Most of us are probably already familiar with at least the idea of Munchausen Syndrome by Proxy, even if we aren’t familiar with the name. It has entered the popular imagination thanks to movies and TV shows like Hulu’s Emmy-winning true crime series The Act, which chronicled the life and murder of Dee Dee Blanchard by her daughter, Gypsy Rose, whom she abused.
The phrase, first coined in 1976, describes a caregiver who either encourages their charge to feign illness or, in some extreme cases, actually makes them ill in order to receive diagnoses, medical care, and, ultimately, attention and sympathy. At least, that’s how it is popularly understood. The name comes from Munchausen Syndrome, a term first coined in 1951 to describe individuals who exaggerated or staged their own medical symptoms, itself named for the fictional Baron Munchausen, a character from an 18th-century German book.
But what is Munchausen Syndrome by Proxy really? How does it manifest? And how common is it? To answer those questions, we’ll have to delve a bit into the term itself. In actual fact, the disorder has never been listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association—at least, not by that name. In the fifth edition of the manual, the disorder was listed as Factitious Disorder Imposed on Another (FDIA), which is its currently accepted name in diagnoses, at least within the United States. Similarly, the World Health Organization identifies the condition simply as “Factitious Disorder.”
History of Munchausen Syndrome by Proxy
As such confusion about terminology might suggest, while public belief in the existence of Munchausen Syndrome by Proxy (by whatever name) may be commonplace, the reality, nature, and prevalence of the disorder itself remains controversial in medical circles. Indeed, Roy Meadow, one of the doctors often credited with coining the term, was later accused of concocting a “theory without science.”
In part, this controversy comes from the fact that Factitious Disorder or Munchausen Syndrome by Proxy is almost impossible to prove, requiring not only evidence that a child’s illness is not real, but an understanding of the motives behind why the illness was faked or exaggerated. A sufferer from the disorder might show every sign of genuinely believing that their child was ill, while an abuser not suffering from the disorder might mimic it perfectly in an effort to cover up the evidence of their abuse.
Further harming the credibility of the disorder are several high-profile cases in which Roy Meadow was a key witness. Throughout the 1990s and early 2000s, Meadow was instrumental in the prosecution of several cases which sent mothers to prison for the deaths of their children, and in 1998 he was knighted for his work in child health.
However, in more recent years, several of the cases in which Meadow acted as a witness have been overturned, and he was stricken from the British Medical Register due to his role in the trial of Sally Clark—who was convicted of killing her two infant sons—only to have the conviction overturned in 2003 when Meadow was accused of giving false and misleading evidence. Unfortunately, even after her release, Clark suffered from numerous difficulties brought on by her ordeal and died of alcohol poisoning within just a few years.
These controversies over the diagnosis and its admissibility in court have continued into recent years, with the disorder coming up in court cases as recently as 2021. They also make it difficult to pin down exactly how common the disorder really is, with estimates ranging from 1 in a million to 28 per million, though there are some who suspect that the little-understood disorder may be more common than is generally thought.
What is Munchausen Syndrome by Proxy?
For those who accept its existence, the disorder manifests as a form of abuse, in which a caregiver (usually a parent, most often a mother) either coaches their child to fake being sick or else actually makes them sick in order to receive often costly, painful, and invasive medical interventions. The reasons for this behavior are among the controversial elements of the disorder but are often regarded as a pathological need for attention and validation—a way for the caregiver to vicariously experience the “sick” role.
Despite its relative rarity, the disorder is a particularly dangerous and insidious form of abuse, with a mortality rate that may be 6-10% or even higher. Some consider it the most lethal form of abuse, and even when individuals who have been the victims of Munchausen Syndrome by Proxy do survive, they are often subject to chronic difficulties stemming both from the abuse itself and, often, from the unnecessary medical interventions they were made to endure.
Munchausen Syndrome by Proxy Cases
In part because of these dangers, and in part, because the cases themselves are particularly dramatic when they are revealed, there have been a number of high-profile cases involving Munchausen Syndrome by Proxy over the years.
Among these is the case of Kathy Bush, a Florida woman whose daughter, Jennifer, had spent more than 640 days in various hospitals undergoing some 40 surgeries by the time she was eight years old. The case got the attention of no less than First Lady Hillary Clinton, but in 1996, Bush was accused of actually tampering with her daughter’s medical equipment and medications in order to prolong her illness. Kathy Bush went to prison and Jennifer was removed from the home, though more than 19 years later, the two had reunited and Jennifer claimed that her mother never abused her.
Many other cases had more tragic endings. Take, for example, the case of Garnett-Paul Thompson Spears, whose single mother, Lacey, fed him so much table salt that he died from it at the age of five. During her trial, where she was found guilty of both second-degree murder and first-degree manslaughter, it was claimed that her method of poisoning came about due to internet research, and she was motivated by the attention her son’s illness garnered her on social media.
Dee Dee Blanchard
Perhaps the most notorious recent case involving Munchausen Syndrome by Proxy is the murder of Dee Dee Blanchard. It was only after the Missouri woman was found stabbed repeatedly in the back that the truth of her life with her daughter became clear—while those who knew them had believed Blanchard’s claims that she was a single mother with a chronically ill daughter who could not care for herself, after Blanchard’s murder, it became clear that her daughter, Gypsy Rose, had been a victim of years of abuse.
Related: The Chilling Case of Gypsy Rose
For one thing, Gypsy Rose was older than her mother claimed. While Blanchard said that her daughter was still a teenager, Gypsy was actually 24 at the time she and her online boyfriend conspired to kill her mother. As the truth of Gypsy’s long-term abuse came out, public sympathy turned her way, and though she was ultimately convicted of second-degree murder for her part in her mother’s death, she received a lesser sentence, with the prosecutor calling the case “extraordinary and unusual.”
Featured photo from "Mommy Dead and Dearest" via HBO.