Faking Illness to Meet Real Needs: Understanding Factitious Disorder

Factitious disorder, more commonly known as Munchausen syndrome, is characterized by deliberately inventing, producing, or exaggerating physical or psychological illness. Unlike cases of malingering, people with factitious disorders do not engage in deceit for financial or other practical rewards and, unlike those with somatoform disorders, they do not believe that they actually have the illness they describe. Rather, they deliberately mislead clinicians, loved ones, and/or strangers in an attempt to garner attention, love, sympathy, and care. In extreme cases, people with factitious disorder undergo extensive and unnecessary medical treatments, tamper with medical tests, alter medical records, and harm or injure themselves to produce medical problems. Dr. Marc Feldman, a psychiatrist at the University of Alabama and author of Playing Sick? says, “I’ve encountered two women who’ve lied to their doctors in order to get mastectomies unnecessarily. That’s how desperate their need of hospitalization and love and attention is.” Although prevalence in the general public is unknown, writer Cienna Madrid reports that, “[A 2011 case report on factitious disorders published in Innovations in Clinical Neuroscience suggests that roughly 9 percent of inpatients in tertiary care (specialized treatments, like cancer care) suffer from some form of factitious disorder.”

People with the disorder may go to great lengths to fabricate illnesses, often conducting thorough research to create convincing stories. However, the following may be signs that your loved one is suffering from a factitious disorder:

• Inconsistent and extensive medical history
• Frequent doctors’ visits and hospitalization
• Symptoms that change unpredictably and do not respond to treatment
• Enthusiasm for undergoing medical tests and procedures, including surgeries
• Detailed knowledge of medical practices and terminology
• Symptoms that are not observable to others
• Disallowing family contact with treatment providers

The exact causes of the disorder remain unknown, but some researchers have found that people with the disorder often have a history of childhood trauma, abuse, or neglect. Early experiences of loss and abandonment may trigger the condition, and experiencing or witnessing serious illness in childhood can also increase risk. People with certain personality disorders, particularly Borderline Personality Disorder and Narcissistic Personality Disorder, may be especially susceptible to factitious disorder. What all people suffering from the illness appear to share is an overwhelming desire to fulfill unmet emotional needs.

The internet may be increasing the prevalence of factitious disorder by offering a seemingly lower-stakes platform for gaining sympathy and attention. Although high visibility cases like that of Belle Gibson have multiplied in recent years, Dr. Feldman noted the emergence of a new articulation of the illness, referred to as Munchausen by Internet, as early as 2000. In her riveting article for The Stranger, Madrid sums up the appeal of Munchausen by Internet:

You’re anonymous—you can manifest any symptoms you want, like puking pints of blood, without having to actually puke pints of blood. And instead of being examined by the trained eyes of a doctor, you’re welcomed unconditionally by flocks of people who stand on-call, ready to shower you with attention and emotional support 24 hours a day. For weeks or months or years, you can live out your deception without the fear of having your lies challenged in person. And if someone does eventually doubt your story, you can simply log out. Change your name or your illness. Find a fresh group of sympathizers.

By allowing for flexible, self-directed, and often anonymous self-presentation, online spaces present new opportunities to invent illness narratives without the burdens of physical reality. The online environment provides a responsive audience that can give factitious disorder sufferers the instant feedback they crave; health-related support forums, personal blogs, and social networking platforms offer virtually limitless opportunity for connection, recognition, and validation. Simultaneously, instant access to detailed medical information can allow people with factitious disorder to gain the knowledge they need to convincingly describe symptoms, procedures, and disease progression. However, as recent exposés show, Munchausen by Internet can have very real consequences as the lies are uncovered and create deeper psychological suffering.