April 22, 2003
By Anne E. Stein
Orlando Sentinel staff writer
The boy named "Chris" posting to an online support group for migraine sufferers had a story that was odd but plausible enough, at least initially.
He was 15 and struggling with intractable migraines. Rather amazingly, as some sort of child genius, he was attending medical school. His youth and unique qualities brought him instant sympathy from the group.
Later he revealed that he suffered from hemophilia and a seizure disorder because his father had thrown him against a wall. His stepfather was an alcoholic, and his mother was deaf.
Taken all together in hindsight, Chris' history was ridiculous. Because it came out in bits and pieces, however, his fellow migraine sufferers bought it, even though Chris wouldn't say where he went to medical school because his "mother" wouldn't let him.
Chris also posted that he skateboarded three miles to a bus stop to get to class and made money playing drums at a nightclub. Unbelievable? Sure. But suspicious members of the group were criticized.
"When anyone came back at the kid with disbelief, others would rally around him like he was being attacked," recalled Diane Hamilton, a New Jersey library administrator and former migraine sufferer who posted to the group from 1997 to 1999.
Eventually Chris' "mother" signed on and scolded the group, saying the questions could send him into a deep depression. When the questioning continued, "Chris" complained that the spirit of the Internet had been violated and he stopped posting.
There are thousands of health and medical support groups on the Web similar to the migraine group, focusing on everything from cancer and lupus to multiple sclerosis and depression.
The groups, some connected to medical Web sites, serve as invaluable sources for families and patients to exchange information on doctors, drugs and current treatments, as well as a place for 24-hour-a-day sympathy and compassion.
But they've also become a target for cyberspace fakers pretending to be ill. It's what factitious-disorders expert Dr. Marc Feldman, a psychiatrist in Birmingham, Ala., has dubbed Munchausen by Internet, or MBI.
Variation of syndrome
It's a new variation on Munchausen syndrome, in which people feign, exaggerate or actually self-induce illness in order to win attention and nurturing they feel unable to obtain any other way.
Instead of seeking care and attention at hospitals and doctors' offices as traditional Munchausen patients do, Feldman explained, these people click from one online support group to the next, establishing different stories and personalities on various sites.
Social workers discovered that a woman in a Duke-sponsored breast cancer support group had been faking her illness, even shaving her head and losing 50 pounds to mimic the effects of chemotherapy.
Feldman treated the woman and started studying and writing about Munchausen syndrome and Munchausen syndrome by proxy, in which a person makes another person ill, often a mother inducing illness in a child.
In 1997, he discovered what he calls Munchausen by Internet, a phenomenon that hethinksis increasing as the number of online support groups grows.
"It's not just a playful activity, where you try on a persona and discard it because it's a game," he said. "The consequences have been really tragic in MBI cases."
Feldman's first published paper on MBI appeared in the July 2000 issue of the Southern Medical Journal. Since then he has been contacted by numerous victims of MBI via his Web site, www.munchausen.com.
The problem with MBI is that illness-based online groups may be some people's sole support. While the betrayal is happening, valuable time and resources are displaced from those who need them.
For the housebound, the groups are a lifeline to the outside world and the only connection to people living as they do.
"To have someone make a mockery of their illness and misappropriate it does matter," Feldman said. Some victims feel they can never again log on and post intimate things about themselves.
Feldman cited several cases where people actually have staged their own "deaths" online, in real time. For instance, he says, one individual was being actively challenged by others in his bipolar disorder support group.
He seemed to be using the group as a cruising spot. Several of the women discovered he had arranged real-life trysts among different members, Feldman says. When he was accused, he typed and staged his suicide. That was followed by his "son" typing, "Oh, my God, my father just shot himself."
"Several days later the group, which believed this actually occurred, had an online wake that the son attended," Feldman says.
"A couple of weeks later some of the less-gullible members of the group figured it all out; the fellow who had supposedly killed himself then signed on and said, 'You forced me to do this because of your lack of sympathy.' He was very blaming, very psychopathic."
Although not all cases are that dramatic, they follow similar patterns.
For example, a person's story becomes more unbelievable over time; the posts duplicate material in other Web sites, posts or text books; characteristics of the person's illness are based on his/her misconceptions and are inaccurate; claims are contradicted by later posts or are disproved (calls toahospital can't confirm the patient is there); the person resists telephone contact or won't reveal other basic facts.
"I think it's a widespread problem," Feldman said.
Studies estimate that every moderate-sized hospital has one Munchausen
patient at any given time. In the online world, that number is probably
higher. "It's much easier to do this online than in real life. And I think
there are loads of cases where people are too smart and crafty to be detected
but ultimately tire of the game and move on."
Copyright © 2003, Orlando Sentinel