Munchausen by Proxy: Mental Illness or Child Abuse?

By Kelly Burch 11/18/18

Feldman has seen horrific cases of Munchausen by proxy, from mothers injecting their children with bacteria to cause infection to parents suffocating their infants. But most perpetrators are not motivated by a desire to see their child in pain.

Gypsy Rose Blanchard with her mother, Dee Dee and a dog. Case of Munchausen by proxy
“I don’t have cancer? So what other illnesses don’t I have?” Gypsy Rose Blanchard with her mother, Dee Dee Blanchard.

“That Bitch is dead!”

The post would have been alarming on anyone’s Facebook page, but it was especially jarring when it appeared on the page of Dee Dee Blanchard, a single mom who was the full-time caregiver to Gypsy Rose, a teen with a host of medical issues ranging from muscular dystrophy to cancer.

An even more alarming post — which talked about slashing Dee Dee’s throat and raping Gypsy — appeared soon after. Friends were horrified when they went to the Blanchard’s home and discovered that both women were missing, but all three of Gypsy’s wheelchairs, which she needed to get around, were still there. When police found Dee Dee’s body in her bedroom with multiple stab wounds, friends and neighbors became certain that Dee Dee and Gypsy had been targeted by a random and sadistic killer.

The truth, it turned out, was much more complex. A few days after Dee Dee’s body was found, Gypsy Rose walked into a court — no wheelchair needed — to face charges that she planned her mother’s brutal murder. Encouraging her boyfriend to kill her mother was, she would later say, the only way that she could escape years of medical abuse.

It soon became clear that Gypsy Rose was, for the most part, a perfectly healthy young woman (not a teen — her mom had changed her birth certificate and lied to Gypsy about her age). Dee Dee had fabricated much of Gypsy’s medical history, feigning her daughter’s illnesses in a pattern of behavior known as Munchausen syndrome by proxy. Dee Dee’s deceptions were so thorough that even Gypsy didn’t realize their extent. In fact, it wasn’t until her attorney told her that there was no medical record of her having cancer that she realized her mother had made that up too.

“It shocked me,” Gypsy Rose said in a documentary that recently aired on Investigation Discovery. “I don’t have cancer? So what other illnesses don’t I have?”

Since the well-publicized murder in 2015, the story of the Blanchards has captivated the attention of the media and the public. Although the case was extreme both in the extent of Dee Dee’s abuse and its ultimate violent ending, cases of Munchausen by proxy are not as rare as you might expect. Here’s the truth about this complex and disturbing phenomenon.

What is Munchausen by proxy?

Munchausen by proxy (MBP) occurs when a person in a position of control feigns, exaggerates or induces an illness in a child, vulnerable adult, or pet to gain emotional gratification or attention.

“Munchausen syndrome by proxy is limited only by knowledge, creativity and motivation of the perpetrator,” said Dr. Marc D. Feldman, a clinical professor of Psychiatry and adjunct professor of Psychology at the University of Alabama and author of the book Dying to Be Ill: True Stories of Medical Deception.

In 95 percent of cases the perpetrator is the child’s mother, and in the remaining cases the perpetrator is almost always a female relative or caregiver, Feldman said. Although the condition may seem far-fetched, it can occur in up to 1 percent of the population and is likely under-diagnosed.

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), Munchausen syndrome by proxy is listed as a type of factitious disorder imposed on another (FDIA). FDIA is described as a psychiatric disorder in which individuals persistently falsify illness in another even when there is little or nothing tangible for them to gain from the behavior. But Feldman cautions against thinking of Munchausen by proxy as an illness.

“People assume it’s a mental illness, but I tend not to view it as that, but as a form of abuse,” Feldman said. “The moment you consider it a mental illness, the perpetrator can argue that they’re the victim of a mental disorder and ask for a much lighter sentence or no sentence at all. This is a form of abuse like any other.”

What causes a mother to hurt her child?

In the nearly 30 years he’s worked with individuals affected by MBP, Feldman has seen horrific cases, from mothers injecting their children with bacteria to cause infection to parents suffocating their infants. But most perpetrators are not motivated by a desire to see their child in pain.

“There are some perpetrators who are sadistic and enjoy the act of harming their children,” Feldman said. “[But] for most they are after the reaction: the sympathy, care and concern… all the emotions received as the result of having a terribly ill child.”

Perpetrators like Dee Dee Blanchard, who may be fairly ordinary in their normal life, get emotional gratification by being painted as a loving and selfless caregiver. In Blanchard’s case, she also received financial benefits tied to Gypsy’s perceived illnesses including free trips, additional child support and even a home from Habitat for Humanity. Perpetrators don’t usually kill their victims, since they prefer the ongoing attention from their communities.

Why don’t doctors intervene?

One of the most mind-boggling aspects of the Gypsy Rose case is that Gypsy received actual medical treatment — including surgery — for conditions that Dee Dee had fabricated. Munchausen by proxy can be hard to spot, and Feldman said that doctors are cautious about questioning a parent whose child appears to be in medical distress. In addition, many perpetrators have some medical training, so they know how to make their case look compelling.

These delays can lead to continued abuse: in most cases, there is a year and a half between when doctors first suspect MBP and when it is actually diagnosed.

“That’s a hefty period of time, and speaks to the reticence of doctors to make the diagnosis,” he said.

Feldman said that doctors tend to think they need a smoking gun before alerting police or social services to their suspicions. But in most states doctors are mandated reporters of child abuse, and just having a hunch should be enough to compel them to act.

"The doctor doesn’t have to be a detective, they just have to have a suspicion.”

Can Munchausen by proxy be treated?

It is extremely rare for a perpetrator of MBP to be rehabilitated because there is usually deep denial about the behavior, Feldman said. In one case he worked on a mother was confronted with a video showing her suffocating her infant by putting her hands over the baby’s mouth and nose.

“She said ‘I’m just tickling his mouth,’” Feldman recalled. “Perpetrators come up with bizarre explanations to explain away their actions.”

In the face of such strong denial, it’s nearly impossible to establish a therapeutic rapport with the perpetrator in order to make progress in treating the condition, Feldman said. These issues are compounded when the perpetrator is jailed and has limited access to mental health care.

Feldman has seen one case in which the mother was rehabilitated. That woman claimed that her child had seizure disorders and that her other children had died in infancy from the condition. When Munchausen by proxy was discovered, the child was removed from the mom’s custody. Ten years later the woman had another baby. In the interim she had undergone psychotherapy and Feldman was able to recommend that the whole family be reunited.

“They’re doing beautifully together,” he said.

What’s it like to be a victim of Munchausen by proxy?

Most victims of MBP are young children or infants. Although the behavior and abuse usually occur in early childhood, there are lifelong effects, Feldman said. Many victims develop PTSD and can have trouble distinguishing reality. In some cases, victims develop Munchausen syndrome, which manifests in them making themselves sick.

“They’re trying to master the trauma by doing it to themselves,” Feldman said.

Gypsy Rose said that realizing her mother had made up all of her medical conditions was disorienting.

“I was happy to know I was perfectly healthy, but at the same time it hurt because it’s like my whole world had been tossed up,” she told Investigation Discovery. “I realized that my mother wasn’t who I thought she was. I have a lot of complicated emotions for my mother.”

After the murder, as the truth about the extent of Dee Dee’s abuse came out, many people were sympathetic toward Gypsy. In 2016, she pled guilty to second-degree murder and received a ten-year prison sentence for planning her mother's killing.

Gypsy’s ex-boyfriend, Nicholas Godejohn, was found guilty of first-degree murder last week. Godejohn was the one who actually killed Dee Dee, stabbing her multiple times. However, his attorney argued that he was manipulated by Gypsy and couldn't fully understand the consequences of his actions because of his autism and intellectual delay. At Godejohn's trial, the defense called Gypsy as a witness. When Gypsy was asked who spearheaded the murder plans, she answered: “I did, I talked him into it.”

Despite this, Godejohn now faces a mandatory sentence of life in prison without the possibility of parole. Gypsy, on the other hand, will be eligible for parole in 2024 when she is 32. In the meantime, she is reportedly “thriving” in prison, according to her stepmom, Kristy Blanchard.

"Despite everything, she still tells me that she's happier now than with her mom," Blanchard said. "And that if she had a choice to either be in jail, or back with her mom, she would rather be in jail."

“She feels freer in prison than she did in own home with her mother,” Feldman said. “That’s a really telling comment that speaks to the extent of the abuse.”


Other notable cases of Munchausen by proxy:

“Mommy Blogger” Lacey Spears

Marybeth Tinning

Blanca Montano

Hope Ybarra

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.