Munchausen and Origins:

Munchausen is a severe form of Factitious Disorder where the person feigns or produces symptoms of illness designed to garner sympathy and attention. (Feldman & Ford, 1995).  In Munchausen, for example, the person may travel and may endure invasive, sometimes dangerous procedures to gain attention and sympathy. The sufferers often take on other personas and invent extensive fabrications to support their claims and gain sympathy.

The word Munchausen comes from Baron Karl Friederich Heironymous Freiherr von Munchausen (1720-1797), a German nobleman and cavalryman, who is said to have regaled his friends and associates with fantastic and often outlandish stories of his exploits.

In 1953, Richard Asher, reported on people feigning illness and  named this disorder after Baron Munchausen. Dr. Asher was a British endocrinologist and haematologist. He worked in the mental observation ward at the Central Middlesex Hospital and described Munchausen Syndrome in an article in 1951 (The Lancet, 1951).
 
Munchausen differing from other disorders:

In her profiling journey, Pat Brown, talks of volunteering in hospitals to learn and observe people’s behaviors and often seeing how some willingly create and act out symptoms to get attention and sympathy and to control others around them, often unaware and uncaring of the toll it takes on others.(Pat Brown, The Profiler: My Life Hunting Serial Killers and Psychopaths, 2010).

Munchausen is also commonly recognized as Munchausen by Proxy, where a primary caregiver fakes or exaggerates illnesses or symptoms in a dependent, usually a child. This illness is extremely difficult to diagnose since the caregiver is often very attentive and caring and puts on a good show. The caregiver is often familiar with the medical illnesses and carefully plans the exaggeration of symptoms, at times, putting the child at grave risk.

Munchausen differs from Malingering which has external incentives, while attention and emotional gains are the driving motives for Munchausen. Malingering is the purposeful production of falsely or grossly exaggerated complaints with the goal of receiving a benefit or reward, such as money, insurance settlement, drugs, avoidance of work or military duty or some other kind of responsibility (Psychology Today, 2010)  

In Somatoform disorders, the symptoms are not voluntarily produced.  The somatoform disorders are a group of psychiatric disorders in which patients present with a myriad of clinically significant but unexplained physical symptoms. They include somatization disorder, undifferentiated somatoform disorder, hypochondriasis, conversion disorder, pain disorder, body dysmorphic disorder, and somatoform disorder not otherwise specified.1 These disorders often cause significant emotional distress for patients and are a challenge to family physicians. (American Family Physician, 2007)

Conversion disorder, also known as Hysterical Neurosis, is a mental health condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. Sufferers are not making up the symptoms and usually are afflicted because of an underlying emotional or psychological conflict/stress or trauma (A.D.A.M. Medical Encyclopedia., Nov 17, 2012)

Munchausen by Internet:

With the advent of the internet and the resources it offers, Munchausen has developed in a new way. As we all know and utilize, and often direct clients to, there is an abundance of online support groups, chat rooms, newsgroups, social media, etc. Often, the ones using these groups, see them as an invaluable resource where they receive and offer support to others like them, sharing their hopes, fears and information. However, at times, some of the members are not there because they too have suffered as the because of an underlying emotional or psychological conflict/stress or trauma (A.D.A.M. Medical Encyclopedia., Nov 17, 2012)

Recent Events:

There have been several recent events reported in the news media about people claiming to be someone they are not, while inserting themselves in people’s lives to gain sympathy and emotional support, like Mandy Wilson and Manti Te’o. The behaviors demonstrated by the Mandy Wilson and T’eo’s relative are surprisingly similar along with the motive of gaining love and sympathy.

Mandy Wilson from Australia, posted her plight to an online support group attended by people from around the world, about her struggle with cancer as a single mother. Her Facebook page showed postings from her friends regarding her condition, which all turned out to be falsely created to get the emotional support and sympathy of the support group members. It all came to light when a 42 year old Canadian, Dawn Mitchell, who was closely involved with Mandy Wilson, grew suspicious after seeing pictures of Mandy after chemotherapy. Mandy had hair growing out quickly, something that doesn’t happen after hair loss due to chemotherapy. Dawn searched for obituaries of Mandy’s friends who had supposedly died and was unable to find any news on their deaths. Dawn was instrumental in exposing Mandy to the other group members. Mandy Wilson disappeared and has probably joined other online support groups under a different persona with a new set of online community supporters She left behind many who were disillusioned and jaded with the online group and hurt at the time and emotional investment they had put forth.

Manti T’eo, a Notre Dame football player, got involved with a woman online in 2011. He never met her in person, but carried on a 2 year online relationship. He went on to dedicate a game to his girlfriend, who he believed to have died because of cancer. When people questioned T’eo about meeting this girl, he claimed to have met her because he did not want to be ridiculed for having a purely online relationship and not questioning the identity of that person. It was eventually revealed that the online persona was created by a family friend who was in love with Te’o. To save face, T’eo frequently changed his story, at one point claiming he had met the woman in person. Te’o, like numerous others, was embarrassed for his gullibility in falling for this deceit.

Unfortunately, as news  stories reveal, Te’o was not initially believed and many a sports writers had a field day making fun of him. The person who defrauded Te’o came up with an elaborate explanation for his actions. He calls himself confused and in recovery from homosexuality.

In the following case, the progression of events are very apparent with how the stage was set, how convincing the story was, how it evolved to fit the needs of the person, and how it hooked those close to her to fill her deep need for attention.

Setting The Stage: Paints a pitiful picture
In the beginning of 2007 after a painful breakup, Liz reconnected with her first cousin, Karen who lived in Toronto. Karen was 14 years younger, told Liz of a difficult childhood, including sexual abuse by a babysitter’s husband and physical abuse by her parents. Karen quickly inserted herself into Liz’s  life, often calling and texting her, telling her about her (Karen’s) medical problems and unsupportive family. Karen told Liz about a horrible gang rape in high school and her first boyfriend dying tragically a few years previous. Karen’s current boyfriend contacted Liz about Karen’s health, showing great concern. Shortly thereafter, Karen accused her boyfriend of raping her and cut off contact with him. Her counselor, in Toronto also contacted Liz, via email and text about Karen’s  depression. When Liz  expressed concern about Karen’s health, Karen’s cardiologist contacted Liz about Karen’s heart problems. From 2007 onwards Karen began visiting Liz  regularly: Karen often  insisted on being introduced as Liz’s oldest daughter.

The Plot Thicken; Hooking The Prey:
In 2007, when Liz  signed on to Chemistry.com, Karen’s counselor in Toronto introduced Liz to her close friend, Tony. This online relationship developed quickly. However, they never talked on the phone and he was reluctant to visit. Karen quickly put any doubts on Liz’s part, to rest, telling Liz  she was friends with Tony’s now deceased daughter, confirming he suffered from PTSD so could not talk on the phone. Karen often assured Liz that Tony would someday visit Liz in the Bay Area.

More Drama
In 2009, Karen told Liz that she had begun a new relationship with her best friend’s ex-boyfriend. She asked for Liz’s help and support as she was afraid of being ostracized by her best friend. Karen’s health problems had escalated and she had now been diagnosed with Lupus. Tragically, Karen’s new boyfriend died suddenly of massive heart failure at the age of 30 in London, England. Tony was instrumental in helping Liz connect with Karen’s new boyfriend during his hospitalization, through some of his good friends who were physicians in England. Along with these physicians there were several minor players introduced, too many to mention here.

The Unraveling
Liz became increasingly exasperated with Tony and his reluctance to meet her. Her relationship with Karen also began faltering in 2012.  Liz cut off contact with Tony, and lost touch with some of the people in Karen’s life, her counselor and cardiologist, who had been regularly contacting her until that time. . Karen’s counselor had sent some bizarre accusatory messages to Liz  regarding Karen’s care, so Liz cut off contact with the counselor.  Liz finally broke off with Karen herself when Karen became increasingly needy and self- centered, all her conversations focusing on herself, her needs and her successes.

The Truth
In the early part of 2013, at the urgings of a friend, Liz began to search for Tony, Karen’s therapist and Karen’s cardiologist. She called other family members to confirm Karen’s illnesses and the people involved in her life. She discovered that none of them existed. In all, Liz found that Karen had created over 12 online personas who had contacted Liz at various points in the past 5 years, to create a concerned and supportive network for Karen. All them were email entities only, all the emails originating from proxy servers and from one single server based in the Bay Area. Some were modeled after real people in Karen’s friend’s lives, but no one in the whole story except Karen was real.

Symptoms or Ways to Recognize Munchausen by Internet: So what do you do when you suspect someone you know online is not being honest? It is important to note, these people are very intelligent and should really be script writers in Hollywood instead of creating elaborate schemes to hook their supporters. Some of the red flags are:

Working knowledge of symptoms of diseases and illnesses, some descriptions match posts and explanations on websites.
Symptoms escalate if doubts are brought up or focus shifts to others.
Miraculous recovery or dissipation of symptoms.
Contradictory statements with no relevant explanations.
Online postings, emails, phone calls,(?) texts etc. by people around the person such as friends, family, etc. who support the individual, often similar wording and patterns. These people never appear in the flesh.
Elaborate stories and events, one more fantastic then the other like dying or moving away, etc.

Some technical ways to verify people and emails: You can find anyone, anywhere, if you know how. I learned a lot and I can find anyone, as long as they exist. Once someone sends an email, they have created an un-erasable path or signature.

Questioning and verifying addresses, if possible, to verify authencity of the user.
Similar methods of communication: same messenger, like Yahoo, or Gmail, which send texts directly to phone numbers.
Find people online using people search engines like People Search, Zaba Search, White Pages.
Use reverse email look up to see originating point of emails. Usually there may be a common originating IP address and/or Proxy servers. Looking for people through home ownership records and other services which are public.

Treatment for the Victims and those diagnosed with Factitious disorder
The victims of people with Factitious Disorder or Munchausen By Internet, often need extensive help and support through their recovery. Their faith and trust in people and the group process is usually shattered. They are deeply ashamed and embarrassed at falling for lies. They need a safe, non-judgmental place to regain that faith and trust again, through individual and ironically, through group therapy. Dr. Feldman recommends an online group therapy to rebuild the broken trust and faith in the power and healing of the group process.

Treatment for those diagnosed with Factitious Disorder, can include several modalities though primarily depends on the
individual’s commitment to change their behaviors. There are no known statistics on successful treatment for Munchausen by Internet.

Some treatment options include but are not limited to:
Traditional talk psychotherapy for the people who commit these frauds is recommended. Treatment includes transparency in their relationships, working in individual and family therapy, on issues of ownership and responsibility. Family therapy increases the chances of recovery, and/or some suppression of some behaviors, like tall tales.

Friends and families can help confront the person and keep them on track. As a word of caution, those involved should be prepared for histrionics and further manipulation. Treating any co-occurring or underlying issues of depression, anxiety or OCD behaviors. Evaluation and treatment for addictions and other maladaptive behaviors.

Those diagnosed with Factitious Disorder, do not take responsibility quickly and easily. They lack empathy for the people hurt by their lies and actions, and often show no remorse for others. Most of the persons who commit such acts usually disappear when confronted. They often manipulate others to generate sympathy for themselves and not their victims.

The Internet can give us a thousand identities and the power to change them as needed. In the end, it is our responsibility to be vigilant of our online communications and interactions, to follow our gut instinct, check and recheck when possible. Remember, if someone feels too good to be true, and you have never seen them, they probably are just that, Too Good To Be True.
  
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I am in full time private practice in Fremont, for the past 7 years. Prior to that, my background includes working for the City of Fremont Youth & Family Services, the Fremont Police Department, Shelter for Violent Environment, the New Haven Unified School District and the Alameda County Sheriff's Office. During the course of the past few years, I have worked with kids, teens, families, individuals and families on a variety of topics. I have dealt with Domestic Violence, Child and Adolescent behavior issues, depression, ADD & ADHD. I work extensively with children, adolescents, individuals, couples and families with emphasis on cross cultural and gender issues, sexuality, assimilation, expectations and communication, using non-verbal methods like play and art therapy with young kids. I am also trained and certified in EMDR.