The Hulu show, The Act, has been making headlines in recent months because of the shocking true story of Dee Dee Blanchard and her daughter, Gypsy Rose.

Dee Dee had Munchausen syndrome by proxy—although the correct name for the disorder is now factitious disorder imposed on another (FDIA)—and raised her daughter as if she had a severe illness when in reality she was healthy. Women’s Health notes that as Gypsy Rose grew up, she realized what her mom had been doing, and later, she and her boyfriend were convicted for murdering Dee Dee. It’s a tragic tale filled with twists, which is why it makes for such interesting television, but it also sheds light on the mental disorder that fabricates an illness for attention.

By proxy refers to “through a substitute,” and Medical News Today notes the first "by proxy" case was in 1976. The exact cause of the disorder is unknown, but past traumatic experience in the abuser’s life and/or personality disorder could be a contributing factor.

According to WebMD, it is a “relatively rare” disorder which affects the primary caretaker, in this case, it was the mother (and it is commonly the mother, with NHS noting that in over 90 percent of reported cases involving fabricated or induced illness, it has been the child’s mother who is responsible). That said, it is incredibly difficult to compile statistical evidence because many cases are undetected, they are also hard to diagnose.

Individuals with this disorder “may create or exaggerate a child's symptoms in several ways” and the child is exposed to ongoing abuse. This includes tampering with results, lying about symptoms, and even inducing symptoms (by poisoning, starving, and other means). Some cases can be fatal.

Although this condition can affect anyone, the NHS notes that the most severe cases often involve children who are under five.

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