Munchausen by proxy is a rare mental disorder and can become a serious form of child abuse. Recently, the condition has gotten increased attention due to its connection to a major news story.
Gypsy Rose Blanchard, the child abuse victim who was convicted in 2016 of killing her mother the previous year, was released from prison on Dec. 28, 2023.
Gypsy Rose Blanchard was granted parole and released from prison three years early after she was originally sentenced to 10 years for her role in the second-degree murder of Clauddine “Dee Dee” Blanchard in Springfield, Missouri.
In court, prosecutors claimed that Dee Dee Blanchard had Munchausen syndrome by proxy, NBC News previously reported.
Gypsy Rose and Dee Dee Blanchard’s case has been covered extensively in podcasts, documentaries and television shows. Now, Gypsy Rose Blanchard is telling her own story first-hand in the Lifetime series “The Prison Confessions of Gypsy Rose Blanchard," released Jan. 5.
Here's what to know about Munchausen syndrome by proxy, according to experts.
What is Munchausen by proxy?
Munchausen syndrome by proxy is a psychological disorder where a "caregiver feigns, exaggerates or induces illness in (another person) with the primary goal being to get attention, sympathy and praise,” Dr. Marc Feldman, board-certified psychiatrist and author of “Dying to be Ill: True Stories of Medical Deception,” tells TODAY.com.
It's related to Munchausen syndrome, a condition where a person pretends to be sick or deliberately produces symptoms for attention, per the Cleveland Clinic.
Munchausen by proxy affects the caretaker of a dependent — such as a child, an elderly adult or a person with disabilities — and it's most commonly seen in mothers of young children, says Feldman, who has studied the condition for over 30 years.
The child victims often have multiple unexplained ailments that do not get better over time, despite being given the appropriate treatments and care, says Feldman, who did not treat Gypsy Rose Blanchard.
“Often, the caregiver keeps taking the child to doctors, hospitals, and emergency rooms looking for the opinion they want, which is that their child is desperately ill,” says Feldman, adding that this behavior is called “doctor shopping.” They often spin an intricate web of false claims and self-reported diagnoses.
“They get a lot of gratification out of the fact that they are able to deceive health care professionals,” Feldman adds.
Parents may give their children medications they do not need or subject them to unnecessary procedures and surgeries, Janet Cahill, Ph.D., a clinical psychologist and professor emerita at Rowan University, tells TODAY.com. Some caregivers will tamper with a child’s urine or blood samples to alter laboratory results.
In severe cases, caregivers will purposefully cause symptoms or injure children, says Feldman. Outcomes can be fatal.
Munchausen by proxy's new name
The term "Munchausen syndrome by proxy" was first coined in 1977, but the condition is now also called "factitious disorder imposed on another," and "fabricated or induced illness in a child," Feldman explains.
"It's a form of medical child abuse that goes by different names," he adds.
Gypsy Rose Blanchard and Munchausen by proxy
During Gypsy Rose Blanchard's trial, lawyers said she was a victim of Munchausen syndrome by proxy. Although her mother, Dee Dee Blanchard, was never formally diagnosed while she was alive, according to local paper the Springfield News-Leader, many experts suspect she had the disorder.
“I think it’s incontrovertible that it was a case of Munchausen by proxy, as well as other things,” says Feldman. (Feldman did not treat Gypsy Rose Blanchard and has not spoken to her or any members of the Blanchard family.)
During trial, Gypsy Rose Blanchard testified that her mother took her to doctors throughout her life to treat various condition that she never actually had, such as leukemia and muscular dystrophy, TODAY.com previously reported.
In addition to subjecting Gypsy Rose Blanchard to medications and surgeries, Dee Dee Blanchard made her daughter use a wheelchair and an oxygen tank even though she required neither, according to the Springfield News-Leader.
In a 2017 interview with talk show host Dr. Phil McGraw, Gypsy Rose Blanchard said her mother forced her to eat through a feeding tube and shaved her head. During this time, Gypsy Rose Blanchard was homeschooled and spent many years isolated from others, BuzzFeed News reported.
The mother and daughter originally lived in Louisiana, but after Hurricane Katrina, they relocated to Missouri, where Dee Dee Blanchard told doctors that her daughter’s medical records had been destroyed by flooding, according to CBS affiliate KOLR.
The Blanchards received donations from charities, moved into a home built by a local Habitat for Humanity group, and met singer Miranda Lambert through Make-A-Wish Foundation, KOLR reported.
“Dee Dee was seeking money and other kinds of tangible gains. We call it malingering,” says Feldman.
Some doctors pushed back on Dee Dee Blanchard’s claims of her daughter’s illnesses.
Dr. Bernardo Flasterstein, Gypsy Rose Blanchard's neurologist, said he became suspicious of Dee Dee Blanchard’s claim her daughter had been diagnosed with muscular dystrophy in Louisiana when he noticed no abnormalities in her MRIs and blood tests, KOLR reported.
Gypsy Rose Blanchard remained under her mother's care until her 20s. In 2015, she and her then-boyfriend, Nicholas Godejohn, were arrested in connection to the murder of Dee Dee Blanchard, who was found stabbed to death in her Springfield, Missouri, home.
“The choice that I made to commit murder was never the right choice,” she told People in an interview published Jan. 4. “My mission now is to take what I’ve done and what (my mom) did and make it worth something. So I think it’s really important for me to get out as much awareness about Munchausen by proxy as I can and really try to focus in on mental health.”
Gypsy Rose Blanchard’s verified Instagram account, which has more than 7 million followers, states that she is a "Munchausen Syndrome by Proxy Advocate."
Is Munchausen syndrome by proxy a crime?
“It is both a mental health diagnosis and a crime,” says Cahill, who specializes in child protection. "The core characteristic for Munchausen by proxy is adults are deliberately doing these things to children to meet their own psychological needs.”
Increasingly, people are recognizing Munchausen syndrome by proxy as medical child abuse, says Feldman. However, the various names for the disorder and lack of knowledge about it among the general public can create confusion.
"No matter what term you use, it's still a crime," says Feldman.
Consequences for perpetrators who are caught may range from termination of parental rights to incarceration, the experts note.
“They’re very, very good at lying ... and we often don’t catch them until very late in the game,” says Cahill.
According to Feldman, about 6–9% of the victims among published reports of the condition have died as a result of the medical abuse. "This makes it perhaps the single most lethal form of child abuse, and yet, I've seen cases that are remarkably severe where there's been no criminal charge brought," says Feldman.
Treatment of the disorder is exceptionally difficult because many people remain in intense denial, says Feldman, even when presented with evidence of their abuse or deception.
"Whether you consider it a mental disorder or not, we should all be agreeing that it's criminal behavior that is to be identified and punished when appropriate," says Feldman.
Munchausen syndrome be proxy red flags
The signs of Munchausen syndrome by proxy can vary and range from mild to severe, the experts note. Feldman has compiled a list of "red flags" from the medical literature and his own experience treating Munchausen by proxy, which include:
- Persistent or recurrent illnesses for which a cause cannot be found
- Unusual symptoms or signs that do not make clinical sense
- Persistent failure of a child to tolerate or respond to medical therapy without clear cause
- Discrepancies between a patient's history and clinical findings
- The child’s appearance is inconsistent with their alleged illness
- The illness gets better when the child is separated from the parent
- The caregiver refutes or is angered by negative test results or findings and is noncompliant with treatment
- The caregiver provides false information to professionals and other individuals
- Other children in the family have had unexplained illnesses or died for reasons that are unclear
- The caregiver’s social media posts do not accurately reflect events or the child’s health
What causes Munchausen syndrome by proxy?
The specific cause of Munchausen syndrome by proxy is unknown. However, theories suggest it may be linked to a history of trauma, neglect or abuse during the caregiver's childhood, according to the Cleveland Clinic.
"Often, these people have deep-seated personality disorders, which means they have long-term, unhealthy ways of trying to get their needs met," says Feldman. These include narcissistic personality disorder and borderline personality disorder.
Some people with the disorder have a history of pathological lying or Munchausen syndrome themselves. "They were making themselves sick and now they’re transferring it to a new generation,” says Feldman.
How common is Munchausen by proxy?
Munchausen syndrome by proxy is relatively rare.
"About 6% of all reports of suspected child abuse to Child Protective Services in the United States relate to medical child abuse or Munchausen by proxy," says Feldman. There are about 3 million reports each year, Feldman adds, so 6% can translate into a hefty number.
However, the condition is vastly under-diagnosed, the experts note. “I think the biggest problem is failure of doctors to even consider the diagnosis, if they’ve even heard of it," says Feldman.
More than 90% of the perpetrators are the mothers and the victims are their children, the experts note.
How to watch "Prison Confessions of Gypsy Rose Blanchard"
“The Prison Confessions of Gypsy Rose Blanchard” will air on Lifetime at 8 p.m. ET starting Friday, Jan. 5. The series can also be streamed via DirecTV Stream, Sling TV, Fubo TV and Hulu + Live TV, many of which offer a free trial.
Episodes will also be available to stream the next day using the Lifetime app.