He's faking it everyone. (Photo by Andrew Lichtenstein/Corbis via Getty Images)
People are nicer to you when you’re ill; they pay you more attention. Most of us appreciate this special treatment, but what if you begin to crave it? What if you craved it so much that you started to embellish a little, making your symptoms seem worse than they really were? What if you went further, and pretended you had an illness when in fact you didn’t?
Munchausen’s Syndrome, or as it’s referred to in the medical literature, “factitious disorder”, is one of those conditions that’s rare enough that we don’t know how rare it is. It usually goes unnoticed for years or decades. Patients often visit many different doctors and hospitals, sometimes abruptly disappearing if anyone questions the reality of their illnesses, means it’s difficult to diagnose, let alone study. But there’s plenty of evidence of these fake illnesses ruining real lives.
At the end of last year, Helen Naylor published a memoir, My Mother, Munchausen’s, and Me. The final word in the title could be referring not only to the author, but also to ME — Myalgic Encephalomyelitis, or Chronic Fatigue Syndrome — which Naylor’s mother Elinor claimed to have all the way through Naylor’s childhood. She required, she said, long bed rest every day, meaning she was rarely around to look after Naylor. Years later, Naylor discovered that her mother had regularly gone out shopping and on day trips while she was at school.
Over time, Naylor’s mother seemed to forget the ME, instead seizing on a diagnosis of “mild Parkinsonism” — a set of minor symptoms that are related to the vastly more serious Parkinson’s Disease, but are absolutely not the same thing. Doctors told her that it would be decades, if at all, before the symptoms had an impact on her life, and yet she obsessed over it, blowing it out of all proportion, mentioning it at every opportunity and becoming terribly offended when anyone tried to change the subject.
Her diary, which she’d diligently kept for decades, was focused on her never-ending sicknesses. Her daughter’s life, her husband’s death, the birth of her grandchildren: these were side issues, in which she showed little interest — her focus was always on herself, her fragilities, and her visits to the doctor. But her diary entries didn’t display anything like the normal reaction to being ill, which might involve anxiety, stress, or some form of coping mechanism like denial. This was glee: Naylor’s mother delighted in every potential disease she might have caught and symptom she might be showing, regularly researching conditions to find out more of the grisly details.
There is no known treatment for Munchausen’s. It presents all sorts of challenging questions — for instance, whether doctors should confront a patient about their fake illnesses, or whether that would make things worse. Since symptoms vary so much, medical researchers have to rely on small amounts of case experience — doctors describing their experiences with individual patients — rather than any larger-scale samples.
Those case studies often make for grim reading. For instance, one report from 2019 describes a man in his 20s who went from hospital to hospital across the whole of Italy — and sometimes abroad — complaining of a wide variety of symptoms and pains that required investigation. He had a total of 41 known hospitalisations in a four-year period, and managed to convince enough doctors to perform invasive surgical tests that his torso was covered in scars. He was taking a variety of drugs, including testosterone — which was necessary since he’d had both of his testicles removed in one of his numerous unnecessary operations. When asked by aghast doctors the reasons behind this “mutilating operation”, he could only give a vague, noncommittal reply.
As the Italian doctors pointed out, patients like this aren’t delusional per se; nor are they delirious, suffering from some kind of altered state of consciousness — they’re not mistaken about the illnesses they claim to have. And they aren’t “malingering”, which is when people fake illnesses for a specific reason, like avoiding military service or gaining benefits. Neither are they hypochondriacs — neurotics who worry too much about their health (indeed, like Naylor’s mother, they often get great pleasure from the idea that they’re sick). Instead, they have a compulsion that’s more difficult to pin down — an irrational, uncontrollable desire to have more consultations with medical professionals, more hospital visits, and above all more attention.
In 2016, two psychiatry researchers collected together all the published case studies of adults with factitious disorder. They tried to draw out some broad patterns from the 455 cases they found. The first thing they noted was that 66% of patients were female — strange, since a previous edition of the Diagnostic and Statistical Manual of Mental Disorders, psychiatry’s Bible, claimed on the basis of no stated evidence that the disorder was more common in men.
The second interesting observation was that the factitious patients often claimed to have previously worked in healthcare — as a lab assistant in a hospital, say. This makes sense: people who are obsessed with illness might gravitate to jobs where they can observe and research it closely.
But just putting together case reports only gets you so far (even though other case reviews find a similar pattern of results). All the numbers the researchers could provide are subject to huge margins of error — and might be tainted by bias. For instance, cases that are particularly outrageous or extreme are more likely to be written up as case reports and sent to journals, so we might get a skewed image of what the average patient with the disorder looks like. This is, ironically, a kind of scientific Munchausen’s-by-proxy, where doctors hype up the illnesses of their patients, or at least focus on the most shocking ones, to gain attention for themselves.
A suite of studies — again, mainly case reports — now exists on “Munchausen by Internet”, where someone with factitious disorder uses the internet to build a fake persona as a sick person — as well as sockpuppet accounts for fake relatives or friends to buttress their story. They might infiltrate support groups for an illness, or build a social media following, basking in the sympathy they receive from well-meaning commenters and supporters (“you are so brave — keep fighting!”).
Whether this is a specific new disorder is arguable: it sounds more like a mutation of the old problem. But — and I won’t provide any links, for obvious reasons — there is definitely a new genre of social media account which the owner uses to provide regular updates on what’s often a long list of medical conditions. They post photos of medical equipment such as feeding tubes, and seem to be take a suspicious amount of pleasure in the trials and tribulations of having a long-term medical condition.
Just to be completely clear, I’m not arguing that disability advocates who discuss their conditions and raise awareness on social media are suffering from Munchausen’s. But clearly, in some cases, the internet can become a crucial crutch for a minority who have a tendency to exaggerate (or even fake) symptoms. Indeed, thinking of the often-perverse dynamics of who gets attention on social media, one could hardly imagine this not being the case.
The paradoxical thing about factitious disorder is that although it involves faking and overstating illnesses — and causes immense frustration and distress for family members and doctors who have to deal with it — it is itself a serious medical condition. Many sufferers start to deliberately harm themselves, out of desire for sympathy and medical attention. They might deliberately give themselves cuts and bruises — a relatively easy way to fake an injury. Reports abound of patients rubbing dirt or faeces into their open wounds in an attempt to aggravate them. And the Italian Munchausen’s sufferer who’d been mysteriously castrated actually died, suddenly, during one of his many hospital visits, of acute heart failure. All operations and medical procedures come with risks, and when you subject yourself to dozens of them, those risks begin to multiply.
And in the case of Helen Naylor’s mother, increasingly frantic attempts to fake illness — starving herself and refusing to leave her bed for any reason — eventually turned into the real thing. She was admitted to a nursing home in her 60s, with the frailties of someone far older, and died before her 70th birthday. Chest and mouth infections seem to have been the final straw that led to her death. And just like the doctors and researchers who have studied this disorder — so well-known in culture but so poorly understood by science — her daughter was left not with closure, or explanations, or even relief. There was nothing but sheer bewilderment.
Stuart Ritchie is a psychologist and a Lecturer in the Social, Genetic and Developmental Psychiatry Centre at King’s College London
StuartJRitchie 
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeIn the modern world victimhood and weakness are perceived as manifestations of virtue. Is it any wonder then that psychotics like these exist?
I’d love to read/hear about what the equivalent would be in a different age. Did they all join the Flagellants? Or just suck the life from those nearest and dearest to them like [I can’t remember the name but she’s a stereotype that C S Lewis talks about, the overbearing mother who suffocates her family with her excessive scruples on their behalf and the concomitant suffering she endures *for them*]
I wonder to what extent this issue is contributed to by under pressure doctors providing shaky diagnoses to patients. There seems to be an overriding need for everything to be pathologised somehow – sadness and lack of motivation becomes depression, poor lifestyle becomes chronic fatigue etc – and it may be easier to tell a patient they have a disease and prescribe some pills rather than telling some unpalatable truths that may result in complaints and an even greater burden of work. Doctors are even being criticised for warning patients about being obese, so a busy clinician might simply find the path of least resistance. That is surely an ideal environment for factitious disorders to emerge.
Interesting article – sad subject.
Also, it seems the best remedy is love and a sense of real purpose.
I used to work with someone who told everyone, including his wife and kids that he had bowel cancer, many hospitalisations and time off work supposedly for cancer, even though sick notes used to say hypertension. His wife used to drop him at the hospitality for ‘chemotherapy’. It was only when his brother got diagnosed with bowel cancer and was asked if there was family history he got caught out. I was told I was cruel… and other things…. for not believing him.
Claire: Ha! Good for you. I was primary caregiver for my late mother, who had COPD (and still smoked) and had a version of attention-seeking–not sure I’d call it Munchausen because it applied across all areas of her life.
I’d actually HAD breast cancer, for which she couldn’t even help drive me to appointments or take my kids to school while I was in the hospital, because “the traffic made her nervous.” She managed to buy a new carseat and call everyone to get sympathy for all of the caregiving work she’d have to do for her daughter, but then of course the carseat ended with the rest of the hoard and I had to arrange carpools. She was clearly envious of the attention I got when I was ill, and never asked me anything about my BC or would change the subject the few times I brought it up,
So, when I had to take her to all of her appts/hospitalizations 15 years later once she became severely ill with the COPD that would kill her (while still smoking, with an oxygen machine in the house), she’d tell EVERY new intake worker, after a long, dramatic, breathy pause, that she was “on chemo.” They’d look confused, and give her that hit of special attention/pity with an automatic “awwwww,” and then not know what to say since it wasn’t in her record, until I explained, “actually, she’s getting bi-monthly injections for wet macular degeneration, which are an ‘off-label” use of chemo drugs at about 1% of a normal chemo dose.” Once she’d heard that it had chemo in it, she was just thrilled to finally have a cancer term to use for herself. She must have intentionally misled 20 healthcare workers with the chemo thing before I finally said the silent part out loud, saying that she was “accidentally worrying them that she had cancer and should reword it.”
PS: The extent of that co-workers deception is scary, though. About eight years ago a guy who’d been kind of taken in by a well-meaning couple and who worked for their congressman boss was making up all sorts of things about MS and later pancreatic cancer, with elaborate dropoffs at the local hospital. He was embezzling the pol’s money, and when the so sweet wife finally started to figure it out and asked him, he stabbed her to death. He was gay and obsessed with the husband, we later found out.
In my experience, that kind of healthcare histrionic stuff in males is usually on the gay/trans spectrum, simply because traditional males both have the expectation that they’re supposed to be “strong” and because men have other outlets for their narcissism, whereas women and more feminine males typically resort to more passive aggressive methods. Hence, I’d wonder if your co-worker’s behavior might be masking actual criminality, not just attention-seeking.
“In my experience, that kind of healthcare histrionic stuff in males is usually on the gay/trans spectrum” – anecdotally it is my belief that it’s more a case of the very binary way of viewing the world that comes from autism spectrum disorder impacting their decision making. Transitioning is correlated heavily with autism, and potentially so is this.
Thanks for the article.
An additional way this causes harm–and an important dimension to remember– is the historic reality of seemingly vague, unconnected symptoms (such as MS or Ehlers Danlos, as well as CFE, post-Lyme syndrome, certain gastric illnesses, etc.) being dismissed as psychogenic by the medical establishment until firm physical or genetic proof has been identified. Women in particular are subject to accusations of psychopathologizing and/or malingering. Mothers of children with Ehlers Danlos are doubly screwed, because their children can have unexplained joint dislocations and bruises and have been referred to child abuse services for “Munchausen’s by Proxy.” (There are legal specialists who work just in this area.)
It’s taken decades of advocacy for us to get Ehlers Danlos Syndrome Type III recognized, and now we’ve got people faking it (or self-diagnosing without actual symptoms) who are making it difficult (all over again) for those of us with it to be taken seriously. And that’s with physicians/people with good will–not the ones, male and female–who seem to enjoy blaming women for anything and everything and are thrilled to find any evidence to minimize their suffering.
It is vital that people with these syndromes don’t get invalidated again in patients. Studies have shown that EDS patients see an average of 20 doctors (at least before the current era) before they’re properly diagnosed, and are routinely blamed for their dislocations, nerve pain, profound exhaustion from weak muscles stressed from having to do the work of dysfunctional joints and ligaments, and the range of dysautonomic symptoms that come along with it–cardiac, gastro, pulmonary, etc. Our charts are thick because those of us who haven’t completely given up have been searching for doctors to properly diagnose it along with all of the systems issues that come up that our healthcare system keeps divided so that we’ve got to educate each gastro, derm, ortho, PT, internist, cardiologist, pulmonologist, and worst of all–pain management “psychiatrist”–about what’s going on, and get treatment for each of those symptoms.
I’ll note that there’s a “relief”–not “glee,” with which I’m familiar because my Mom had it, a diagnosis I only made after reams of evidence because I didn’t want to invalidate my own Mom–when you finally get a physical diagnosis, because you’re constantly told it’s in your head and you just think you’re lazy and crazy and should “exercise’ more. So if you’ve got a diagnosis that pulls it all together, it’s preferable to thinking you just lack all willpower.
But the attention-seeking to me is the tell, and particularly envy if someone else is getting attention for their illness. It’s _not_ histrionic to reach out for help, or simply saying something like, I know I don’t look sick but I can’t walk three miles at the fair today because I’ll be in bed for a week because my body will think it’s undergone stress torture and I have basic tasks I need to do at home like laundry or a small project and I’ll use all of that up walking if I don’t pace myself. However, I’ve suspected I’m seeing some Munch/influencer patients on the EDS list and on FB, though. They’re usually the ones narrating every test appointment to a broad audience, and who aren’t actively seeking anything that can make their symptoms better. And with an invisible disability, it’s customary to have a lot of guilt and social anxiety because you want to do so much more than you’re capable of…..if instead the person seems to enjoy the drama and doesn’t convey anxiety about getting better, being believed, or explaining in deep shame why they couldn’t keep up with their usual workaholic past–that’s a big tell.
Fibromyalgia has recently been revealed to be an auto-immune disorder, not psychosematic after all. My friend who has been ridiculed and suffering for years describes it a living death that has robbed her of her fertility and youth. No Munchausen’s here.
I’ve got a cure: ignore them.
I’ve recently been blown away by all of the people that I see in my Chronic Illness forums! There are so many of them! Most of the fakers that I see are young girls/women who are obviously suffering from eating disorders, and using the boards for a lot of pro anorexia stuff. They are so proud of their feeding tubes coming from everywhere! One girl really blows my mind! She was in the same hospital for a year! Continuously pulling out all of her picc lines, Ng tubes, even bladder tubing going direct from her abdomen with the balloon still inflated calling it an accident! There’s a constant flood of pictures of her where you can see that her arms are even put in casts and/or splints so as to prevent her from messing with her lines! Yet again and again, she’ll just starve herself or whatever it takes to get more procedures (she calls them all major surgeries).. Then you’ll catch them because they’ll say that they can’t eat anything by mouth and next thing you see is a post on another page or even the same where the person is clearly eating and drinking just fine!
There’s also the complete fakers that will post pics of them supposedly with their head in the toilet, but you can tell its a selfie, who would pause in the middle of puking to take a selfie? and not even have a drop of sweat or puffy, red watery eyes, etc…no..She’s smiling! This one young AN girl is always posting crazy stuff on ticktock dancing and happy stating that she is in the hospital with C-Diff(A horrible infection that causes uncontrollable diarrhea and pain )..wearing white shorts…like right! Always with a big smile on her face! “I’ve been puking for a week straight..” .lets dance about it on tick tock! Others are going out and buying dangerous neck braces that would normally never be used outside of the hospital, you can find them on Amazon and these people all seem to have the same neck brace! I saw a post of a girl on a boat dock w/ no railing in a chair wearing one of those braces. She also had tubing connected to her shirt with this little strap. Like 6 feelt of IV tubing! It wasn’t even clamped, and even if she did have a port o cath(surgically implanted IV access ), she wouldn’t have more than about a few inches of tubing attached. you wouldn’t be able to wrap it up in a bundle outside of your shirt…
Which takes me back to the “tubies” is what I call them..They are always so proud of their infections in their lines! That can kill you so fast! They are always in pictures with their tubing exposed instead of being properly covered and protected, you never see them with alcohol swabs everytime they touch their tubing..they are not only putting their own lives in danger, but giving advice for other anorectics on how to “dump their feeds” and all sorts of crazy stuff! Usually the moderators of the support forums will pick up on this sort of thing and end it quick. Anything that can be triggering to people with chronic illness or anything that is just inappropriate such as a video of someone vomiting in a forum for people who deal with this daily is not something that is posted. Also really graphic photos, unless it is flagged and there is a specific reason for the photo usually will not be seen on a good forum. Unfortunately there. are social media like instagram and ticktock which don’t moderate this type of behavior! When you see someone’s entire instagram filled with nothing but medical stuff, continuous gory photos, asking for handouts…You’d think someone would take notice. Lives could be saved! From MBI to MS and even MBP there are so many cases where lives of children and adults could have been saved if only someone had questions about the situation and acted on it. There was a MBP case several years ago where a lady was reported to CPS by several concerned people seeing her social media posts, but she managed to slip through the cracks by continuously moving. But there are other cases where people had all social media accounts absolutely filled with nothing but their illness. When you are chronically ill, the last thing you want is to focus on illness all of the time. you need a break! I will post something if i’m in the hospital every now and then just so that my fans and business partners know what is going on, but I’ll never have gory photos. Usually I’ll try to add humor like posting pics of hospital food and just letting everyone know that I’m ok. I did have one video where I survived my umpteenth blood clot, and I almost died. I just made the video of me really out of it, but saying that I just survived a blood clot.
I’ve been studying about these disorders lately because i had a friend who was MS/MBP who let a really good friend die and used to stay with me until I kicked her out for her behavior. It was unbelievable! She would get a glucose meter and eat a whole bag of candy(halloween size) and test her sugar! The doctor never fell for that, but she tried to get every medicine that myself and my husband were on! She took a bunch of lactulose and black walnut which will clean you out crazy, ended up ruining our friend’s bed just so she could have an excuse to need diapers! Like who wants to have to wear diapers at 40 years old?! She would see me get sick all of the time with my stomach condition and she’d be by my side in the hospital, dumping my puke bucket,,then we’d be at home, and she’d fake being sick. It made me feel bad. I didn’t want attention, I was grateful to not be alone, but it just got crazy! Next thing she started abusing neurontin (I don’t get that! It made me feel horrible when I had to take it) but next thing, she’d be passed out in the hallway and it just got ugly. I started looking into the MBI after seeing some crazy stuff on Reddit . I thought I’d check it out, and dang! I was shocked! A ballerina put her body through hell, and eventually had her legs amputated! I just don’t understand how someone would want to be stuck in hospitals and sick at home when there is a real life out there for them.I have PTSD from hospitals, and I really try to deny a lot of stuff that is going on that is serious. I’m just tired of being labeled it chronic this and that but no cure.. What I would do to be young and healthy! What hurts the worst is when people claim to have the same condition as you, but they are able to work, go out every day and night…while I am stuck and nearly homeless due to my problems. Maybe I’m mad at these people because I am jealous. I wish I had their youth and so much to live for,
Ah yes. Reminds me “long COVID”.
That is not my experience.
My colleagues ask me “Marcus, how was you holiday? South East Asia is a wonderful experience is it not? The culture, the food, the nature, what more could you want?”
“Absolutely fantastic. I cannot tell you how much I needed that break. Three weeks of utter depravity and on my return my private doctor prescribes me a mere ten day course of antibiotics. Not the strong ones either. The medium ones. I could not be prouder of myself.”
I felt a certain chill in the air when I said that in the Staff Room.
What I find most surprising is that people outside the medical profession don’t know how pervasive this issue is.
I think we do; it’s just that we struggle to put a name to it and confront it.
Lived with this long enough to see it manifest itself into making the children ill. Fictitious ailments and self mutilating were all part of the package.
I broke and dislocated my shoulder once and was in a lot of pain. This was easily shrugged off by her as of no consequence and she gave me zero support duringthe healing process.
Covert incest, self directed Munchausen and Munchausen by Proxy are so hard to bring to light and often it is only seen or acknowledged by partners or others who are very closely involved.
Like narcissists, they do not wish to be well. They enjoy the pain they inflict upon others. Especially their own children.
I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their website at http://www.ultimatelifeclinic.com . I can breathe much better and It feels comfortable!