Munchausen syndrome by proxy remains a controversial diagnosis because information is easily tainted to make the mother appear responsible for her child's symptoms. This article focuses on the “separation test,” which is often recommended on the basis of misrepresented mortality rates. Once the child has been removed, the separation test is seldom used to evaluate alternative hypotheses (falsify the diagnosis), but most often to gather evidence against the mother. The basic rules of science and clinical medicine must be followed or false positive cases will be unacceptably high. Alternatives to the separation test are recommended.
AndersonE., & FreemanE. (2004). Recognition of movement disorders: Extrapyramidal side effects and tardive dyskinesia. Would you recognize them if you see them?Practical Gastroenterology, 28, 14–26.
2.
BassC., & BenjaminS. (1993). The management of chronic somatization. British Journal of Psychiatry, 162, 472–480.
3.
BergB., & JonesD.P.H. (1999). Outcome of psychiatric intervention in factitious illness by proxy (Munchausen by proxy syndrome). Archives of Diseases in Childhood, 81, 465–472.
4.
BoolsC.N.NealeB.A., & MeadowR. (1993). Follow up of victims of fabricated illness (Munchausen syndrome by proxy). Archives of Diseases in Childhood, 69, 625–630.
Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 59 (1993).
9.
DavisP.McClureR.J.RolfeK.ChessmanN.PearsonS.SibertJ.R. (1998). Procedures, placement, and risks of further abuse after Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Diseases in Childhood, 78, 217–221.
10.
Delaware v. McMullen, 900 A. 2d 103 (Del. Super. Ct. 2006).
11.
EWHC 31 (Family Division) Case No: WR03C00142. 2005.
12.
FeldmanM.D., & EisendrathS. (1996). The spectrum of factitious disorders. Washington, DC: American Psychiatric Press.
13.
FeldmanM.D., & AllenD.B. (1996). “False-positive” factitious disorder by proxy. Southern Medical Journal, 89, 452.
JonesJ.G.ButlerH.L.HamiltonB.PerdueJ.D.SternH.P., & WoodyR. C. (1986). Munchausen syndrome by proxy. Child Abuse & Neglect, 10, 33–40.
19.
KrenerP. (1994). Factitious disorders and the psychosomatic continuum in children. Current Opinion in Pediatrics, 6, 418–422.
20.
KrenerP., & AdelmanR. (1988). Parent salvage and parent sabotage in the care of chronically ill children. American Journal of Diseases of Children, 142, 945–951.
21.
Lehr v. Robertson, 463 U.S. 248 (1983).
22.
MartE. (1999). Problems with the diagnosis of factitious disorder by proxy in forensic settings. American Journal of Forensic Psychology, 17, 69–82.
McClureR.J.DavisP.M.MeadowR., & SibertJ.R. (1996). Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation. Archives of Diseases in Childhood, 75, 57–61.
25.
MeadowR. (1989). Letter to the Editor. Child Abuse & Neglect, 13, 289.
26.
MeadowR. (1995). What is, and what is not, “Munchausen syndrome by proxy?”Archives of Diseases in Childhood, 72, 534–538.
27.
MeadowR. (2002). A case of murder and the BMJ. BMJ, 324, 41–43.
28.
MorleyC.J. (1995). Practical concerns about the diagnosis of Munchausen syndrome by proxy. Archives of Diseases in Childhood, 72, 528–529.
29.
MorleyC.J. (1998). Concerns about using and interpreting covert video surveillance. BMJ, 316, 1603–1605.
30.
MorganB. (1999). Death from Munchausen syndrome by proxy is overestimated. BMJ, 318, 462 (13 February).
31.
OrneM. (1962). On the social psychology of the psychological experiment with particular reference to demand characteristics and their implications. American Psychologist, 17, 776–783.
32.
OstfeldB.M., & FeldmanM.D. (1996). Factitious disorder by proxy: Clinical features, detection, and management. In FeldmanM.D. & EisendrathS. (Eds.), The Spectrum of Factitious Disorders (pp. 83–108). Washington, DC: American Psychiatric Press.
33.
PankratzL. (1998). Patients who deceive. Springfield, IL: Charles Thomas.
34.
PankratzL. (1999). Factitious disorders and factitious disorder by proxy. In NethertonS.HolmesD., & WalkerC.E. (Eds.), Child and adolescent psychological disorders: A comprehensive textbook (pp. 304–319). New York: Oxford University Press.
PankratzL. (2006). Persistent problems with the Munchausen syndrome by proxy label. Journal of the American Academy of Psychiatry and Law, 34, 90–95.
37.
R v. LM. (2004). 192 QCA (AUSTL.)
38.
RandD.C., & FeldmanM.D. (1999). Misdiagnosis of Munchausen syndrome by proxy: A literature review and four new cases. Harvard Review of Psychiatry, 7, 94–101.
39.
RosenbergD. (1987). Web of deceit: A literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11, 547–563.
40.
RosenbergD. (2003). Munchausen syndrome by proxy: Medical diagnostic criteria and legal burdens of proof. Child Abuse & Neglect, 27, 421–430.
41.
Santosky v. Kramer, 455 U.S. 745 (1982).
42.
ScherrV.T. (2005). Munchausen's syndrome by proxy and Lyme disease: Medical misogyny or diagnostic mystery?Medical Hypotheses, 65, 440–447.
43.
SchreierH. (2002). Munchausen by proxy defined. Pediatrics, 110, 985–988.
44.
ShactmanT. (2006). Medical sleuth. Smithsonian, 36 (11), 23–30.
45.
SheridanM.S. (2003). The deceit continues: An updated literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 27, 431–451.
46.
TalbotM. (2004, August 9 and 16). The bad mother. New Yorker.
47.
Venema v. The Netherlands, 36 ECHR 345 (2002).
48.
WatkinsS.J. (2000). Conviction by mathematical error?BMJ, 320, 2–3.
49.
WrennallL. (2007). Munchausen syndrome by proxy/Fabricated and induced illness: Does the diagnosis serve economic vested interests, rather than the interests of children?Medical Hypotheses, 68, 960–966.
