Faking Illness to Meet Real Needs: Understanding Factitious Disorder

Belle Gibson was just 20 years old when she was diagnosed with brain cancer. Given four months to live, she turned to the internet for solace and began blogging about her illness and its treatment, which consisted of radiation and chemotherapy. After just eight weeks of treatment, however, she turned away from conventional medicine and sought to combat her cancer through alternative and holistic therapies, including a strictly controlled diet, colonic irrigation, and oxygen therapy. And it worked. Seeking to share her success with others, she launched a healthy living and recipe app called The Whole Pantry, which was met with rave reviews, was downloaded over 300,000 times, and became a standard part of the Apple Watch. A companion cookbook was published by Penguin and included more details about her natural approach to fighting the cancer that threatened to take her young life. Elle named her “The Most Inspiring Woman You’ve Met This Year” and Cosmopolitan gave her a “Fun, Fearless Female” award. And then the cancer came back. Through her Instagram account, Gibson revealed that not only had her brain cancer returned, but it was accompanied by cancer of the spleen, uterus, and liver.

Except none of it was true. Belle Gibson never had cancer. Nor did she experience the stroke, two heart attacks, three heart operations, or two instances of flatlining on operating tables that she claimed to have endured. As her star rose, increased public interest in her story led to questions about both her business practices and the veracity of her health claims, ultimately unraveling the elaborate lies she had spun, and leading Gibson to confess to fabricating her multiple illnesses. Yet her story is still very much about illness–just not about those she was claiming to have. Gibson serves as one of the most highly publicized cases of factitious disorder to ever come to light. While her actions have provoked outcries of anger and profound feelings of betrayal from her readers, they have also opened up the door for increased public awareness of a complex mental health disorder that can cause deep distress for both those who suffer from them and their families.

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.

People who suffer from factious disorder are unlikely to seek help spontaneously. Rather, treatment usually requires intervention from family or friends. Recognizing that your loved one suffers from factitious disorder can be a difficult process, both emotionally and practically, and you may be reluctant to accuse someone you care about of lying. However, ignoring the problem will only prolong your loved one’s suffering and may lead to serious emotional, social, and even physical damage as they attempt to fill a powerful psychological void. The sooner your family member, partner, or friend accesses treatment, the sooner they can begin to heal. If your loved one’s factitious disorder is an extension of a co-occurring mental health disorder such as a personality disorder, it is imperative that they receive specialized care that adequately addresses the full scope of their psychological state in order to provide meaningful and effective intervention.

Bridges to Recovery offers compassionate, innovative care for people suffering from factitious disorder. Contact us to learn more about how we can help you or your loved one on the path to recovery.