Munchausen syndrome by proxy, also known as factitious disorder imposed on another, is when caregivers fabricate illnesses in a child or dependent to gain attention or sympathy. While Gypsy Rose Blanchard’s case introduced the issue into popular culture, many misconceptions still surround the motivations behind the abuse.
“This is a behavior that people are doing knowingly and should be held accountable for,” author Andrea Dunlop tells A&E True Crime. “It’s an extremely compulsive behavior which offenders are unlikely to stop, so we have to prioritize the safety of children.” Dunlop also hosts a popular podcast about Munchausen by proxy, “Nobody Should Believe Me.”
Dunlop teamed up with former Tarrant County, Texas, investigator Mike Weber to write “The Mother Next Door: Medicine, Deception, and Munchausen by Proxy.” The book details cases of Munchausen mothers, such as Hope Ybarra, who not only pretended to have terminal cancer but also fabricated her daughter’s cystic fibrosis diagnosis. Weber, who investigated the case, uncovered that Ybarra subjected her daughter, starting shortly after her birth, to four years of unnecessary surgeries and medical procedures. To keep up the facade, Ybarra poisoned her daughter with pathogens from her job to manipulate sweat tests that diagnose the fatal genetic disorder.
Ybarra was sentenced to 10 years for the abuse. Dunlop and Weber argue her light sentence shows the criminal justice system also fails to recognize Munchausen syndrome by proxy as an act of intentional violence.
Because we don’t want to disturb the societal perception of motherhood, Weber says, we tend to give mothers the benefit of the doubt when deciding whether their actions constitute abuse.
Dunlop and Weber tell A&E True Crime about the steps they feel the legal system must take to understand and address Munchausen syndrome by proxy.
What are some common misconceptions about Munchausen syndrome by proxy?
Dunlop: The most common misconception [about Munchausen syndrome by proxy] is that it’s extremely rare. That’s not what the recent and reliable data shows.
I’ve heard from hundreds of people who are survivors, family members, professionals in the midst of cases [and] people thinking back on situations that they experienced earlier and now suddenly have the name for. It’s not that it’s rare—it’s that it is underdiagnosed, underrecognized and not handled properly in [many] systems.
[Another] very dangerous misconception is that this abuse is primarily an issue of mental illness in the perpetrator. There’s confusion about culpability for these acts because there’s so much confusion about the issue itself. I want to emphasize that while there is an underlying psychiatric diagnosis that can be applied to perpetrators, it’s not a mental illness that’s diagnosed and [widely] treated.
Weber: I also think the most common misperception is it’s [just] a mental disorder. You’ll see articles in the media about mom’s mental health that don’t mention the word abuse.
The term Munchausen by proxy was coined by Dr. Roy Meadow—a pediatrician, not a psychologist. It was originally meant to be applied to the victim, but through society and some bad media reporting, we flipped that around and applied it to the offender.
[The abuse] can sometimes be so outlandish it makes people think [they have] to be mentally ill. These offenders demonstrate in spades they know right from wrong at the time. When I do offender interviews, they will first lie to me. I have certain facts that I will present to them, then they will change their story to align with those facts. I may get admissions, but I’ll never get the whole truth. If they were clinically or legally insane…their story would not change. It’s the same behavior I’ve seen in any child abuse offender or criminal: They’re lying because they know they’ve done something wrong.
[Stream Gypsy Rose: Life After Lock Up in the Lifetime app.]
What are some red flags or commonalities among cases of Munchausen syndrome by proxy?
Weber: [The district attorney’s] child abuse pediatrician told me that red flags are multiple symptoms over multiple body systems that don’t make sense. You’ve got gastro symptoms combined with neurological and pulmonology symptoms that do not fit any known medical pattern. As medical professionals, that’s when you start to suspect abuse is occurring.
What I’ve come to realize is they look for things that are very hard to medically test for. Because a diagnosis relies on the history given by the parents, [who] control the treatment. That’s why the number one medical complaint we see is gastrointestinal issues.
Feeding tubes are the number one surgical procedure we see. We [also] see neurological issues, seizure disorders and apnea. Apnea can be scary because if there are actual signs, the mother may be suffocating the child. [Additionally,] early diagnosis of autism or Attention Deficit Disorder by report of the offender [is common]. A lot of kids are put in wheelchairs who don’t belong there, again because that’s visible and gets attention.
Dunlop: The constant and persuasive deception also stands out to me. A lot of lying about qualifications for work. We see a lot of fake nurses and PhDs. Beyond that, other sorts of financial shenanigans, like fraudulent fundraising. Everything about the perpetrator turns out to be a lie.
How do you differentiate between Munchausen by proxy and a legitimate medical condition? What are some obstacles when investigating these cases?
Weber: The main obstacle is a complete lack of understanding by all the systems involved.
For instance, CPS in Texas has no policies on this abuse, and they don’t provide mandated training to their investigators on [it]. If someone tries to report this abuse, they don’t have a box to check for it. Oftentimes, it’ll come in as “medical neglect.” You have a young CPS worker who maybe never heard of [Munchausen by proxy], seeing a mother who’s always taking her child to the doctor. That’s not medical neglect, so they’re going to close their case and it’ll never get to the police.
[As for family courts,] the last two articles in the Juvenile and Family Court Journal on this [kind of] abuse were in 1990. This abuse has changed substantially due to social media and the internet. The way to address it has changed since then.
Proving medical child abuse is a job for criminal [courts] if it rises to a criminal level. There are tons of things I can do as a criminal investigator to help doctors prove this.
I recall one case where a mom was posting on Facebook [about her] baby in the hospital [and how] her oxygen levels were at 30, and she had coded three times. I compared the Facebook posts to the medical record… None of that happened. She was just making it up for attention. That gives me a motive, it shows the attention-seeking aspect.
Have more Munchausen by proxy cases gone to trial? What has been the result?
Weber: In my jurisdiction, we’re going backward on it. I think it has to do with some distrust in medical institutions. Some people have a hard time separating issues, and they’re not willing to trust medical professionals. This is why police involvement is so important.
I’ve made 12 arrests for this [type of] abuse [from 2008-2015]. Eight of those were guilty pleas. A lot of them were pled way too [leniently] The reason is a lack of prosecutorial understanding; a DA’s office doesn’t want to spend the money [and time] to prosecute a case that they know they’re only getting going to get about 10 years on.
What bothers me are cases like Kristi Carroll’s [who was charged with injury to a child in 2021 for faking her toddler son’s medical issues]. She was on video [creating fake] vomit over 20 times and breaking [her son’s] GJ (gastrojejunostomy) tube. It was pleaded down to probation and CPS left the child in the home.
In the last case we had, [Jesika Jones] admitted to poisoning her 4-year-old with four to six adult-strength [allergy medicine tablets] at a time to make the child simulate seizure disorder symptoms. They let her out on bond, because they didn’t take it seriously. [After violating her bond by being around children,] they finally kept her in jail. It really depends on the person in the system you get and how seriously they will take the allegation.
[Editor’s note: Jones was sentenced to 60 years in prison in August 2024.]
Is there a way to treat or remedy Munchausen syndrome by proxy?
Dunlop: The cases of successful treatment are vanishingly rare. The remedy for the abuse is about protecting the child. I think it’s fine to explore what treatments are possible, but even our most optimistic colleagues will say it’s very rare the perpetrator can accomplish the first steps.
[According to] Dr. Mary Sanders and Dr. Brenda Bursch’s ACCEPTS model, the first step is full acknowledgement of the behavior. You rarely get that [because] they will minimize without taking full accountability.
You can’t just send them to a therapist for counseling, which often happens. That is just not sufficient to protect children. Monitoring for the rest of the person’s life [is what I believe is needed], especially if they’re going to be around children—not something they go to for six months and they’re done.
What is necessary for the public to understand about Munchausen syndrome by proxy?
Weber: What I will tell the layperson: If you suspect something is wrong, report it. It’s not up to you to prove it. Doctors: It’s never your responsibility to prove that abuse is occurring. Your responsibility is to report it when you suspect it. Currently, law enforcement and Child Protective Services (CPS) are terrible at understanding and investigating this abuse. That is their responsibility—and those roles need to be divided.
Dunlop: This can happen in any family. This is not race or class-specific. Some perpetrators were victims of abuse when they were growing up, others appear to come from nice, close-knit families. I believe anybody who works around children should know about this abuse …just as they watch for any other form of child abuse.
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Why Munchausen by Proxy Can Be So Hard to Prove in Court
The Fascination Around Munchausen by Proxy and Crimes that Fake Serious Illness
