What is Munchausen syndrome by proxy?

Munchausen syndrome by proxy (MSP) is clinically known as factitious disorder by proxy. It occurs when a caregiver deliberately makes someone in their care ill, or prompts them to display symptoms of an imaginary illness. In a typical case, the caregiver—usually a parent—thrives on the attention they receive from friends, family, and medical professionals.

The name of the condition comes from Baron Munchausen, a German nobleman in the fictional works of Rudolf Erich Raspe. Based on an actual baron in the 18th century, Munchhausen told dramatic—but false—stories of his exploits.

One of the most famous examples of MSP was the heartbreaking story of Gypsy Rose Blanchard. Gypsy's mother, Dee Dee, went to great lengths to make the girl seem ill, feeding her seizure medication and confining her to a wheelchair for years. Dee Dee claimed that Gypsy suffered from muscular dystrophy, leukemia, digestive disorders, and epilepsy, among other illnesses.

Medical professionals often have trouble diagnosing this disorder since caretakers will seem very invested in the health of the child. The caregivers will often know quite a bit of medical terminology, and they'll do whatever's necessary to keep up the illusion—even if that means changing blood samples or switching doctors to avoid an accurate diagnosis.

In the vast majority of cases, the people displaying symptoms of factitious disorder by proxy are women. In 2017, a study in the International Journal of Child Abuse and Neglect reviewed 796 cases of the disorder and revealed that 95.6 percent of munchausen perpetrators were the child's mother.

In recent years, pop culture depictions of this disorder have become popular. HBO's miniseries Sharp Objects, based on a novel of the same name, is one prominent example. Hulu's The Act is another.

Similar to MSP, Munchausen syndrome, or factitious disorder imposed on self, is when someone repeatedly acts like they are ill.