Thank you for the added information. Yes, it helps a lot. I believe I can now be of help with this issue.
First, let me say I can imagine how confusing this situation must be for you. Munchausen By Proxy is one of the most difficult disorders to treat and certainly one of the most difficult for non-professionals to understand. It is in professional terms a factitious disorder.
And this is actually the key to my answer to you that you need to consider and think about. Factitious disorders are usually classified as attention seeking disorders. The most common is where the person invents illnesses that they have, when they don't at all have those disorders. You can easily see how this is a way to gain attention and would serve this subconscious purpose. Munchausen Syndrome is psychologically more complex because it is by proxy: she is inventing her kids' illnesses. You can see how this indicates a personality that is much more complex in its disorder and compensatory needs.
It indicates that her need for self focus is complex and "twisted", to use a layman's term. There is a need to display that something is wrong but to somehow distance it from herself in some way. That may be with her the tie in to the paranoid symptoms. That she needs to be "safe". Her kids can have the illnesses, but she is scared if she herself would have the illnesses. Paranoia is a self-protective disorder. It centers on self in a protective manner.
So in all, the diagnosis of Paranoid Personality Disorder seems like a better primary diagnosis for her and it's good that it was arrived at. She is clearly very ill and your brother needs to be very careful in how he proceeds with her to always document everything, to go through the attorneys, guardian ad litem, therapists, doctors, anyone official. Why?
Because whenever there is a thought disorder that has a personality aspect to it, there is always a great risk of untruths and accusations and fantasies flying. He's already experienced this. He has to expect this on an ongoing basis.
It's wonderful that you're a caring and concerned sister here. Print out my answer and share it with him because he needs to try to protect the kids as much as possible. And himself.
I wish you the very best!
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