Munchausen by Internet

Munchausen by Internet

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Münchausen by Internet is a pattern of behavior in which Internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...

 users seek attention by feigning illnesses in online venues such as chat room
Chat room
The term chat room, or chatroom, is primarily used by mass media to describe any form of synchronous conferencing, occasionally even asynchronous conferencing...

s, message boards, and Internet Relay Chat
Internet Relay Chat
Internet Relay Chat is a protocol for real-time Internet text messaging or synchronous conferencing. It is mainly designed for group communication in discussion forums, called channels, but also allows one-to-one communication via private message as well as chat and data transfer, including file...

 (IRC). It has been described in medical literature as a manifestation of factitious disorder
Factitious disorder
Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...

 or factitious disorder by proxy
Munchausen syndrome by proxy
Münchausen syndrome by proxy is a label for a pattern of behavior in which care-givers deliberately exaggerate, fabricate, and/or induce physical, psychological, behavioral, and/or mental health problems in others. Other experts classified MSbP as a mental illness...

. Reports of users who deceive Internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The pattern was identified in 1998 by psychiatrist Marc Feldman, who created the term "Münchausen by Internet" in 2000. It is not included in the fourth revision of the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

(DSM-IV-TR).

The development of factitious disorders in online venues is made easier by the availability of medical literature on the Internet, the anonymous and malleable nature of online identities
Online identity
An online identity, internet identity, or internet persona is a social identity that an Internet user establishes in online communities and websites...

, and the existence of communication forums established for the sole purpose of giving support to members facing significant health or psychological problems. Several high-profile cases have demonstrated behavior patterns which are common among those who pose as gravely ill, victims of violence, or whose deaths are announced to online forums. The virtual communities that were created to give support, as well as general non-medical communities, often express genuine sympathy and grief for the purported victims. When fabrications are suspected or confirmed, the ensuing discussion can create schisms in online communities, destroying some and altering the trusting nature of individual members in others.

Characteristics


The term "Münchausen by Internet" was first used in an article published in the Southern Medical Journal written by Marc Feldman in 2000. Feldman, a clinical professor
Clinical Professor
Clinical Professor is an academic appointment made to a member of a profession who is associated with a university and engages in practical instruction of professional students. It generally does not offer a "tenure track," but can be either full or part time, and is typically noted for its...

 of psychiatry at the University of Alabama at Birmingham
University of Alabama at Birmingham
The University of Alabama at Birmingham is a public university in Birmingham in the U.S. state of Alabama. Developing from an extension center established in 1936, the institution became an autonomous institution in 1969 and is today one of three institutions in the University of Alabama System...

, gave a name to the phenomenon in 2000, but he co-authored an article on the topic two years earlier in the Western Journal of Medicine, using the description "virtual factitious disorder". Factitious disorder
Factitious disorder
Factitious disorders are conditions in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder by proxy is a condition in which a person deliberately produces, feigns, or exaggerates symptoms in a person who is in their...

s are described in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

(DSM) as psychological disorders involving the production of non-existent physical or psychological ailments to earn sympathy. These illnesses are feigned not for monetary gain or to avoid inconvenient situations, but to attract compassion or to control others. Chronic manifestation of factitious disorder is often called Münchausen syndrome
Munchausen syndrome
Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...

, after a book about the exaggerated accounts of the adventures of Baron Münchhausen
Baron Munchhausen
Karl Friedrich Hieronymus, Freiherr von Münchhausen , usually known as Baron Münchhausen in English, was a German nobleman born in Bodenwerder and a famous recounter of tall tales....

, a German cavalry officer in the Russian Army, that was written by Rudolf Erich Raspe
Rudolf Erich Raspe
Rudolf Erich Raspe was a German librarian, writer and scientist, called by his biographer John Carswell a "rogue"...

. When another person's symptoms are caused, such as a child or an elderly parent's, it is called factitious disorder by proxy, or Münchausen syndrome by proxy.

Feldman noted that the advent of online support group
Support group
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic...

s, combined with access to vast stores of medical information, were being abused by individuals seeking to gain sympathy by relating a series of harrowing medical or psychological problems that defy comprehension. Communication forums specializing in medical or psychological recovery were established to give lay users support in navigating often confusing and frustrating medical processes and bureaucracy. Communities often formed on those forums, with the goal of sharing information to help other members. Medical websites also became common, giving lay users access to literature in a way that was accessible to those without specific medical training. As Internet communication grew in popularity, users began to forgo the doctors and hospitals often consulted for medical advice. Frequenting virtual communities that have experience with a medical problem, Feldman notes, is easier than going through the physical pain or illness that would be necessary before visiting a doctor to get the attention sought. By pretending to be gravely ill, Internet users can gain sympathy from a group whose sole reason for existence is support. Health care professionals, with their limited time, greater medical knowledge, and tendency to be more skeptical in their diagnoses, may be less likely to provide that support.

People who demonstrate factitious disorders often claim to have physical ailments or be recovering from the consequences of stalking
Stalking
Stalking is a term commonly used to refer to unwanted and obsessive attention by an individual or group to another person. Stalking behaviors are related to harassment and intimidation and may include following the victim in person and/or monitoring them via the internet...

, victimization, harassment
Harassment
Harassment covers a wide range of behaviors of an offensive nature. It is commonly understood as behaviour intended to disturb or upset, and it is characteristically repetitive. In the legal sense, it is intentional behaviour which is found threatening or disturbing...

, and sexual abuse
Sexual abuse
Sexual abuse, also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another. When that force is immediate, of short duration, or infrequent, it is called sexual assault. The offender is referred to as a sexual abuser or molester...

. Several behaviors present themselves to suggest factors beyond genuine problems. After studying 21 cases of deception, Feldman listed the following common behavior patterns in people who exhibited Münchausen by Internet:
  • Medical literature from websites or textbooks is often duplicated or discussed in great detail.
  • The length and severity of purported physical ailments conflicts with user behavior. Feldman uses the example of someone posting in considerable detail about being in septic shock
    Septic shock
    Septic shock is a medical emergency caused by decreased tissue perfusion and oxygen delivery as a result of severe infection and sepsis, though the microbe may be systemic or localized to a particular site. It can cause multiple organ dysfunction syndrome and death...

    , when such a possibility is extremely unlikely.
  • Symptoms of ailments may be exaggerated as they correspond to a user's misunderstanding of the nature of an illness.
  • Grave situations and increasingly critical prognoses are interspersed with "miraculous" recoveries.
  • A user's posts eventually reveal contradictory information or claims that are implausible: for example, other users of a forum may find that a user has been divulging contradictory information about occurrence or length of hospital visits.
  • When attention and sympathy decreases to focus on other members of the group, a user may announce that other dire events have transpired, including the illness or death of a close family member.
  • When faced with insufficient expressions of attention or sympathy, a forum member claims this as a cause that symptoms worsen or do not improve.
  • A user resists contact beyond the Internet, by telephone or personal visit, often claiming bizarre reasons for not being able to accept such contact.
  • Further emergencies are described with inappropriate happiness, designed to garner immediate reactions.
  • Other forum members post on behalf of a user, exhibiting identical writing styles, spelling errors, and language idiosyncrasies, suggesting that the user has created fictitious identities
    Sockpuppet (Internet)
    A sockpuppet is an online identity used for purposes of deception. The term—a reference to the manipulation of a simple hand puppet made from a sock—originally referred to a false identity assumed by a member of an internet community who spoke to, or about himself while pretending to be another...

     to move the conversation in their direction.

Notable cases


Feldman's article in the Western Journal of Medicine was picked up by The New York Times
The New York Times
The New York Times is an American daily newspaper founded and continuously published in New York City since 1851. The New York Times has won 106 Pulitzer Prizes, the most of any news organization...

in a story by Denise Grady, who described three cases of Internet forum members who were "incorrigible fakers". These include a woman with a professed eating disorder
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...

 who posted to a support group saying she was reporting from an intensive care unit
Intensive Care Unit
thumb|220px|ICU roomAn intensive-care unit , critical-care unit , intensive-therapy unit/intensive-treatment unit is a specialized department in a hospital that provides intensive-care medicine...

 via her laptop computer, and claimed to have had a stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

 while online, to be followed by her mother's posts declaring that she too had to be hospitalized; the original poster's father purportedly continued to update the online group. In another example, a teenager frequenting a forum for mothers with premature infants
Premature birth
In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...

—some of whom had endured lengthy, expensive, and painful medical procedures, or had died—claimed to have given birth to a premature baby and expressed her fears for her own child, after which she received support and sympathy from the 400-member group. The teenager confided to the group that her baby had also died, and soon after returned to the forum to announce she was again pregnant and feared her baby would be premature, which it turned out to be, more frail this time than the first. Forum members eventually became unsympathetic with her vivid descriptions of surgeries and confronted her. Grady also addresses a similar confrontation that occurred when a man who claimed to be a monk with end-stage cancer posted long descriptions of his trials and struggles with facing death alone, eventually arousing the suspicions of other forum members who were not convinced someone so sick could correspond with so much vitality.

Some deceptions may take many months to unravel, such as a case that lasted over a year involving a 15-year-old boy participating in an online support group for people enduring debilitating migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...

 headaches. Some of the group's members had been on disability pension
Disability pension
A disability pension is a form of pension given to those people who are permanently or temporarily unable to work due to a disability. It is distinct from welfare.- North America :...

 or gone through drug regimens for years to no avail. The boy represented his mother as deaf and his father an alcoholic, and he reported seizures and hemophilia as complicating conditions. However, he also claimed to be a medical student who performed as a drummer in a band. Resources of the forum became constantly directed at the boy, especially when some members expressed doubt about his story. The boy's mother—previously noted by him to be neglectful—logged on to post that questions about his conditions would worsen them; when they did not cease, he left the group, saying the atmosphere violated "the spirit of the internet".

Internet venues unrelated to medical issues have also been the audience for such cases. A member of an online fan club for the musical Rent
Rent (musical)
Rent is a rock musical with music and lyrics by Jonathan Larson based on Giacomo Puccini's opera La bohème...

divulged numerous illnesses that caused her to slip in and out of comas, prompting some cast members to send sympathy cards. When other fan club members expressed their concern, even purchasing airline tickets to visit the sick woman, she reported that she had immediately improved.

From 1999 to 2001 a 40-year-old homemaker named Debbie Swenson perpetrated a ruse under the identity Kaycee Nicole
Kaycee Nicole
Kaycee Nicole was a fictitious persona played by Debbie Swenson in a well-known case of Münchausen by Internet. Between 1999 and when the hoax was discovered in 2001, Swenson, playing the role of Kaycee, represented herself on numerous websites as a teenager suffering from terminal leukemia...

, a 19-year-old woman in Kansas who shared the details of her battles with leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...

 online. The Guardian
The Guardian
The Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...

newspaper reported that millions of Internet users read the fictional blog
Blog
A blog is a type of website or part of a website supposed to be updated with new content from time to time. Blogs are usually maintained by an individual with regular entries of commentary, descriptions of events, or other material such as graphics or video. Entries are commonly displayed in...

, as well as Swenson's own blog, in which she posed as Kaycee Nicole's mother, describing the trials of living with an intelligent and optimistic daughter who was dying. On May 16, 2001, Kaycee Nicole's death of an aneurysm
Aneurysm
An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...

 was announced, shocking her readers and causing them intense grief. Soon however, Swenson caused skepticism in online communities. Although many cards and gifts had been previously sent, she refused to accept more. People began to learn that no one named Kaycee Nicole lived in Kansas, had been enrolled in schools, or admitted to local hospitals, and no obituary had been printed. The photo representing the girl was found to be that of a local basketball player, who was alive. After repeated questioning, Swenson posted that she had woven the stories of three cancer patients to create the character of Kaycee Nicole, who had never existed.

Causes


Feldman has admitted in several interviews that he has been the victim of people who email him to explain psychiatric symptoms, only to divulge eventually that they created it all to fool a doctor. For prolonged cases, he states the impetus for such behavior is the "longing for nurturing, sympathy, care and concern that they feel unable to get in appropriate ways," and that the admiration of forum members is a strong motivator to continue. As manipulation is integral to most cases, the need to control others to feel as if the perpetrator is in control of his or her own life is apparent, as is the pre-existence of underlying personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

s. Many people who present factitious disorders crave sympathy and support because it was notably absent in childhood. In a story published in The Village Voice
The Village Voice
The Village Voice is a free weekly newspaper and news and features website in New York City that features investigative articles, analysis of current affairs and culture, arts and music coverage, and events listings for New York City...

in 2001, a woman recovering from factitious disorder remembered her drive to create conditions that did not exist: "When I'd do something to attract the paramedics and police, I got an adrenaline rush. I believe I got addicted to it. At the time, it didn't occur to me I was hurting anyone but myself." A psychologist who was a member of the support group for premature infants stated in The New York Times article, "People who do this need something. I wonder if it's a metaphor for some other loss she experienced and is playing over and over again in different shapes."

Feldman reports that most of the cases of Münchausen by Internet communicated to him come from the United States, although he has corresponded with forum members making inquiries from Australia, Canada, New Zealand and the United Kingdom. Reports parallel manifestations of factitious disorder, peaking between a person's 20s and 30s.

In an article published in The Guardian, Steve Jones, a communications professor at the University of Illinois at Chicago
University of Illinois at Chicago
The University of Illinois at Chicago, or UIC, is a state-funded public research university located in Chicago, Illinois, United States. Its campus is in the Near West Side community area, near the Chicago Loop...

, gave his perspective on the Kaycee Nicole case. Jones credits the anonymity of the Internet for impeding people's abilities to realize when someone is lying: "Given the mutability of identity, how are we to negotiate social relations that, at least in the realm of face-to-face communication, were fixed by recognition of identity?" Online interaction has only been possible since the 1980s, steadily growing over the years. After analyzing several cases of online deception and interaction, social theorists Adam Joinson and Beth Dietz-Uhler write in a 2002 Social Science Computer Review article that deception on the Internet is a paradox: the faceless nature of online communications not only gives opportunity to the unscrupulous and attention-seekers, but also allows earnest users to express themselves more freely, representing a truer version of themselves. Typically, Internet deception takes the form of gender masking or presenting one's own idealized image of oneself. Joinson and Dietz-Uhler cite a chapter in Network and Netplay, in which researchers note the purpose of some forums is to allow their members to participate in a kind of online party, affording chances to pretend and perform: "the type of play on the Internet is usually allowed only in children or adults during masked balls or carnivals". More practical issues such as age, location, marital status, and occupation are also frequently changed online, or left ambiguous to preserve users' privacy or continue identity play.

Discovery and impact on online communities


Forum members whose ruses are discovered by their support groups are frequently banned from such communities—sometimes after demanding that site administrators do so—moving to other websites to display other ailments. Denise Grady noted in The New York Times that the woman with the eating disorder moved to a group for sexual abuse survivors then another where she claimed to be dying of AIDS. An article in The Weekend Australian
The Australian
The Australian is a broadsheet newspaper published in Australia from Monday to Saturday each week since 14 July 1964. The editor in chief is Chris Mitchell, the editor is Clive Mathieson and the 'editor-at-large' is Paul Kelly....

highlighted an example of this in 2003: a woman in London admitted to belonging to online support forums dedicated to helping members cope with migraines, grieving over dead children, and breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

, all at the same time. She told a psychiatrist that she would study a specific malady and subsequently present herself with its symptoms; her time at each forum followed a daily schedule. Others disappear and simply stop posting, such as the monk who claimed to have cancer.

When confronted with inaccuracies or inconsistencies, those who are suspected of perpetrating fabrications may compound the deceit by accusing forum members of imposing greater stresses upon them, exacerbating their conditions, or worsening their depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

. Users may employ sockpuppet
Sockpuppet (Internet)
A sockpuppet is an online identity used for purposes of deception. The term—a reference to the manipulation of a simple hand puppet made from a sock—originally referred to a false identity assumed by a member of an internet community who spoke to, or about himself while pretending to be another...

s—separate online identities controlled by the same person—to accuse other forum members of disloyalty and persecution, or support the user who is under suspicion. Feldman's 1998 article in the Western Journal of Medicine notes a case in which a member of a support group for people with Chronic Fatigue Syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...

 created a husband, sister-in-law, and family friend who simultaneously engaged in arguments with and about the original member; when the amount of attention directed toward the original member became inadequate, she claimed the sister-in-law committed suicide in response to the lack of support.

Other perpetrators suggest that their lying may actually assist group members, as one member of a Harry Potter
Harry Potter
Harry Potter is a series of seven fantasy novels written by the British author J. K. Rowling. The books chronicle the adventures of the adolescent wizard Harry Potter and his best friends Ron Weasley and Hermione Granger, all of whom are students at Hogwarts School of Witchcraft and Wizardry...

 fan forum posted following the discovery that she had not, in fact, died of tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...

: "After realising the effect my bravery in my illness had on people, I then used it as a vehicle to try and get some of the idiot emo kids on [the forum] to buck up and realise they don't really have it all that bad ... the lie was worth something, wasn't it? How bad is a lie if it helps?"

Because no money is exchanged and laws are rarely broken, there is little legal recourse to take upon discovery of someone faking illness. However, a participant in a 7,000-member online support group brought a lawsuit against a website for defamatory language in 2005. The lawsuit followed heated discussion on the website about his dire predicaments and related crises, which seemed to contradict medical knowledge and his own accounts. The lawsuit was withdrawn after the presiding judge intended to allow cross-examination of the plaintiff's medical history.

Such dramatic situations often polarize online communities, making many members feel ashamed for believing elaborate lies while others remain staunch supporters. Members who admit to feigning their conditions often respond by implicating the gullibility of forum members, suggesting it is their own fault for being deceived. Feldman admits that an element of sadism may be evident in some of the more egregious abuses of trust. A grief counselor named Pam Cohen, who witnessed the outpouring of emotion for Kaycee Nicole, likened the personal devastation resulting from genuine concern, sympathy, and support that forum members gave to the 19-year-old and her mother only to discover none of it was true, to "emotional rape". Joinson and Dietz-Uhler in Social Science Computer Review, address deception perpetrated on some forums—specifically IRC and multi-user dungeons
MUD
A MUD , pronounced , is a multiplayer real-time virtual world, with the term usually referring to text-based instances of these. MUDs combine elements of role-playing games, hack and slash, player versus player, interactive fiction, and online chat...

—and state that masquerading is so common that hoaxes are expected, and their perpetrators are sometimes even praised for creating realistic ones.

Other perpetrators react by issuing general accusations of dishonesty to everyone, following the exposure of such fabrications. The support groups themselves often bar discussion about the fraudulent perpetrator, in order to avoid further argument and negativity. Many forums do not recover, splintering or shutting down. In 2004, members of the blog hosting service LiveJournal
LiveJournal
LiveJournal is a virtual community where Internet users can keep a blog, journal or diary. LiveJournal is also the name of the free and open source server software that was designed to run the LiveJournal virtual community....

 established a forum dedicated to investigating cases of members of online communities dying—sometimes while online. Writer Howard Swains referred to the online deaths as "pseuicides" in Wired.com. New Zealand PC World Magazine called Münchausen by Internet "cybermunch", and those who posed online "cybermunchers". The LiveJournal forum reported in 2007 that of the deaths reported to them about 10% were real.

External links