October 1st, 2016

Munchausen by Internet cases increase

Munchausen by Internet – a syndrome where a person pretends to have a medical condition using the Internet as a tool in this deception – is on the rise, said Marc D. Feldman, M.D., clinical professor of psychiatry at the University of Alabama who coined the term in 2000, although it is not recognized as a disorder in the DSM-5.

He says since he published an article first describing this condition, he has been contacted about 120 cases, which he said “has got to be the tip of the iceberg because people are having to make some effort to reach out to me to tell me about a case.”

Cases have grown as more people gain access to the Internet, he said, although people contact him less often as there are more resources available. Feldman has recently published a book called “Playing Sick,” several journal articles on Munchausen by Internet, and has a Web site on Munchausen disorders.

He said those dealing with the syndrome may find it helpful to lie online if it means not having to hurt themselves in real life in order to appear to be sick.

“There is no doubt that it is far easier to be a Munchausen patient online than it is in real life,” Feldman said. “It used to be that people had to go to medical libraries and study up on particular aliments and then go to the emergency room and act as if they were sick and hopefully get hospitalized and even get surgery they knew they didn’t really need. Now, all you have to do is sit down at a computer and become an expert in a medical syndrome within 15 minutes by reading Wikipedia or Medscape.”

Eric G. Mart, Ph.D., a forensic psychologist in N.H., said the syndrome has been around for a long time, but has become more pronounced with social media. “If your goal is to get attention and sympathy, what better way?” he said.

Like other versions of this disorder, emotional gratification is the goal. Often, patients are feigning illness for attention and sympathy, Feldman said. Sometimes, they or others start fundraising campaigns.

“They often don’t intend to make money off their lie; but people may establish those accounts on their behalf thinking they need money to pay for the chemotherapy they have to have for the cancer that doesn’t exist,” he said. “The moment that happens it become malingering and the police get interested in those cases.”

Mart said the Munchausen label often gets applied but it could be other things, like fraud or somebody dealing with delusions.

The most common form of Munchausen is factitious disorder, which tends to arrive in late adolescence or early adulthood especially among women and even more so among women in healthcare occupations, Feldman said.

Severe cases tend to be men who don’t have family relationships and have a tenuous connection to society because they go from hospital to hospital feigning illness, he said. Online cases also tend to be women.

Often, patients won’t seek out treatment, but for those that do, there are not many psychologists or psychiatrists offering treatment on the disorder – in part because Munchausen by Internet is not in the DSM-5, Feldman said.

“If you see a Munchausen by Internet patient and try to bill, you are not going to collect anything. People are waiting and watching to see if it’s promoted as a mental disorder.”

In the DSM-5, Munchausen is included as factitious disorder imposed on self or factitious disorder imposed on another, previously known as Munchausen by proxy.

Mart said Munchausen cases are relatively rare, and often, those who have it only seek treatment if they are caught.

By Rivkela Brodsky

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