Munchausen by Internet</TITLE><TITLE>Munchausen by Internet
Munchausen by InternetWithin the past few years, the Internet has exploded into a medium of choice for those interested in health and medicine. Along with the promise of immediate access to authoritative resources via websites, the Internet offers "virtual support groups" through formats such as chat rooms and newsgroups. These person-to-person exchanges, typically focusing on a specific topic, can be invaluable sources of information and compassion for patients and their families. However, individuals may misuse these Internet groups at times, offering false stories of personal illness or crisis for reasons such as garnering attention, mobilizing sympathy, acting out anger, or controlling others. I present four such cases and, based on experience with these and other cases of "virtual" factitious disorder and Munchausen by proxy, summarize indicators of factitious Internet claims and the reactions that participants usually experience once the ruse is recognized.
The Internet has evolved into a massive repository of information, with 37% of users regularly accessing online materials related to health and medicine. With the recognition that anyone can "publish" information through a simple upload, questions have been raised about the reliability of these materials, particularly the evaluation and treatment recommendations that appear on many websites. Organizations such as the Health on the Net Foundation attempt to separate the virtual wheat from the chaff by analyzing and scoring websites according to objective criteria of accuracy and scholarship.
Less attention has been accorded health-related claims and suggestions transmitted person- to-person over the Internet. Formats for such direct communication among patients, family members, and others include newsgroups and mailing lists; chat rooms, clubs, and communities; independent bulletin boards; Internet Relay Chat; private electronic mail (email); and discussions sponsored by websites. These interactions typically take place via the World Wide Web (WWW) or Usenet, a bulletin board system in which messages are arranged into categories. As McLellan notes, "[T]he topics run the gamut of the illness experience: the physical effects of chemotherapy, the jumble of emotions that chronic illness stirs up in families, the bureaucratic entanglements of clinics, hospitals, and insurance companies, miscommunication between doctors and patients, and gratitude for serendipitous acts of kindness." Although these posts can assist others by capturing the feelings and facts of illness and treatment, they usually lack the formal involvement of any health professional and are not subject to the fact-checking that commonly occurs in other media. Therefore, it is not surprising that, in their review of an online discussion group about repetitive strain injury, Culver et al concluded that a third of the advice given was unconventional, unconfirmed, or inappropriate.
The risk exists not only that faulty information will be imparted unwittingly, but also that cyberspace resources will be deliberately mis-used to garner attention and nurturance. Such online behavior can be viewed as a manifestation of factitious disorder or Munchausen by proxy (MBP). In these conditions, individuals willfully feign or induce illness in themselves or in others, respectively. Their goal is emotional gratification from commandeering the sick role. Instead of seeking care at numerous hospitals, these individuals can now gain new audiences merely by clicking from one support group to another. Under the pretense of illness, they can also join multiple groups simultaneously or establish different personae on a single group. False claims of victimization have also been conceptualized as a variant of factitious disorder or MBP. Fabricated reports of stalking, assault, harassment, and sexual abuse have been described in which the motive for the deceptions was mobilization of care and concern, and this manifestation has moved onto the Internet as well. These claims often include elements of pseudologia fantastica, in which one lies floridly about one's personal history, but in a manner that remains compelling.
The following four cases illustrate the misappropriation of the community of support online through the use of spurious illness or victimization. I was alerted to them by one or more of the deceived participants through my website on factitious disorder and MBP (http://www.munchausen.com), and the material was confirmed. Names have been changed to preserve anonymity, though having appeared on the Internet, the case information is a matter of public record. Individuals whom I asked to supply additional information have consented to its use in published work.
The Internet has evolved into a massive repository of information, with 37% of users regularly accessing online materials related to health and medicine. With the recognition that anyone can "publish" information through a simple upload, questions have been raised about the reliability of these materials, particularly the evaluation and treatment recommendations that appear on many websites. Organizations such as the Health on the Net Foundation attempt to separate the virtual wheat from the chaff by analyzing and scoring websites according to objective criteria of accuracy and scholarship.
Less attention has been accorded health-related claims and suggestions transmitted person- to-person over the Internet. Formats for such direct communication among patients, family members, and others include newsgroups and mailing lists; chat rooms, clubs, and communities; independent bulletin boards; Internet Relay Chat; private electronic mail (email); and discussions sponsored by websites. These interactions typically take place via the World Wide Web (WWW) or Usenet, a bulletin board system in which messages are arranged into categories. As McLellan notes, "[T]he topics run the gamut of the illness experience: the physical effects of chemotherapy, the jumble of emotions that chronic illness stirs up in families, the bureaucratic entanglements of clinics, hospitals, and insurance companies, miscommunication between doctors and patients, and gratitude for serendipitous acts of kindness." Although these posts can assist others by capturing the feelings and facts of illness and treatment, they usually lack the formal involvement of any health professional and are not subject to the fact-checking that commonly occurs in other media. Therefore, it is not surprising that, in their review of an online discussion group about repetitive strain injury, Culver et al concluded that a third of the advice given was unconventional, unconfirmed, or inappropriate.
The risk exists not only that faulty information will be imparted unwittingly, but also that cyberspace resources will be deliberately mis-used to garner attention and nurturance. Such online behavior can be viewed as a manifestation of factitious disorder or Munchausen by proxy (MBP). In these conditions, individuals willfully feign or induce illness in themselves or in others, respectively. Their goal is emotional gratification from commandeering the sick role. Instead of seeking care at numerous hospitals, these individuals can now gain new audiences merely by clicking from one support group to another. Under the pretense of illness, they can also join multiple groups simultaneously or establish different personae on a single group. False claims of victimization have also been conceptualized as a variant of factitious disorder or MBP. Fabricated reports of stalking, assault, harassment, and sexual abuse have been described in which the motive for the deceptions was mobilization of care and concern, and this manifestation has moved onto the Internet as well. These claims often include elements of pseudologia fantastica, in which one lies floridly about one's personal history, but in a manner that remains compelling.
The following four cases illustrate the misappropriation of the community of support online through the use of spurious illness or victimization. I was alerted to them by one or more of the deceived participants through my website on factitious disorder and MBP (http://www.munchausen.com), and the material was confirmed. Names have been changed to preserve anonymity, though having appeared on the Internet, the case information is a matter of public record. Individuals whom I asked to supply additional information have consented to its use in published work.