Back in 2014, Belle Gibson was riding high. The story of how this young Australian wellness blogger had overcome inoperable brain cancer through healthy eating and alternative medicine drew worldwide attention, and her Apple app, The Whole Pantry, racked up 300,000 downloads. A Whole Pantry cookbook, to be published by Penguin, was on the way. Then came the bombshell dropped on her 200,000-plus Instagram followers: Gibson’s brain cancer had returned – and spread to her blood, spleen, uterus, and liver.
The next year, an even bigger bombshell: Gibson had made the whole thing up. She’d never had cancer. “None of it’s true,” she admitted to The Australian Women’s Weekly. Also false was her promise to give a chunk of the proceeds from her app to charity. In 2017, a federal court fined the social media star once called “the queen bee of wellness” $410,000, and last year, in an effort to collect the overdue fine, sheriff’s department officers raided her Melbourne home, just weeks before the BBC released its 2021 documentary Bad influencer: The Great Insta Con.
If all this sounds like a cautionary tale, it hasn’t had much effect. Since Gibson’s story unraveled – and especially since the rise of TikTok – the faking of illness on social media has only increased. Follow #malingering on TikTok, and you’ll find countless teenagers calling out their peers for pretending to be sick. Another TikTok hashtag, #illness, has generated roughly 400 million views. Granted, many of the people in those videos aren’t faking, but experts say a growing number of them show signs of factitious disorder, defined by the Mayo Clinic as “a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury.” Munchausen syndrome is a severe and chronic form of factitious disorder, though the two terms are often used interchangeably.
The Surge on Social Media
Then there’s the online form of factitious disorder, Munchausen by internet (MBI), first identified more than 2 decades ago by Marc D. Feldman, MD, a clinical professor of psychiatry at the University of Alabama in Tuscaloosa and the author of Dying to Be Ill. Also known as digital factitious disorder, Munchausen by internet refers to medical deception that happens completely online, and it has come a long way since Feldman coined the term in 2000. The widespread posting of “videos and still photos that purport to show medical signs and/or medical paraphernalia” – what some call “medical porn” – marked a turning point, according to the doctor. “In 2000, posts to social media were largely through words, with videos being particularly unusual,” he explains. “This change opens the door to very dramatic presentations that are even more engaging than those posted with words only.”
Unlike Belle Gibson, most people who feign illness don’t confess to the deception – often not even to themselves – and that makes factitious disorder hard to treat and nearly impossible to quantify. Cleveland Clinic data suggests that about 1% of hospital patients have the disorder, though a higher number of cases is suspected. Those with factitious disorder generally have unconscious motives and, again unlike Gibson, aren’t typically out for material gain. Malingering, on the other hand, is defined as lying or exaggerating sickness with a specific aim, such as getting money or avoiding a jail sentence. These patients know they aren’t sick but will pretend to be until they get what they want.
A recent surge in factitious disorder has taken place online, where faked or exaggerated illnesses range from autoimmune deficiencies to leukemia – and, notably, Tourette’s syndrome and dissociative identity disorder. “Clinicians and researchers have become much more aware of the phenomena of MBI and social contagion lately, and it appears to be due largely to TikTok,” Feldman says. Noting that “both authentic and false” symptoms can be seen in user-generated videos, he says that “some of these posts are intended to educate, but many – if not most – seem to be attempts to feel ‘special’ by having a dramatic diagnosis.”
Since the spread of COVID-19, amped-up Tourette’s symptoms in particular have become so prevalent that a 2021 research project described “TikTok tics” as a “mass sociogenic illness” and a “pandemic within a pandemic.” According to this study, done by the Department of Neurological Sciences at Rush University Medical Center in Chicago, the recent trendiness of Tourette’s is tied directly to TikTok, which saw an 800% increase in users between January 2018 and August 2020, when the number of its users worldwide reached 700 million. Although boys are more likely than girls to be diagnosed with Tourette’s, 64.3% of the study’s subjects identified as female, and they frequently developed tics seen in other TikTok videos. Their average age: 18.8 years old.
A recent analysis by Phil Reed, PhD, a professor of psychology at the University of Swansea in the U.K., noted that people pretending to be sick on social media tend to be younger than their off-line counterparts. Most of the people with signs of MBI are in their teens, while factitious disorder patients outside the internet are often in their 30s and 40s. A significant number of those on social media also show symptoms of a personality disorder such as narcissistic personality disorder and borderline personality disorder, according to Feldman. “I think that depression and personality disorders … are salient as underlying factors in almost all medical deception cases,” he says.
Signs of MBI aren’t easy to spot, nor do most laymen on social media look for them. After all, it’s difficult to imagine that people would claim to have, say, terminal cancer when they don’t. But there are red flags, such as:
- Descriptions of symptoms that appear to have been copied from health sites
- Near-death experiences followed by incredible recoveries
- Easily disproved claims linked to the feigned illness
- A sudden medical emergency that brings attention back to the patient
- An online spokesperson, seemingly a friend or relative, who sounds just like the patient – because that’s exactly who it is
If you feel compassion and offer online support to someone you believe is truly sick, the discovery that you’ve been duped can be very hurtful. The degree of that pain “depends on the extent to which the person who has been deceived has gotten involved with the poser and their apparent struggles,” Feldman says. “Most will simply view it as a learning experience and be more circumspect in the future. But there have always been those who spend vast amounts of time online with the poser. … I think of them as codependent and enabling.” In such cases, he recommends therapy.
Backlash Against Fakers
Outrage erupted around the world when Belle Gibson was exposed as a fraud, and one woman who was conned into spending up to 12 hours a day counseling someone she believed to have cancer had a similar reaction. When the deceit came to light, she described the experience as “emotional rape.”
Today, more people are aware of Munchausen by internet, as evidenced by r/IllnessFakers, a message board where Reddit users point their fingers at what they believe to be medical deception, often deriding people with MBI as “Munchies.” But this, too, poses a danger. Many of those targeted by the discussion site have turned out to be genuinely sick.
And don’t the fakers have an illness, even if it’s not the one they pretend to have? “I would not want to paint all MBI posers with that broad a brush,” says Feldman. “However, if the MBI behaviors are emotionally gratifying, have the potential to be self-defeating, and/or impair the poser’s social or occupational functioning, I would indeed say that they have an illness.” Alluding to the title of his first book, Patient or Pretender, he says that “in such cases, the posers are both patients and pretenders.”