10 Facts About Munchausen Syndrome By Proxy That Go Beyond “The Act”

If you're like me, you stay up late Tuesday nights waiting for the next episode of The Act to drop at midnight eastern time on Hulu. The dramatization of Gypsy Rose Blanchard's real-life plot to kill her abusive mother brings up some fascinating facts about Munchausen syndrome by proxy, which Blanchard's mother Dee Dee reportedly lived with. The DSM-5 describes Munchausen syndrome by proxy, also called factitious disorder imposed on another, as a "psychiatric disorder that describes individuals who persistently falsify illness in another even when there is little or nothing tangible for them to gain from the behavior."

The most recent episode of The Act, starring Patricia Arquette as Dee Dee and Joey King as Blanchard, reveals the beginning of Dee Dee's abuse toward Blanchard. Dee Dee lies to the doctor about the medication she has given her overbearing dying mother, but because she expresses concern about her mother's condition, the doctor calls her a saint. It's clear in the episode that this praise is a salve for Dee Dee's insecurity. And the desire for more of it leads to Blanchard using a wheelchair at the end of the episode, despite the fact that she could walk without assistance.

While it might seem surprising that Dee Dee was able to fool friends, family members, social services, and medical professionals for years, the Psychiatric Times noted that there are several case studies that report any disorder can be successfully falsified. What's more, people with Munchausen syndrome by proxy put a great deal of time and effort into fooling people. Here are some other fascinating facts about this rare and often deadly form of abuse.

1. People With Munchausen Syndrome By Proxy Might Also Have Munchausen Syndrome

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People with Munchausen syndrome by proxy thrive off of the attention and praise they receive for being dedicated caregivers. Knowing this, it's not surprising that the Psychiatric Times reported that between 30-70% of people with MSBP also have Munchausen syndrome, a similar disorder that results in the person making themselves sick or falsifying an illness for attention.

2. Pets Can Be Victims Of Munchausen Syndrome By Proxy

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Aside from children, the elderly, and disabled people, pets can also be victims of Munchausen syndrome by proxy. On an episode of Mental Health News Radio, Munchausen syndrome by proxy expert Dr. Marc Feldman, clinical professor of psychiatry at the University of Alabama and author of the book Playing Sick?, talks about medical abuse of pets, also known as Munchausen by animal proxy. This is when a pet parent intentionally harms their pet in order to get attention.

3. People With Munchausen Syndrome By Proxy Can Be Skilled In Deception

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While it's thought that around 1% of the population has Munchausen syndrome by proxy, it's likely under diagnosed because those with the disorder are master manipulators. People with Munchausen syndrome by proxy appear to be dedicated caretakers, according to the Cleveland Clinic. Because of this, they are often the last people to be suspected of abusing someone in their care.

These people stay by the bedside of loved ones, appear knowledgable about medical conditions, and seem genuinely concerned. However, people with Munchausen syndrome by proxy often contaminate lab tests or falsify medical records. In addition, they are fully aware that what they are doing is wrong, but will deny any and all accusations if they are confronted. Often people are afraid to challenge caregivers who seem devoted, even if some of what they say is absurd.

4. Munchausen Syndrome By Proxy Victims Can Die From The Abuse

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If you've seen the HBO limited series Sharp Objects then you know that victims of Munchausen syndrome by proxy can die from the abuse. A study published in the European Child & Adolescent Psychiatry journal cited the mortality rate for victims as 9%. While the caregivers may not intend to kill those in their care, repeated induced illnesses could lead to death, like with Marian in Sharp Objects. What's more, mothers who inflict medical child abuse on their children often subject more than one child to the abuse

5. The Cause Of Munchausen Syndrome By Proxy Is Unknown

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While the cause of Munchausen syndrome by proxy is not clear, Psychology Today cited a 2005 UK study that found it could be derived from childhood attachment issues. The study focused on 67 mothers who had been charged with medical child abuse and found that 85% of them cited insecure attachments to their own parents. Other studies reported that those with disorganized attachments to their own parents can become compulsive or controlling caregivers, like Adora on Sharp Objects.

6. Mothers Are The Most Common Perpetrators Of Medical Child Abuse

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While men can have Munchausen syndrome by proxy, it's rare. Mothers are usually the ones harming the children, and abusers are likely single or have detached relationships with their partners. What's more, the other parent generally doesn't participate in the abuse, but also may not intervene and may not even suspect anything is wrong, according to the Journal of Child and Adolescent Behavior.

In Sharp Objects, Camille's stepdad suspects that Adora is making the girls sick, but he chooses to ignore it by turning up his record player and deferring to his wife when it comes to the children's medical care.

7. Gypsy Rose Blanchard's Case Is Unprecedented

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As is depicted in The Act, Blanchard coordinates with a man she meets online to kill her mother after suffering years of medical child abuse. According to Dr. Marc Feldman, Blanchard's case is unprecedented. Dr. Feldman told the Springfield News-Leader that in his more than two decades studying Munchausen syndrome by proxy, he's never come across a case where a victim has retaliated and killed a caregiver. Blanchard is currently serving 10 years in prison for her role in her mother Dee Dee's murder.

8. People With Munchausen Syndrome By Proxy Lie About Other Things, Too

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People with Munchausen syndrome by proxy don't just lie about their child's illnesses and medical history. According to the Journal of Child and Adolescent Behavior, perpetrators of medical child abuse also lie about other things. In the Blanchard case, Dee Dee lied to Blanchard about her age and about her father. She also changed the spelling of the family's last name to avoid being detected as she went from hospital to hospital.

It's also unclear whether or not the Blanchards were actually displaced by Hurricane Katrina, though Dee Dee used the story to secure a house from Habitat for Humanity. People with Munchausen syndrome by proxy might also lie about their employment history, education, marital status, and more.

9. Victims Can Develop A Form Of Stockholm Syndrome

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As is seen in both The Act and Sharp Objects, victims of Munchausen syndrome by proxy are rewarded and showered with love for being compliant. A study published in the journal Frontiers in Pediatrics found that victims can develop a form of Stockholm Syndrome. This happens when someone bonds with their abuser, often because they are completely dependent on them.

The study reported one case in which the only way a victim could sustain a relationship with her mother and receive love was by submitting to being made ill. If the victim is not sick, the caregiver does not get attention and can withhold love and affection to regain control, as is seen with Adora and Camille in Sharp Objects.

10. Victims May Avoid Medical Treatment Later In Life

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According to Medical News Today, little research has been done about what happens to medical child-abuse victims later in life. Because they've endured years of abuse at the hands of trusted caregivers, survivors could experience PTSD, anxiety, behavioral problems, delayed development, and mental illness. What's more, a study published in the journal Child Abuse & Neglect found that survivors of Munchausen syndrome by proxy are less likely to seek medical care as adults, which could lead to undiagnosed illnesses.

It's no secret that Munchausen syndrome by proxy is a headline-grabbing and devastating act of cruelty. If you suspect someone you know is a victim of Munchausen syndrome by proxy, the American Academy of Family Physicians said on its website that you can report it confidentially by calling Childhelp National Child Abuse Hotline at 1-800-4-A-CHILD (1-800-422-4453).