When a person with Munchausen by proxy (MBP) directs his mental illness at a child, it is a particularly insidious form of child abuse. Characterized by the caregiver falsifying an illness in the child, this is achieved via any or all of a number of highly manipulative and often dangerous methods, including: creating a distorted sense of reality and self-perception in the child; constricting normal developmental experiences that can reinforce the distorted sense of reality and self-perception in the victim as well as create social, academic or other deficits; creating medical risks due to unnecessary medical intervention; and actually assaulting the victim’s body, both by the perpetrator and unsuspecting clinicians. MBP is often difficult to detect and can persist for a remarkably long time because the manipulative abuser appears to be an extremely attentive and devoted custodian.

This chapter describes common legal challenges in cases of suspected MBP, including jurisdictional issues and rules of evidence. It reviews ideal approaches to diagnosis, assessment, differential diagnosis, treatment and expert qualifications. Finally, it outlines common expert deficits, problems in assessment, ethical lapses by professionals, and the potential for catastrophic outcomes when inaccurate clinical and/or legal conclusions are made in either direction. Particular topics include: