Factitious disorder, more commonly known as Munchausen syndrome, is a mental health disorder in which people fake serious illness to gain sympathy, attention, and support. A related disorder, Munchausen by proxy, or Factitious Disorder Imposed on Another, is a mental health condition in which someone claims that a person within their care is sick and needs medical attention when they do not, in order to gain sympathy, attention and support. It is a type of abuse.

Munchausen by internet is relatively new. It’s where a person joins an internet support group for people with a serious health condition, such as cystic fibrosis or leukaemia, and then claims to have the illness themselves.

In the following podcast, produced by the American Psychological Association, Medical Deception: Understanding Munchausen syndrome/factitious disorder Psychiatrist Marc Feldman, MD, and psychologist Janet Cahill, PhD, discuss researchers’ evolving understanding of these disorders, how common they are and the phenomenon of “Munchausen by internet” where people lie to strangers online for attention.

Mills: Dr. Feldman, I want to ask you a question. Back in the 1990s, you coined the term Munchausen by internet. How has the internet changed how this disorder presents itself? Is Munchausen by internet as common as regular Munchausen syndrome, or is it even more common at this point?

Feldman: Well, I coined the term because people, when I lectured, would often come up to me after the lecture and tell me about online cases. Some of them were so extreme it was hard to believe that anyone else believed them, but they tend to impart this catastrophic information about illness or crisis in a gradual way that becomes believable, because who would think somebody would go online and lie about their child’s health or their own health?

Many of the support groups they would log onto are explicitly supportive, they’re there to provide health information and health support, they’re not there to question anything that goes on. But it can be explosive when it’s discovered that a person has lied online, whether about themselves or children, and it can often lead to the end of the group because the group members divide into camps of the believers, those who still believe the stories are true, and those who were finished with the group because they know they’re not.

I think there are way more Munchausen by internet cases these days than real life Munchausen cases, because it used to be that people would have to go to medical libraries, study up about illnesses, then go to an emergency room or a doctor’s office and act really, act out an illness. They had to have acting skills and not everybody does, so sometimes they were detected sometimes quite easily. But Munchausen by internet is different in that it just involves the gift of using words. You can become an expert in almost any medical ailment by spending 20 minutes on Wikipedia. It can include ailments that doctors themselves don’t know that much about. I think, again, if they’re discovered they simply go elsewhere on the internet and may continue the same kind of deception or go into a completely different group, research that one and try to be credible as they post online.

That last paragraph brought to mind this post in the Human Line Project “support group,” Sometimes just throwing a lot of big words around on a subject most people don’t know about is enough to make you sound like an expert.

Mills: Well, Dr. Feldman, let me ask you, how difficult is it to diagnose factitious disorders? Do you think that MDs are sufficiently aware of the syndromes so that they can spot it in patients?

Feldman: I actually believe that the majority of these cases go undetected. A lot of that has to do with a knowledge deficit and an educational deficit among healthcare providers. But if a patient is particularly crafty, we may see no red flags. Again, as I said before, I think the majority of these cases go unrecognized.

Cahill: Well, by definition, an individual who meets the criteria for factitious disorder is doing this on purpose for their own psychological needs, and so it’s very, very hard to catch up with them. We have colleagues now who are doing some research on this, and the more we research it, the more we find it. I think it’s out there more than we expected, but it’s also difficult to get a handle on it.

Feldman: This is deliberate deception. They know what they’re doing, there’s often considerable planning involved in executing the behaviors, the deceptive behaviors.

This 2012 paper points out:

What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims.

Factitious disorder imposed on another in the DSM-5

The diagnostic criteria of factitious disorder imposed on another as presented in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) includes:

1. Falsifying physical or psychological signs or symptoms, or creating an injury or condition in order to deceive someone.
2. One person presents someone else (victim) to others as ill, impaired or injured.
3. The deceptive behavior happens without obvious external rewards.
4. The behavior isn’t caused by another mental health condition.