Why did she do it? Hulu’s new The Act series has been chronicling the story of Gypsy Rose Blanchard and her mother, Dee Dee Blanchard, and their bizarre, toxic relationship. It’s, of course, a fictionalized account of what Gypsy went through at the hands of her mom, but based on very real, very scary events.

In 2015, Gypsy became known to the public when it appeared that she had been abducted and her mother was murdered. Later, authorities discovered that Gypsy and her boyfriend, Nicholas Godejohn, were likely responsible for Dee Dee’s death. However, Gypsy didn’t help commit the heinous act for no reason. Dee Dee likely had Munchausen syndrome by proxy (MSBP) and fabricated Gypsy’s illnesses and diseases — even going so far as to harm her with unnecessary medical prescriptions and procedures. In order to save herself, Gypsy arranged to have her killed. But what is MSBP exactly, and why can’t we say for sure whether Dee Dee had it?

What is Munchausen Syndrome by Proxy?

Munchausen syndrome by proxy “is a mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability. Because vulnerable people are the victims, MSBP is a form of child abuse or elder abuse,” Michigan Medicine through the University of Michigan reported. The Cleveland Clinic calls it “Factitious Disorder Imposed on Another (FDIA),” and reported that it is “a mental illness in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick.”

Dee Dee told people Gypsy “suffered from leukemia, asthma and muscular dystrophy, was wheel-chair bound and had the mental capacity of a 7-year-old child due to brain damage she sustained from being born premature,” Inside Edition reported. But today, as Gypsy serves time in prison, she is reportedly healthy and feels “free,” according to ABC News. Therefore, much of what her mother told others about her daughter’s health issues had to be lies.

Did Dee Dee Blanchard Have Munchausen Syndrome by Proxy?

There’s no definitive way of knowing whether Dee Dee had MSBP. People can’t be diagnosed officially after they die, and Dee Dee was killed on June 14, 2015. But while in jail, Gypsy reportedly looked up the definition of Munchausen after she kept hearing the term used to describe her situation, and she told Buzzfeed News in August 2017 that her mother “matched every symptom.”

How Is Munchausen Syndrome by Proxy Treated?

Gypsy Rose Blanchard on Dr. Phil

Michigan Medicine reported that “child protective services, law enforcement, and doctors are all involved in treatment for Munchausen syndrome by proxy.” Caregivers who suffer from it need long-term counseling, and medicines are only used if they have another health problem like anxiety disorder. The site reported, “For victims, the first step is to protect the child by moving him or her into safe custody. Then a doctor will monitor the child for symptoms. Most of the time, the child’s symptoms stop after the child is away from the caregiver.” That seems to be what happened to Gypsy.

Munchausen syndrome by proxy sounds like a terrifying disorder. Gypsy may have escaped the control of someone who likely had it, but she paid the price. In July 2016, she made a plea deal with prosecutors and agreed to plead guilty to a second-degree murder charge in exchange for a 10-year sentence. She is set to be paroled before her 33rd birthday.

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