The digital age has opened up vast new audiences for those who lie about having medical ailments to gain attention, giving rise to Munchausen by Internet. Physically healthy individuals detail their fake battles with real diseases on social media and other online forums.
“Technically, it falls under digital factitious disorder in the DSM-V, which is a somatic symptom disorder,” said Gina Slobogin, DNP, APRN, FNP-BC, NHDP-BC, NEA-BC, PGMT-BC, BC-ADM, TCRN, CEN, CPEN, CFRN, CTRN, PHRN, in the session “Munchausen by Internet,” another name for the disorder. “These people know the statements they’re making are false.”
Individuals who engage in this kind of medical deception are often clever, with extensive knowledge of medical terms and diseases. It is common for them to be eager to undergo frequent testing or risky operations, and to argue with doctors and medical staff. They also may be reluctant to allow health care providers to talk to their family, friends or other health care professionals.
“They’re probably not going talk to their family and friends about what’s going on. They’re not going to be the ones coming into the ER with three family members with them. They’re probably going to be by themselves,” Slobogin said. “You’re going pull them up in your charting system, you’re going to see that they’ve been there 37 times in the last month because they keep coming in with these vague symptoms.”
Despite frequently seeking attention for their afflictions, it is not unusual for individuals with factitious disorder to report minor and unclear symptoms or to claim having a condition that doesn’t respond as expected to standard therapies.
“So, it is kind of hard to decipher where their symptoms are coming from. Is it a real illness? Is it something they’ve made up?” Slobogin said.
To help determine whether someone has factitious disorder, Slobogin said providers should conduct a detailed interview with the individual, require past medical records, work with family members for more information if the patient grants permission, and run only the tests required to address possible physical problems.
“Some people don’t understand why they feel the need to make up these symptoms, and they may not recognize they have a problem,” Slobogin said.
The primary criteria for diagnosis of factitious disorder are:
- Intentional falsification of physical or psychological signs or symptoms.
- The individual presenting themselves as ill, impaired or injured to others.
- The deceptive behavior persists even in the absence of external incentives or rewards.
- Another mental disorder does not better explain the behavior.
Childhood trauma is a significant risk factor for developing factitious disorder. Other risk factors include serious illness during childhood, personality disorders, poor sense of identity, desire to be associated with doctors or medical centers, and work in health care.
“Getting to the root of people’s traumas can help with diagnosis of this sort, because you can see where it’s coming from,” Slobogin said. “People who didn’t have enough attention as a child will tend to make up symptoms later on so that they get that attention. Or, if they had a sibling growing up who had a complicated medical disorder, as they get older they may start to develop symptoms similar to that so they can get the attention they saw that sibling have.”
Treatment for Munchausen by Internet can include psychotherapy and behavioral therapy, medications such as selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors, and hospitalization for severe cases.
“But these patients usually have horrible compliance with treatment because they know that if they take the medications you gave them for the psychiatric disorder, they’re not going to get as much attention as they would for the other disease that they think they have,” Slobogin said.