentages of AAF occurring likely or certainly in veterinary clinics, as per report of our participants, may not be regarded as prevalence numbers. Also, people inflicting AAF may or may not be seen in veterinary clinical settings. The need for attention is central to the condition that leads a person to abuse a proxy by condition falsification. Such attention may be received by visiting veterinary clinics. Yet, people may fulfil the condition-related psychological need via the internet [23,24], possibly limiting their visiting of veterinary clinics for attention purposes. Although the studies on internet-related expression of the condition did not regard animals specifically, the mode may similarly apply to situations when animals are proxy. Thus, further studies are needed to assess prevalence aspects of AAF and to validate which signs and symptoms in client behaviour and relating to animals and conditions are telling of AAF and which may be most suitable as warning signs. We note that the signs and symptoms listed in this study unlikely cover all possible warning signs of AAF. AAF may present itself highly varied in the veterinary clinical setting, as it does in the human medical setting [2].

We stress that further studying of AAF may have an additional possible importance. If future studies can contribute to creating AAF guidelines and support the veterinary profession in early recognition of possible AAF cases, this is of value to not only animal welfare, but may have broader societal implications. Cases are known in which both animals and children are a proxy [13,25]. Already in 1998, a case was described where in one household child and animal were proxy, in a study on male perpetrators of child abuse by falsification [25]. And, in 2001, an AAF case was described where dog poisoning surfaced after the poisoning of a child came to light [13]. Thus, studying AAF may have a broader value than animal welfare value. With the continuously growing body of literature on the relation between animal abuse and child abuse [26–28], the studying of AAF may contribute to (early) recognition of abuse cases and possibly more complex situations of intergenerational abuse effects [29,30].

 Conclusion

Animal abuse by (Condition) Falsification (AAF) is recognised by a part of the Dutch veterinary profession and warning signs of the phenomenon are known to some extent. Yet, presently little guidance exists for (early) recognition of these particular animal abuse cases. A support need could possibly be filled, at least in part, by creating guidelines on the assessment and management of AAF. Before such guidelines can be established, the further studying of AAF, its prevalence and (warning) signs is needed as an initial step to support the veterinary profession.

 Supporting information Survey items on Animal Abuse by Falsification (AAF).

(DOCX)

 Literature sources for Animal Abuse by Falsification (AAF) signs and symptoms.

(DOCX)

 Participant details.

(DOCX)

 Animal Abuse by Falsification (AAF) signs and symptoms mentioned by participants to the open question on recognition: ‘Which signs would make you think of AAF?’.

(DOCX)

 What would aid in reporting Animal Abuse by Falsification (AAF) as mentioned by participants in the open question on reporting: ‘What would help you to report AAF?’.

(DOCX)

 Data file.

(XLSX)

 References Geist R, Gary M, Kiper V, Cockerell K. Hidden harm: Factitious disorder imposed on another. Nurs Made Incr Easy. 2024;22(4):6–14. doi: 10.1097/nme.0000000000000055 Oxley JA, Feldman MD. Complexities of maltreatment: Munchausen by proxy and animals. Companion Animal. 2016;21(10):586–9. doi: 10.12968/coan.2016.21.10.586 Shaw RJ, Dayal S, Hartman JK, DeMaso DR. Factitious disorder by proxy: pediatric condition falsification. Harv Rev Psychiatry. 2008;16(4):215–24. doi: 10.1080/10673220802277870 18661364 Bass C, Glaser D. Early recognition and management of fabricated or induced illness in children. Lancet. 2014;383(9926):1412–21. doi: 10.1016/S0140-6736(13)62183-2 24612863 Lazenbatt A. Fabricated or Induced Illness in Children: A Narrative Review of the Literature. Child Care in Practice. 2012;19(1):61–77. doi: 10.1080/13575279.2012.732928 Jaghab K, Skodnek KB, Padder TA. Munchausen’s Syndrome and Other Factitious Disorders in Children: Case Series and Literature Review. Psychiatry (Edgmont). 2006;3(3):46–55. 21103164 Sanders MJ, Bursch B. Forensic assessment of illness falsification, Munchausen by proxy, and factitious disorder, NOS. Child Maltreat. 2002;7(2):112–24. doi: 10.1177/1077559502007002003 12020067 Squires JE, Squires RH. A review of Munchausen syndrome by proxy. Pediatr Ann. 2013;42(4):67–71. doi: 10.3928/00904481-20130326-09 23556520 Kozlowska K, Foley S, Crittenden P. Factitious Illness by Proxy: Understanding Underlying Psychological Processes and Motivations. ANZ J of Family Therapy. 2006;27(2):92–104. doi: 10.1002/j.1467-8438.2006.tb00703.x Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41:20–8. doi: 10.1016/j.genhosppsych.2016.05.002 27302720 Feldman MD. Canine variant of factitious disorder by proxy. Am J Psychiatry. 1997;154(9):1316–7. doi: 10.1176/ajp.154.9.1316b 9286197 LeBourgeois HW 3rd, Foreman TA, Thompson JW Jr. Novel cases: malingering by animal proxy. J Am Acad Psychiatry Law. 2002;30(4):520–4. 12539907 Munro HM, Thrusfield MV. “Battered pets”: Munchausen syndrome by proxy (factitious illness by proxy). J Small Anim Pract. 2001;42(8):385–9. doi: 10.1111/j.1748-5827.2001.tb02486.x 11518417 Hoffman JS, Koocher GP. Medical Child Abuse Hidden in Pediatric Settings: Detection and Intervention. J Clin Psychol Med Settings. 2020;27(4):753–65. doi: 10.1007/s10880-019-09666-8 31602528 Worley C, Feldman M, Hamilton J. The case of factitious disorder versus malingering. What are the distinctions?. Psychiatr Times. 2009;26(11):26. Williams JM, Wauthier L, Scottish SPCA, Knoll M. Veterinarians’ experiences of treating cases of animal abuse: An online questionnaire study. Vet Rec. 2022;191(11):e1975. doi: 10.1002/vetr.1975 36039932 Bursch B, Emerson ND, Sanders MJ. Evaluation and Management of Factitious Disorder Imposed on Another. J Clin Psychol Med Settings. 2021;28(1):67–77. doi: 10.1007/s10880-019-09668-6 31612305 Nardello R, Cordova G, Spina CL, Piro E, Serra G, Corsello G, et al. Knowledge and management of Münchausen’s Syndrome by proxy: a survey conducted through the compilation of a questionnaire by pediatricians belonging to the Italian Society of Pediatrics. Ital J Pediatr. 2025;51(1):59. doi: 10.1186/s13052-025-01878-z 40001260 Abraham-Bizot A, Greco C, Quartier P, Loschi S, Soyeux E, Ikowsky T, et al. Medical child abuse: Medical history and red flags in French adolescents. Child Abuse Negl. 2023;146:106523. doi: 10.1016/j.chiabu.2023.106523 37950944 Arkow P, Boyden P, Patterson-Kane E. Practical guidance for the effective response by veterinarians to suspected animal cruelty, abuse and neglect. Schaumburg, IL: American Veterinary Medical Association. 2011. Touroo R, Baucom K, Kessler M, Smith-Blackmore M. Minimum standards and best practices for the clinical veterinary forensic examination of the suspected abused animal. Forensic Science International: Reports. 2020;2:100150. doi: 10.1016/j.fsir.2020.100150 Federatie Medisch Specialisten. Richtlijn kindermishandeling door falsificatie (KMdF). 2025. Feldman MD. Munchausen by Internet: detecting factitious illness and crisis on the Internet. South Med J. 2000;93(7):669–72. 10923952 Pulman A, Taylor J. Munchausen by internet: current research and future directions. J Med Internet Res. 2012;14(4):e115. doi: 10.2196/jmir.2011 22914203 Meadow R. Munchausen syndrome by proxy abuse perpetrated by men. Arch Dis Child. 1998;78(3):210–6. doi: 10.1136/adc.78.3.210 9613349 McPhedran S. Animal abuse, family violence, and child wellbeing: A review. J Fam Viol. 2009;24(1):41–52. doi: 10.1007/s10896-008-9206-3 Monsalve S, Ferreira F, Garcia R. The connection between animal abuse and interpersonal violence: A review from the veterinary perspective. Res Vet Sci. 2017;114:18–26. doi: 10.1016/j.rvsc.2017.02.025 28279899 Tomlinson CA, Murphy JL, Matijczak A, Califano A, Santos J, McDonald SE. The Link between Family Violence and Animal Cruelty: A Scoping Review. Social Sciences. 2022;11(11):514. doi: 10.3390/socsci11110514 Isobel S, Goodyear M, Furness T, Foster K. Preventing intergenerational trauma transmission: A critical interpretive synthesis. J Clin Nurs. 2019;28(7–8):1100–13. doi: 10.1111/jocn.14735 30556334 Rees J, Evans B. Breaking the cycle of intergenerational abuse. Intern J Birth Parent Edu. 2021;1(2):19–24. 10.1371/journal.pone.0345067.r001 Decision Letter 0 Alarape Selim Adewale Academic Editor 2026 Selim Adewale Alarape This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Submission Version 0

1 Feb 2026

Dear Dr. Herwijnen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Mar 18 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Selim Adewale Alarape, MVPH

Academic Editor

PLOS One

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include a new copy of Table S4 in your manuscript; the current table is difficult to read. Please follow the link for more information: https://journals.plos.org/plosone/s/tables

3. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

**********

Reviewer #1: The context of the article titled "Animal abuse by falsification – recognition amongst the veterinary profession in The Netherland" is highly appreciable in this era of the sociological need to assess human-animal interactions. The novelty is awesome. However, there is need to look at the following areas for possible amendments to add value to the write up:

1. Line 33-35: There is need for modification and or recapping of the statement. The present forms is more of history than science!. What is the problem statement?. Highlight the gap in knowledge with this sentence.

2. Line 38: What is vet tech? Please, write fully for readers who are not from your field to understand.

3.Line 50-51: What is the essence of the last sentence?

4. Line 78: .......is unknown. Where? Mention the name of the country

5. Line 119: Participants

6. Line 123: What is vet tech??

7. The conclusion is not shown as a distinct subheadings like Results and Discussion. Please, carve the Conclusion out of the discussion.

8. No DOI for the articles listed under the references.

Reviewer #2: Line 36-" perplexing presentation has been mentioned'' include reference so we know who is being referred to.

Line 46- Reporting of AAF in this sample was low. this statement is too short and should be merged with previous statement

Line 47- does the 92% reported here inclusive of the participants that indicated they are unsure and have not seen such cases? I dont think these categories should be in this

line 59- recast the sentence like outcome may include instead of outcome may regard

Line 67: among not amongst

line 74- cant start a sentence with or, please recast or merge

line 77-82: recast the sentence to have a better flow,

Line 85- switching among

Line 178- majority were veterinarians delete was a

Lines 110 and 120- Repeating the same information. Can you please recast the sentence for better clarity to be like we recruited...................... via e mail and platform

Line 164- reframe the sentence ''how likely they thought a case to regard AAF,'

line 200- 31.8% cannot be termed more since 51.2 % already indicated, please remove more and recast the sentence

-- Create a footnote for table 1, what is PU-PD

290-291- e.g. (4) what is the meaning of this? please clarify

Line 291- This, as some participants responded that they recognise as an indication of AAF'' please recast for clarity

Line 297-298-- statement is disjointed, please recast

line 304- please recast

**********

what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: Yes: Olufemi Mobolaji Alabi P.hD

Reviewer #2: Yes: Bukola O. Oyebanji

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

 10.1371/journal.pone.0345067.r002 Author response to Decision Letter 1 Submission Version 1

10 Feb 2026

Response to each point raised:

2. Please include a new copy of Table S4 in your manuscript; the current table is difficult to read. Please follow the link for more information: https://journals.plos.org/plosone/s/tables

Thank you for suggesting this change, we have tried several variants. We have now added a supplement table with larger font size, while still keeping the data in one table. Keeping the information in one table was deemed beneficial by our test readers.

Reviewer #1: The context of the article titled "Animal abuse by falsification – recognition amongst the veterinary profession in The Netherland" is highly appreciable in this era of the sociological need to assess human-animal interactions. The novelty is awesome. However, there is need to look at the following areas for possible amendments to add value to the write up:

Thank you for this appreciated feedback, your reviewing time and suggestions, that helped us improve the manuscript.

1. Line 33-35: There is need for modification and or recapping of the statement. The present forms is more of history than science!. What is the problem statement?. Highlight the gap in knowledge with this sentence.

We have adapted our presentation of the topic at hand in the first three lines of the abstract.

2. Line 38: What is vet tech? Please, write fully for readers who are not from your field to understand.

Thank you for this suggestion, we have replaced ‘tech’ with ‘technician’ throughout.

3.Line 50-51: What is the essence of the last sentence?

We have removed the last sentence of the abstract.

4. Line 78: .......is unknown. Where? Mention the name of the country

We have added the USA region.

5. Line 119: Participants

We have adapted the title of this section.

6. Line 123: What is vet tech??

Thank you for this suggestion, we have replaced ‘tech’ with ‘technician’ throughout.

7. The conclusion is not shown as a distinct subheadings like Results and Discussion. Please, carve the Conclusion out of the discussion.

We have added a conclusion section.

8. No DOI for the articles listed under the references.

We have added the DOI to the articles in the reference list.

Reviewer #2:

Thank you for your time and comments that helped to improve our manuscript.

Line 36-" perplexing presentation has been mentioned'' include reference so we know who is being referred to.

Thank you for your suggestion. We are not customary to adding references to an abstract, but have provided references in the Introduction section.

Line 46- Reporting of AAF in this sample was low. this statement is too short and should be merged with previous statement

We have merged this sentence and the sentence thereafter.

Line 47- does the 92% reported here inclusive of the participants that indicated they are unsure and have not seen such cases? I dont think these categories should be in this

Reporting was indeed reportedly never done by 92.1% (N=81), 4.5% (N=4) reported AAF as animal abuse, 3.4% (N=3) didn’t know.

line 59- recast the sentence like outcome may include instead of outcome may regard

Thank you for this suggestion, which we adhered to.

Line 67: among not amongst

As far as we are aware, amongst is more commonly used in British English, but we have adapted to among, hoping this is in accord with PLOS One.

line 74- cant start a sentence with or, please recast or merge

Thank you for this suggestion, which we adhered to.

line 77-82: recast the sentence to have a better flow,

We have rewritten this section. It now reads: ‘A USA-based study indicated that the true incidence or prevalence of AAF is unknown [2]. The few available scientific studies on the topic, often present cases and do not provide epidemiological data [2]. An example is a UK-based study including six cases identified by veterinarians and three cases included by the researchers as possible AAF cases [13]. In this total of nine cases, signs were noted in the animals, that corresponded with signs in child abuse cases. The respective signs regarded the animal owner’s attention seeking behaviour, recovery of the animal upon owner-separation, serial incidents, real and likely factitious clinical signs, abnormal biochemical profiles, deliberately inflicted injury, tempering with surgical sites and switching from veterinary clinics [13].’

Line 85- switching among

This sentence was adapted.

Line 178- majority were veterinarians delete was a

This sentence was adapted.

Lines 110 and 120- Repeating the same information. Can you please recast the sentence for better clarity to be like we recruited...................... via e mail and platform

Unfortunately PLOS One requires the ethical statement to be formulated as is and our reading panel judged it necessary to present the information that you point at also at the second location to facilitate the readers.

Line 164- reframe the sentence ''how likely they thought a case to regard AAF,'

This sentence was adapted.

line 200- 31.8% cannot be termed more since 51.2 % already indicated, please remove more and recast the sentence

Thank you for pointing out the unclarity in our writing. We have rewritten this text as: ‘51.2% (N=45) indicated to likely see cases. 4.6% (N=4) indicated to certainly see cases, 12.5% (N=11) indicated to certainly not see cases in their clinic. A relatively high percentage of 31.8% (N=28) indicated ‘don’t know’.’

-- Create a footnote for table 1, what is PU-PD

Thank you for this suggestion. We added ‘polyuria-polydipsia’ between brackets behind the abbreviation.

290-291- e.g. (4) what is the meaning of this? please clarify

We have rewritten this text section, taking away the unclarity.

Line 291- This, as some participants responded that they recognise as an indication of AAF'' please recast for clarity

We have rewritten this text section, taking away the unclarity.

Line 297-298-- statement is disjointed, please recast

We have rewritten this text section, taking away the unclarity.

line 304- please recast

This text was adapted.

Submitted filename: Response to Reviewers.docx

 10.1371/journal.pone.0345067.r003 Decision Letter 1 Alarape Selim Adewale Academic Editor 2026 Selim Adewale Alarape This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Submission Version 1

2 Mar 2026

Animal abuse by falsification – recognition amongst the veterinary profession in the Netherlands

PONE-D-25-67684R1

Dear Dr. Herwijnen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Selim Adewale Alarape, MVPH

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

 10.1371/journal.pone.0345067.r004 Acceptance letter Alarape Selim Adewale Academic Editor 2026 Selim Adewale Alarape This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PONE-D-25-67684R1

PLOS One

Dear Dr. Herwijnen,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Selim Adewale Alarape

Academic Editor

PLOS One