The internet is a medium of choice for millions of people who seek health-related information. In addition to websites presenting ostensive medical facts, thousands of virtual support groups have sprung up for those suffering from particular illnesses. Whether formatted as chatrooms, as newsgroups or in other ways, they offer patients and families the chance to share their hopes, fears and knowledge with others experiencing life as they are.
These online groups can counter isolation and serve as bastions of understanding, deep concern and even affection. But despite the apparent intimacy of many health support groups, individuals sometimes choose to mislead others by pretending to have illnesses they do not have – the latest high-profile case of which surfaced this week after "David Rose", a prolific paraplegic blogger, was exposed as a hoax.
The eventual discovery of these online deceptions can be devastating. As I was alerted to such cases by people who had attended my lectures on "real-life" Munchausen syndrome 12 years ago, I dubbed this phenomenon "Munchausen by internet". This term has gone viral as the number of recognised cases has exploded.
For decades, physicians have known about this so-called factitious disorder. Afflicted people will wilfully feign, exaggerate or self-induce illness to command attention, obtain lenience, act out anger or control others. Though feeling entirely well, they may bound into hospitals, crying out or clutching their chests with dramatic flair. Once admitted, they send the staff on one medical goosechase after another. If suspicions are raised or the ruse is uncovered, they quickly move on to a new hospital, town or even country. Like travelling performers, they simply play their roles again.
I coined the term "Munchausen by internet" to refer to people who simplify this process by carrying out their deceptions online, and it appears, because of its ease, to be much more common than its real-life progenitor. Instead of seeking care at hospitals, these pretenders gain new audiences merely by clicking from one support group to another. Under the guise of illness, they can also join multiple groups simultaneously. Using different names and accounts, they can even sign on to one group as a stricken patient, his frantic mother and his distraught son – "sockpuppets" designed to make the ruse utterly convincing. Each of these characters may have a bogus Facebook account or exploit other social networks such as Twitter.
Based on more than 100 cases of Munchausen by internet shared with me via my Munchausen website, I have arrived at a list of clues to the detection of false internet illness claims that I first developed for the Southern Medical Journal. The most important are:
1. The posts consistently duplicate material in other posts, in books or on health-related websites.
2. The characteristics of the supposed illness emerge as caricatures.
3. Near-fatal bouts of illness alternate with miraculous recoveries.
4. The claims are fantastic, contradicted by subsequent posts or flatly disproved.
5. There are continual dramatic events in the person's life, especially when other group members have become the focus of attention.
6. There is feigned blitheness about crises that will predictably attract immediate attention.
7. Others apparently posting on behalf of the patient (eg family members, friends) have identical patterns of writing.
The most important lesson is that, while most people visiting virtual support groups are honest, everyone must balance empathy with circumspection. One should be especially careful about basing their personal healthcare decisions on uncorroborated information supplied on the internet. When Munchausen by internet seems likely, it is best to have a small number of established members gently, empathically and privately question the author of the dubious posts. Even though the typical response is passionate denial regardless of the strength of the evidence, the author will typically eventually disappear from the group. Remaining members may need to enlist help in processing their feelings, ending any bickering or blaming and refocusing the group on its original laudable goal.
