Gypsy Rose Blanchard’s Prison Release Raises the Question — Just What Is Munchausen Syndrome by Proxy?
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The story of Gypsy Rose Blanchard is a disturbing narrative of deception and control, centered on a condition formerly known as Munchausen syndrome by proxy and now called factitious disorder imposed on another (FDIA).
In FDIA, a caregiver — usually a parent — fabricates or exaggerates medical conditions in a dependent, often for personal gratification or attention, says Patricia J. Osborne, PhD, a psychologist and a clinical assistant professor of psychiatry and behavioral health at Stony Brook Medicine in New York.
Dee Dee Blanchard, Gypsy’s mother, began claiming that her daughter suffered from various ailments, starting with sleep problems and epilepsy and escalating into a web of fabricated illnesses that included leukemia, muscular dystrophy, vision and hearing impairments, and seizures, according to a January 2018 ABC News report. For years, Gypsy was forced to use a wheelchair and at one point even had an unnecessary feeding tube inserted because of her mother’s lies.
Typically, the abuse continues for months, years, or until the victim dies or the fabrications are discovered by doctors or social workers. In the case of Gypsy Rose Blanchard, whose story has been portrayed in film and TV on Max, Hulu, and most recently on the Lifetime network, it stopped, according to People, when she convinced a man she met online to stab her mother to death.
Recently released from prison after serving eight years, Gypsy, now 32, has gone public to share her account of the abuse that defined her childhood. Curious about FDIA? Keep reading to find out the signs and symptoms of this rare mental disorder.
What Is Munchausen by Proxy, or FDIA?
Experts believe that Gypsy Rose was a victim of FDIA, formerly known as Munchausen by proxy. FDIA is a mental health disorder recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), in which a caregiver creates the appearance of health problems in another person, typically their child, says Dr. Osborne. “The victim is often a child under the age of 6, but could be another adult [who is] disabled or an elderly person,” she says.
If FDIA involves a child, experts consider it a form of child abuse that carries severe emotional consequences for the victim and can even be fatal, says Osborne. It can also be a criminal offense.
Studies have shown a mortality rate of 6 to 10 percent, making it perhaps the most lethal form of abuse, she adds.
In the disorder, the false or exaggerated symptoms in someone else provide no obvious gain to the perpetrator, says Victoria Soltis-Jarrett, PhD, the Carol Morde Ross Distinguished Professor of Psychiatric Mental Health Nursing at the University of North Carolina at Chapel Hill. This makes FDIA different from malingering, which is when a person fakes illness to avoid work, the law, or to get drugs.
FDIA Is More Common in People Who Work in Healthcare
FDIA is relatively rare, but it’s hard to get an accurate picture because it’s likely there are undetected cases, says Osborne. It’s estimated that about 1,000 of the 2.5 million cases of child abuse reported annually are related to FDIA. That translates to 1 to 30 occurrences per one million children, according to Cleveland Clinic.
Exactly why a person develops FDIA isn’t known — research suggests that both biological and psychological factors may play a role, says Osborne.
“Interestingly, FDIA is much more common in women, and sometimes the caregiver is a healthcare professional,” says Osborne. Although Dee Dee Blanchard eventually stopped working as her deception of healthcare workers became more involved, she did work as a nurse’s aide when Gypsy was a toddler, according to the ABC News report.
Other risk factors include complications of pregnancy, a caregiver who was abused or neglected as a child or had an early loss of a parent, also has the condition factitious disorder imposed on self, or has severe stressors such as marital problems or social isolation.
Red Flags That May Indicate a Case of FDIA
“Typically, the signs do not become concerning until the victim either does not meet the criteria for what the perpetrator is describing, or they express distress that their parent is hurting them,” says Dr. Soltis-Jarrett.
Generally speaking, the situation becomes obvious when the victim’s alleged symptoms and signs do not add up, she says. “For example, the child is reported to have ‘breathing problems,’ but the medical tests do not support a pulmonary problem. In many cases of this type, when a healthcare provider is present, the patient-child is breathing normally, and when they step away, suddenly, the child becomes short of breath and exhibits signs of difficulty breathing,” says Soltis-Jarrett.
Other indications are that multiple medical illnesses are claimed, or that when the first illness proves unsubstantiated there are complications or a new disease or condition is claimed.
That was the case with Gypsy, as her mother had doctors test for one “illness” after another, from epilepsy to leukemia to muscular dystrophy, according to the ABC News report.
Perpetrators Are Sometimes Caught Through Video Surveillance
“Filming what happens in the exam room has demonstrated how the parent suffocates the child or infant so they do appear in distress,” says Soltis-Jarrett. It’s been debated whether video surveillance is ethical or legal. Those in favor of videoing without permission point out that several cases of FDIA would have gone undetected without it.
From the providers’ point of view, in many cases the medical history presented appears credible and the parent appears to be concerned and upset as they ask for help for their child. But if the perpetrator is not believed or is not satisfied with the response, they “up the ante,” she says.
When one of Gypsy’s former doctors, Bernardo Flasterstein, MD, tried to tell Dee Dee that Gypsy’s former diagnoses were wrong, as he described to Deseret News, “She left the office in a storm and told my nurses that I don’t know what I’m talking about and that she’s not coming back.”
Treatments and Interventions for FDIA
When FDIA is uncovered, intervention includes removing the victim from the home, which in some cases may involve foster care, says Osborne.
If a child or adult has been a victim of FDIA, mental health treatment is definitely needed, she says. “There can be long-term emotional effects. Ideally, we would want to connect victims with evidence-based psychotherapy for trauma, which would include a component for any mood and anxiety symptoms as well,” says Osborne.
In addition to legal or criminal punishment of someone with FDIA, psychotherapy would be recommended, though this can be more challenging, she says. “Some perpetrators may deny symptoms or be ambivalent about treatment,” says Osborne.
Limited research exists on the effectiveness of psychotherapy for perpetrators of FDIA, and this remains an important area for future research, she adds.
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