Munchausen-by-proxy syndrome: countertransference as a diagnostic tool

The authors report on an unusual reaction in clinicians interviewing known perpetrators of Munchausen-by-proxy syndrome (MBPS): an uncanny, ego-dystonic, and cognitively dissonant sense that the parent could not be the perpetrator, despite all clinical/forensic evidence. The authors suggest that this reaction can have various sources: One may be "as-if" character pathology in the parent, with the capacity to evoke, unconsciously, disbelief in the clinician. Given the poor treatment outcome reported in MBPS perpetrators, the authors suggest that, if confirmed, this finding will lead to more accurate psychiatric diagnosis of the parent, and more informed treatment of this potentially harmful or lethal syndrome.