Munchausen By Internet: Lies and Deception for Special Attention

A new study raises concerns that Munchausen syndrome by internet could be a resource drain for healthcare providers. Read on to learn more about the study’s findings.

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Munchausen By Internet: Lies and Deception for Special Attention

The story of Gypsy Rose Blanchard, as told through the HBO documentary "Mommy Dead and Dearest" and Hulu's docuseries "The Act", has raised awareness around factitious disorder imposed on another (FDIA), previously called Munchausen by proxy.  Dee Dee Blanchard suffered from FDIA and acted like her daughter, Gypsy Rose, had various illnesses to gain sympathy and special attention.  Unfortunately, Gypsy was subjected to years of painful tests, surgeries and life limiting restrictions.  Now researchers are concerned about another fictitious condition that also twists the truth, Munchausen by internet (MBI).

What is MBI?

To understand Munchausen by internet, you need to be familiar with the conditions of Munchausen by proxy and Munchausen syndrome.  These terms are often used interchangeably, however, there is a difference.

Factitious Disorder Imposed on Another (FDIA)

(Munchausen by proxy)

Characteristics:

  • A need for another person to be seen as ill.
  • Want sympathy, special attention and praise
  • The victim is usually a child, but could also be vulnerable adults (disabled, elderly)

Factitious Disorder Imposed on Self (FDIS)

(Munchausen syndrome)

Characteristics:

  • A person intentionally exaggerated or creates symptoms of medical conditions
  • The person seeks attention through examinations and treatments
  • Usually has a wealth of medical knowledge

Munchausen By Internet (MBI) is a form of FDIS that was coined by Dr. Marc Feldman in 2000. Dr. Feldman is a professor of psychiatry at the University of Alabama in Tuscaloosa, Alabama and is considered one of the top experts in Munchausen disorders.  In MBI, a person uses electronic media to "virtually" carry out their medical hoax.

The Study

Kathryn V. J. Newns, BA, a clinical psychologist in Cambridge, England, along with Dr. Feldman, investigated 5 cases that were brought to their attention by a doula.  A doula is someone without medical training that is hired to provide guidance and support to someone who is pregnant during labor.  The researchers found all 5 MIB cases studied to have the following characteristics:

  • Targeted doulas working remotely during COVID-19 lockdown
  • Lived in the United Kingdom
  • Created elaborate stories with dramatic and immediate needs.  
  • For example, a patient could not go to hospital for delivery because the husband recently had a heart and lung transplant and COVID-19 risks too high.

The perpetrators contacted the doulas through texts, phone and video calls, emails and communication apps.  In one case, the perpetrator's "husband" sent hundreds of emails and texts.  In all 5 cases, the doulas were not paid for their advice and support.

You can read the details of the 5 investigated cases here.

Internet Makes It Easy

MBI has become more common largely because of how easy it is to find an online audience.  Instead of visits to doctor offices and emergency departments, perpetrators can simply join online advice/support forums to communicate with a readily available "virtual" healthcare professional.  And, fakers can join multiple groups, using different names and accounts, all at the same time.  

Quote

"It used to be that people had to go from emergency room to emergency room, they would have to study up on illness and try to be authentic when they were faking.  Now all you have to do is sit at home in your pyjamas and click into a support group and make up a story.”  Dr. Marc Feldman

Signs of Munchausen By Internet

There are certain red flags that may alert providers to potential hoaxers.  These include:

A disconnect between the severity of illness a person has and the duration, length and frequency of posts.  For example, a person claims to be in septic shock but is still posting details of their illness.

  • Posting about near-fatal exacerbations occurring in turn with miraculous recoveries.
  • Personal claims that are over-the-top, but are contradicted or disproved in later posts.
  • Others seemingly post on behalf of the perpetrator, but have similar patterns of writing and make the same grammatical errors.
  • Reports having symptoms of a condition that are much more acute than typical cases
  • Claiming to have seemingly endless dramatic life events, such as death of loved ones or being a victim of a violent crime, especially when someone else in the group is the focus of attention.

Online Training

The doulas in all five cases were not paid for the large amount of time they spent on the hoaxers. The police were unable to take any action because no money actually changed hands. It is understandable that some doulas experienced residual feelings of anger, grief and deception. One of the doulas decided to create an online training program to help protect other doulas from becoming a victim while they work online.  

What Do You Think?

Do you think MBI is an actual condition that could potentially bottleneck certain medical specialties? Or, do you think the doulas contributed to the problem by blurring professional boundaries?

References

Factitious Disorders

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J.Adderton

About J.Adderton, BSN, MSN

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I feel badly for the healthcare professionals in these cases that spent their time and energy in a hoax. This is certainly not a new situation, though, and the internet has allowed millions of people to become something their not throughout the years. About 17 years ago I was on a message board for pregnant women and we were all duped by a woman that joined our group and proceeded to tell us of children that had died, miscarriages, etc. She was with the group for over a year before things got really over the top so we didn't catch on right away. We even raised money and sent it to her after her husband was supposedly in a horrible accident while she was on bedrest with high risk twins. Eventually it got around that there were multiple women on different boards with a similar story. None of us shared pictures online, we were just screen names on a computer, there could have been many imposters on similar groups and no one would have known. 

You can even think of some of the things posted on boards like this. We have a random person who starts a thread with some outrageous story and is never heard from again. What was their goal? I think for people that wouldn't display such behavior, understanding the motivation why is difficult. 

In these days of telehealth and increased accessibility of healthcare providers, I guess instances like this are bound to increase. Especially with the COVID quarantine conditions when people can more easily claim an inability to receive care in person. Maybe the doulas involved need a more rigorous background check of potential clients. People that are really pregnant and need the help would probably not be upset about being asked to verify their condition somehow for the sake of proper care. 

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Specializes in OB.

Wasn't there a member on this board who was guilty of this?  Boston Terrier Lover or something?

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Specializes in Community health.

There is so much of this on Instagram, but typically with the goal of getting donations from community members, rather than medical treatment (so not really Munchausen, but just dishonesty). There is SO MUCH “My child is a medical mystery, he has all these chronic illnesses and I have given up my life to care for him day and night” and “None of my doctors listened to me but I really have EDS, CFS, POTS, MS, CRPS, and FM!”  And the thing is that it is completely impossible to tell who is actually struggling with complex, ongoing issues, and who is making it up. Thus, I would never give money to someone I “knew” from social media, but unfortunately many many people do. Because if you’ve followed someone for a long time, you really do feel that you know them, and you become invested in their tragedies. 

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Specializes in LTC, assisted living, med-surg, psych.
9 hours ago, LibraSunCNM said:

Wasn't there a member on this board who was guilty of this?  Boston Terrier Lover or something?

Ah, yes. I’ll never forget that member, and I’m sure those who like me showered him/her with love and support won’t either. We got suckered in, and I personally felt incredibly foolish because I’m naturally suspicious and quick to catch on to attempted scams. But I bought it, as did many others, and then we all ended up with egg on our faces. That was a lesson for all of us, including the staff who had the wool pulled over their eyes too: trust, but verify. 

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