Why Munchausen By Proxy Often Involves Women

From Adora in Sharp Objects to Paula in Everything, Everything, Mrs. Collins in The Sixth Sense to Dee Dee in The Act, it seems like Munchausen by proxy is everywhere in pop culture. But the latest TV show to feature the creepy mother trope, The Act on Hulu, is based on a bizarre story about a real mother and daughter duo, Dee Dee (played by Patricia Arquette) and Gypsy Rose Blanchard (played by Joey King).

If you're not familiar with the story, Dee Dee convinced Gypsy and doctors that her daughter had multiple illnesses. She shaved her daughter's head so she would appear sick, fed her various medications, lied about her age, and confined her to a wheelchair — but nothing was wrong with Gypsy. Eventually, once Gypsy realized that she was not actually sick, the case was deemed "Munchausen by proxy."

Munchausen by proxy (aka MBP or "medical child abuse") is a situation in which a caretaker feigns, exaggerates, or induces an illness — often in their own child — in order to gain concern and attention for themselves. The concept is disturbing and fascinatingly counterintuitive, which is why it makes for a juicy plot point. But the one common thread that all of these fictional and real cases share is that they all tend to involve women.

The majority of Munchausen by proxy cases entail women, explains Marc D. Feldman, MD, distinguished fellow of the American Psychiatric Association, and author of Dying to be Ill: the Stories of Medical Deception. In a 2017 review of every case of Munchausen by proxy reported in the medical literature, 98% of the abusers were women, and 96% were the victim’s mother. (That said, there have been instances involving men, albeit very few.) Munchausen by proxy mothers are typically married and have history working in healthcare, "reflecting their particular interest in medical matters," he says.

Many perpetrators of Munchausen by proxy grew up maltreated, and some have also induced illness in themselves, Dr. Feldman says. In a clinical setting, this is called "Munchausen syndrome" or "factitious disorder imposed on self," he says. They may also have other personality disorders — such as borderline, histrionic, and avoidant personality disorders, which are much more common among women, he says. From a logistical standpoint, compared to fathers in "traditional marriages," mothers may have more access to their child, and have more responsibility for their healthcare decisions, he says. "This feature contributes to MBP being a 'crime of opportunity' for women," he says.

One reason why the public is obsessed with Munchausen by proxy cases is because it goes against our societal expectations about women and caregivers, Dr. Feldman says. "We expect mothers to be caring and loving," he says. "Munchausen by proxy mothers put up the pretense of caring, but are devious and secretive, and those features make for good drama." Famously, Gypsy Rose said in interviews that she and her mother were like a pair of shoes: "Never good without the other," she said.

So, why would someone, especially a mother, do this to their own child? "The main reasons the mothers behave this way is that they are after attention and concern; they seek to control their child," Dr. Feldman says. For example, they may want to keep their child dependent, or feel motivated to control their other family members by pretending the child is sick. "Or they are angry, rageful people with sadistic tendencies," he says. "This last group is the most likely to actually kill the child."

Whether you're watching these TV shows and movies, or hearing about a case in the news, it's important to remember that Munchausen by proxy is a very real thing that happens, and it can be devastating. In fact, it's considered a serious form of child abuse. People have been calling The Act creepy and disturbing — and maybe that's the whole point. When asked about playing Gypsy, actress Joey King told Refinery29, "Her story is beyond comprehension."