Watching ‘The Act’? The Answers to All Your Qs About Munchausen Syndrome by Proxy
Thanks to Hulu’s new true-crime anthology, The Act, based on the story of Dee Dee Blanchard, who allegedly had Munchausen syndrome by proxy, and her daughter Gypsy Rose, who was treated for chronic illnesses she didn’t have, the mysterious disorder is on our minds again.
Munchausen syndrome by proxy, also known as factitious disorder imposed on another (FDIA), was a major plot twist in HBO’s Sharp Objects last year too. But if you’ve never heard of it, here’s the deal: It’s a pattern of abusive behavior seen in caretakers (typically mothers). Those affected make up or induce symptoms of physical and/or mental illness in a person they look after (usually a child but sometimes the elderly), according to a recent article published in the Journal of Pediatrics.
Here’s everything else you need to know.
1. Victims of Munchausen by proxy caretakers are often injured.
In some cases, the caretaker seeks unnecessary, damaging, or potentially life-threatening medical care, like invasive tests, hospitalization, drugs, or even surgery (like Gypsy Rose’s feeding tube, for example), according to The American Academy of Pediatrics.
2. It’s one of the deadliest forms of child abuse.
Studies have reported that the mortality rate of victims of Munchausen by proxy is between 6 percent and 10 percent, ranking it among highly fatal forms of child abuse.
3. Caretakers with Munchausen by proxy are great with medical terminology.
Like Dee Dee Blanchard, who was a nurse’s aide at one point, caretakers often work in health care or know a lot about medical care, according to the National Institutes of Health (NIH). This allows them to describe the patient’s symptoms in great detail.
4. They might be the last person you’d think has this disorder.
According to the NIH, parents or caretakers with FDIA appear very involved and nurturing of the patient, often seeming devoted to them (e.g., all that hand-holding between Gypsy Rose and Dee Dee). That makes it hard for medical staff to recognize a problem. “They like to be very involved with the health-care team and are liked by the staff for the care they give the child,” according to the NIH.
5. Munchausen by proxy is just one manifestation of the syndrome.
Muchausen got its name in 1951 from British physician Richard Asher, who wrote that those affected by this condition tell dramatic and untruthful stories quite like Baron Munchausen, a fictional character in the 1785 book Baron Munchausen’s Narrative of His Marvelous Travels and Campaigns in Russia. Therein, Munchausen, who was based on a real person who contested the association, claims to have performed absurdly impossible feats.
In Munchausen’s syndrome, a person deceives others by making themselves appear sick—either by lying about symptoms, tampering with test results, self-inflicting harm, or aggravating existing conditions, among other strategies, according to the National Health Service (NHS). Munchausen syndrome by proxy applies when a caretaker comes into play, and Munchausen by internet refers to people who pretend to be sick but only do so online.
6. The symptoms vary greatly.
In Munchausen’s syndrome by proxy, the severity of symptoms can range from nonexistent, like reports of frequent fainting that no one has witnessed, to very serious, like wound infection or poisoning, and can affect any part of the body including the mind, according to the NHS.
7. The cause is unknown.
It may stem from experience with emotional trauma or childhood abuse or from a personality disorder, according to the NHS, which notes that generally, those affected seek attention. Munchausen by proxy sometimes involves people who have a history of faking personal illness, according to MedlinePlus.
8. It’s more serious than faking illness to miss work or school.
People with Munchausen by proxy go to great lengths to make sure a person is perceived as sick—and tampering with test results is just the half of it. To mimic disease, they sometimes cause injury via unnecessary use of medications or harmful substances, by opening old cuts, and so forth for the goal of inducing illness—not to make money or achieve another external reward, according to the Cleveland Clinic. In contrast, Dee Dee Blanchard cashed in on many trips and fund-raising money while faking Gypsy Rose’s illness.
9. Hypochondriasis is way different.
Now categorized as somatic symptom disorder (when a patient has at least one chronic physical symptom they’re excessively concerned about) or illness anxiety disorder (when a patient is intensely anxious about an undiagnosed health condition), hypochondriasis involves people who worry they are sick. In contrast, caretakers affected by Munchausen by proxy know no one is sick—instead, they fabricate symptoms to give the illusion someone is unwell.
10. Its prevalence is anyone’s guess.
Because Munchausen syndrome (and by proxy) involves deception, it’s hard to say how many people have it. In making a diagnosis, psychologists and psychiatrists first have to rule out actual physical symptoms, then look for markers, like a patient’s dramatic but inconsistent health history, illnesses that mysteriously worsen or flare up when the person is alone or only with their caretaker, eagerness to opt into treatment or hospitalization, and extensive medical knowledge, according to Cleveland Clinic.
While considered rare, according to Mayo Clinic, some estimates suggest Munchausen by proxy is more common among women and affects about 2 in 100,000 children.
11. Treatment typically involves therapy.
Although there’s no standard approach to treating Munchausen syndrome, psychotherapy and cognitive behavioral therapy can help, as can family therapy and getting to the root of psychological contributors, such as depression or other personality disorders with medication or psychiatric hospitalization, according to Mayo Clinic.
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