Persistent Problems with the “Separation Test” in Munchausen Syndrome by Proxy

Abstract

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.