She Just Wanted to Help Her Trans Child. She Was Accused of Making Her Sick.
Courts are increasingly using Munchausen Syndrome by Proxy diagnoses to separate trans kids from their families.
Erin* was in the midst of divorce proceedings when the custody trouble began. She was sharing custody of her four children, ages three to nine, with her soon-to-be ex-husband when the children reported feeling unsafe at their father’s. At times, he was drunk and violent, they said. In 2017, one of the children called the police, and two of them reported that their father squeezed their necks and lifted them up by their necks when they misbehaved. After that incident, their father was arrested for child endangerment; Child Protective Services got involved but didn’t open a case. (*Erin is a pseudonym, as the custody case is ongoing.)
However, the trouble didn’t start because of Erin’s husband’s abuse allegations. It started because she was supporting her youngest child, who was assigned male at birth but had increasingly asserted that she was a girl. Gender-affirming care is widely recognized by the mainstream medical community as being best practice for treating kids with gender dysphoria, and it has been shown in research to significantly reduce negative psychological outcomes, including suicidal ideation, in trans children. But because Erin was following the recommendations of medical specialists, she was dragged into a lengthy custody battle that bled her dry financially. A court-ordered psychological evaluation found that Erin was mentally ill and mentioned that Munchausen syndrome by proxy was suspected. Ultimately, she lost custody of her four children. For the past two years, her kids have lived full-time with their father.
As trans children are increasingly coming under attack by state legislatures across the country, families of trans children are terrified that they could lose their kids for simply supporting who they are. These families are right to be worried. In Idaho, a bill passed in its House of Representatives that would criminalize gender-affirming care and punish parents who traveled to access care for their children with a felony. In Texas, Governor Greg Abbott directed the state’s Department of Family and Protective Services to investigate families who provide gender-affirming care to their children for child abuse. The agency initiated at least nine investigations into families with trans children before a lawsuit, filed by the ACLU on behalf of a DFPS employee with a trans child, led to a Travis County judge putting the directive on hold. A trial is scheduled for July, but the state appealed the injunction to the Texas Supreme Court; if the court reverses the injunction, these investigations will resume.
The legal basis for equating such care with child abuse is spurious and comes from a legal opinion issued by Texas attorney general Ken Paxton in February. Paxton’s opinion is full of citations of cases taken wildly out of context and twists the overly broad definition of abuse to make his argument. But he also leans on arguments that have been made in custody cases involving trans youth for years that claim a child’s gender variance is heavily influenced by a parent—almost always the child’s mother.
Paxton cites two CPS cases involving Munchausen syndrome by proxy, which the Cleveland Clinic defines as “a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick.” The cases Paxton cites involve children’s serious physical illness, but he argues that gender-affirming care could constitute “the imposition of unnecessary medical procedures” and thus be considered child abuse.
Factitious disorder imposed on another, the current name for what was formerly called Munchausen syndrome by proxy, is a very rare diagnosis of serious mental illness. The Cleveland Clinic estimates that of 2.5 million child-abuse cases reported annually, just a thousand of the cases are related to FDIA. And crucially, that number pertains just to abuse reports, not to confirmed findings of abuse. The Diagnostic and Statistical Manual of Mental Disorders first proposed the diagnosis in 1994 and officially added the disorder to the DSM-5 in 2013. As the term gained mainstream acknowledgment, the diagnosis has been widely feared by parents of children with chronic or unexplained illness, many of whom feel that the threat of the diagnosis leads to doctors not trusting parents or treating them with suspicion.
The diagnosis of FDIA is real, but it is vastly overdiagnosed, particularly in cases involving mothers of medically complex children, says Loren Pankratz, a psychologist with an expertise in factitious disorders who has served as an expert witness for decades. “Any time you have a diagnosis that is controversial or difficult”—particularly those that are diagnosed by clinicians and not by lab tests—“those are all open for accusations of disagreements and conflict,” Pankratz explains.
Although trans children receive diagnoses of gender dysphoria, many supportive parents don’t consider being trans to be an illness of any kind. “Being trans is valid and normal and just simply, you know, a human condition,” says Camellia Bellis, the founder of Parents in Transition, a support group for affirming parents involved in custody disputes. “Being accused of making your child trans or somehow influencing your child's gender identity is, at its core, offensive—and it highlights the level and the depth of the institutional and interpersonal transphobia that is just so rampant” in the family-court system, she says.
When it comes to something as inflammatory as FDIA, the mere suggestion that a mother could be harming her kids this way, even without an actual diagnosis, can influence courts’ custody decisions. “I do not have Munchausen by proxy and I have never been diagnosed with it,” says Vicki Chaffin, a Kansas City mother who lost custody of her children over affirming her trans son’s gender. Still, Chaffin says the child’s appointed attorney mentioned a suspicion of FDIA in an early email about the case. Years later, a psychological evaluator again floated the suspicion—without a diagnosis—that she says negatively impacted her bid for custody. She’s currently allowed only brief supervised visits with her children.
For Erin, a single psychological evaluation changed the course of her custody case. Erin spent just a few hours with the therapist, but in that time, she was diagnosed with borderline personality disorder, and the therapist suggested that Munchausen syndrome by proxy was behind her child’s gender dysphoria. Erin’s own long-term psychologist disagreed with both diagnoses, but the family court took them as fact. “Dad should have sole legal custody of the children … with no shared decision-making with Mom on any issue affecting the child’s health, education, or welfare due to the mental condition of Mom and the adverse impact of Mom’s conduct and behavior on the children,” the court judgment noted. When Erin lost custody of her children, her youngest was six years old. “He was still coming into my bed to sleep at night,” she says, choking up. “He was little.”
Katherine Kuvalanka is a professor of family science and social work at Miami University in Oxford, OH and the lead author of a 2019 study of 10 cases involving mothers who affirmed their trans children’s gender identity. In four of the 10 cases, the study found, mothers lost physical or legal custody of their children. In three cases, Kuvalanka says, the non-affirming parent claimed the affirming parent had a psychological problem. “What is more likely? That a parent is pushing their child to be trans when their kid actually isn’t?” Kuvalanka asked. “Or is it much more likely that one parent is having difficulty accepting that their child is trans and they’re taking advantage of the courts?”
The research showed that in all but one of the 10 cases, affirming mothers reported coercive and controlling behaviors by their partners, in some cases including emotional and psychological abuse. In one Michigan affirming mom’s case, the father had a documented history of domestic violence and was still granted sole custody of the children. “In some cases, if it wasn’t gender, it’d just be something else, but gender is so ripe for the controlling partners to grab onto. Especially when family-court professionals aren’t knowledgable about trans identities, then those controlling partners, they know that they can wield that power; they can use that as a way to further control their partners.”
Kuvalanka says that in a yet-to-be-published follow up study, several of the mothers experienced a change for the better in their custody agreements, but those positive changes came at a hefty emotional price. For three of the children, changes were made after a “severe deterioration of their mental health and physical well-being,” Kuvalanka says. In the three and a half years between the initial study and the follow-up interviews, two of the kids had attempted suicide.
“The court gets so caught up. They get so focused on that question of ‘Is the child really trans?’” Kuvalanka says, “when really the question should be ‘What is the best environment for this child, and who is going to be providing the safest and most open and free environment for the child to be themselves?’”
