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Persistent Problems With the Munchausen Syndrome by Proxy Label

Dr. Pankratz is Consultation Psychologist in independent practice and Clinical Professor, Department of Psychiatry, Oregon Health and Sciences University, Portland, OR. Address correspondence to: Loren Pankratz, PhD, 1525 S.W. Palatine Street, Portland, OR 97219. E-mail: loren.pankratz{at}comcast.net

After nearly 30 years of clinical and legal experience, the definition of Munchausen syndrome by proxy remains controversial. As a result, mothers who present the problems of their children in ways perceived as unusual or problematic have become entangled in legal battles that should have been resolved clinically. Re-labeling the disorder as Pediatric Condition Falsification misdirects the focus onto mistakes and misunderstandings while avoiding the more crucial issue of intentions. Experts have enflamed the fears of harm by confusing warning signs with diagnostic signs and by citing retrospective studies instead of the more optimistic outcome studies. Accused mothers need the support of multidisciplinary teams but are often forced into contentious struggles with legal professionals and child protection services.