Munchausen by proxy cases have risen to a strange kind of infamy following the release of series and documentaries like The Act and Take Care of Maya. They chronicle the devasting impact that this psychological condition can have on families and the extremes that the abused have reached to escape their situation.

Munchausen syndrome by proxy is also known as factitious disorder imposed on another (FDIA), and it’s characterized by a caregiver inventing or inducing medical issues for another person, most commonly a child. They then bring the fabricated or induced illness to the attention of healthcare providers, who may – without meaning to – perpetuate the abuse by arranging investigations and treatments that the child doesn’t need. 

“The primary motivation in most cases of [Munchausen syndrome by proxy] is considered to be that the perpetrator of the abuse gains from the sympathy and attention given to them by health and social care staff, and sometimes from other family members,” explains a 2017 paper detailing rare Munchausen by proxy cases that involve elder abuse. 

“Unlike conversion disorders, the deception is conscious and intentional, but whereas the usual motivation for such malingering is external personal gain (often financial or other material benefits), in [Munchausen syndrome by proxy] it is generally internal, the benefit arising from the psychological reward of presenting as a dedicated carer and receiving positive attention and support.”

The harrowing example of Gypsy Rose Blanchard – which The Act is based on – has brought Munchausen by proxy to the attention of many in recent times, following her release from prison. Blanchard served eight years in prison after pleading guilty to second-degree murder to her role in the death of her mother who is believed to have had Munchausen syndrome by proxy.

In life, Dee Dee Blanchard tricked doctors into believing Gypsy Rose was chronically and near-terminally ill, lying about her true age, taking away her freedom, and subjecting her to psychological and physical abuse. She was given medications she didn’t need, put through unnecessary and painful procedures and investigations, and tricked – alongside the community and a wealth of healthcare providers – into thinking she was really sick.

“There are certain illnesses that I know I didn’t have, I know I didn’t need the feeding tube," ABC News quotes Blanchard said. “I knew that I could eat, and I knew that I could walk, but I believed my mother when she said I had leukaemia.”

Gypsy Rose met a man called Nicholas Godejohn online and the two hatched a plan to kill her mother, eventually leading to the brutal stabbing of Dee Dee in 2015. Blanchard has since been released two years early from her 10-year sentence, and Godejohn remains serving a life sentence.

Munchausen syndrome by proxy is related to Munchausen, which is characterized by someone fabricating illnesses, signs, and symptoms in themselves. It might sound as if it should be easy to identify with the battery of medical tests and tools available to clinicians today, but those affected have historically gone to great lengths to alter laboratory tests and induce symptoms using medicines or other chemical agents.

There’s no one clear explanation as to why some people develop Munchausen and Munchausen by proxy. Stress or a history of abuse are some of the psychological reasons that have been explored, but it’s also thought there may be physiological drivers behind factitious disease. 

Treatment can be particularly difficult because those affected are rarely willing to accept the diagnosis. Reaching a firm diagnosis for clinicians is also a particularly difficult challenge, as the medical evidence they must work from is sometimes tampered with through the induction of symptoms, and there’s warranted concern about misdiagnosing the condition when a medical explanation for a child's illness can’t be met.

However, greater awareness of Munchausen’s by proxy is vital because if cases go unrecognized, complications of the inappropriate treatment can eventually lead to the death of the abused. As Munchausen by proxy cases such as that of Gypsy Rose Blanchard have shown us, while the reported illnesses may be factitious, the consequences are very real.