Lacey Spears, of Scottsville, Kentucky, has pleaded not guilty to charges of depraved murder and manslaughter in the January death of her son, Garnett-Paul Spears, whose sodium levels rose to an extremely dangerous level with no medical explanation.
As Spears moved around the country - Alabama, Florida and eventually New York - she kept friends updated on her son's frequent hospitalizations with photos and musings on Facebook, Twitter, MySpace and a blog.
"My sweet angel is in the hospital for the 23rd time," she tweeted in 2009. A series of reports on the case by The Journal News, which covers the New York suburbs, found she kept it up right through her son's death, with 28 posts in the last 11 days of Garnett's life, including, "Garnett the great journeyed onward today at 10:20 a.m."
Dr. Marc Feldman, a psychiatrist and forensic consultant in Birmingham, Alabama, who wrote the book "Playing Sick," said he believes the Internet has contributed to the number of Munchausen by proxy cases, estimated from one study to be more than 600 a year in the U.S.
In a case exposed in 2011 in Great Britain, a childless 21-year-old woman joined an Internet forum for parents, claiming to have five children and chronicling her nonexistent baby's battle with celiac disease and bacterial meningitis. Doctors at Seattle Children's Hospital found three cases of mothers who falsely blogged that their children were near death and were rewarded with support.
"There are instantly accessible and endlessly supportive groups out there that will pray with you and cry with you if you purport your child to be ill," Feldman said.
Mark Sirkin, director of the mental health counseling program at Mercy College in Dobbs Ferry, said that with social media, "you can expand your circle from the people you know to strangers who you've never met - you're just getting that much more attention."
While prosecutors and defense attorneys in the Spears case have yet to mention Munchausen in court papers or hearings, experts say the disorder could play a role because Spears fits the pattern of caregivers who invent, exaggerate or cause a health problem in someone in their care and then seek to portray themselves as a hero.
Spears, who was living in suburban New York when her son died, is accused of administering sodium through a feeding tube he had in his stomach while he was hospitalized at Westchester Medical Center. Prosecutors say she did it in the bathroom, where there were no surveillance cameras.
"This mother was intentionally feeding her child salt at toxic levels," Westchester County prosecutor Doreen Lloyd said at Spears' arraignment. She also alleged that Spears had done Internet research on the effects of sodium and that Spears had tried to dispose of a bag tainted with sodium by asking a friend to "get rid of it and don't tell anybody."
According to court documents, Spears told police she used only "a pinch of salt" for flavor when feeding her son fruits and vegetables through his tube.
Spears said the feeding tube was necessary because Garnett couldn't keep food down. Some friends told The Journal News they saw no sign of that. They were also confused by her claims that Garnett's father was killed in a car accident. A man who says he's the father lives in Alabama.
Her attorney Stephen Riebling said last week that the defense would focus "on the relevant facts, not fiction."
Spears' lawyers won't comment on whether a psychiatric defense is planned.
But by using a "depraved murder" charge, the district attorney seems to be taking a disorder like Munchausen into consideration.
The charge alleges "extreme recklessness" and "depraved indifference to human life" rather than an intentional killing, so prosecutors don't have to prove that Spears meant to kill her son.
Feldman said it's difficult for jurors to believe a mother would purposely hurt her child just to get attention.
"These mothers tend to be psychopathic," he said. "They don't experience guilt and they lack empathy."
Louisa Lasher, an Atlanta-area consultant in child abuse cases, said parents who have the syndrome "do not love children in the way that most people do."
Munchausen by proxy has been suspected in several court cases over the years. In 1979, a California woman was convicted of murder for slowly poisoning one child; the case was cracked when a second baby came down with similar symptoms. In 2010, a Tennessee woman pleaded guilty but mentally ill to charges she injected saltwater into her infant son's feeding tube. A woman in Minnesota is accused of smothering her son; she said she wanted more attention from doctors.
Most cases rarely end in death because the child "is the goose that lays the golden egg for somebody who's so needy of attention," Sirkin said. "It would defeat the purpose to kill the child." Often when a death occurs, it's because of a miscalculation, Feldman said.
As for treatment, Sirkin said long-term psychotherapy is required.
"It's not like a snake phobia where you can take somebody through some behavioral training and they'll be over it," he said. "This is a personality type that takes years in the making, and I think it probably involves psychotherapeutic treatment that would also take years."