In 2014, Belle Gibson had the wind in its sails. The story of how this young Australian wellness blogger overcame inoperable brain cancer through healthy eating and alternative medicine captured worldwide attention, and her Apple app, The Whole Pantry , recorded 300,000 downloads. A Whole pantry cookbook, to be published by Penguin, was on the way. Then came the bombshell thrown at his more than 200,000 Instagram followers: Gibson’s brain cancer had returned – and spread to his blood, spleen, uterus and liver.

The following year, an even bigger bomb: Gibson had invented everything. She had never had cancer. “None of that is true,” she admitted The Australian Women’s Weekly. His promise to donate some of the proceeds from his app to charity was also bogus. 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 outstanding fine, Sheriff’s Department officers raided his Melbourne home, just weeks before the BBC released its 2021 Documentary Bad Influencer: The Great Insta Con.

If this all sounds like a cautionary tale, it didn’t have much effect. Since Gibson’s story unfolded — and especially since the rise of TikTok — social media sickness simulation has only increased. Follow #malingering on TikTok, and you’ll find countless teenagers calling out their peers to pretend they’re sick. Another TikTok hashtag, #illness, has generated around 400 million views. Granted, many of the people in these videos aren’t faking it, but experts say a growing number are showing signs of factitious disorder, defined by the Mayo Clinic as “a severe mental disorder in which someone cheats others by appearing ill, falling ill, or self-injuring.Munchausen syndrome is a severe and chronic form of factitious disorder, although the two terms are often used interchangeably.

The Rise of 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, clinical professor of psychiatry at the University of ‘Alabama to Tuscaloosa and author of die of being sick. Also known as digital factitious disorder, Munchausen on the Internet refers to medical deception that occurs entirely online, and it has come a long way since Feldman coined the term in 2000. The widespread posting of “videos and still photos that claim to show medical signs and/or medical paraphernalia” – what some call “medical porn” – marked a turning point, according to the doctor. “In 2000, social media posts were largely done in words, with videos being particularly unusual,” he explains. “This change opens the door to highly dramatic presentations that are even more engaging than those released with words alone.”

Unlike Belle Gibson, most people who fake sickness don’t admit the deception — often not even to themselves — and that makes factitious disorder difficult to treat and nearly impossible to quantify. Data from the Cleveland Clinic suggests that around 1% of hospitalized patients have the disease, although a higher number of cases are suspected. Those with factitious disorder usually have unconscious motives and, again unlike Gibson, are generally not seeking material gain. Faking, on the other hand, is defined as lying or exaggerating illness for a specific purpose, such as making money or avoiding jail time. These patients know they are not sick but will pretend to be until they get what they want.

A recent upsurge in factitious disorders has taken place online, where feigned or exaggerated illnesses range from autoimmune deficiencies to leukemia – and, notably, Tourette syndrome and dissociative identity disorder. “Clinicians and researchers have become much more aware of the phenomena of MBI and social contagion lately, and a lot of that seems to be due to TikTok,” Feldman says. Noting that “both genuine and false” symptoms can be seen in user-generated videos, he says that “some of these posts are meant to educate, but many – if not most – appear to be attempts to feel “special” in having a dramatic diagnosis.

‘TikTok Tics’

Since the spread of COVID-19, Tourette’s amplified symptoms in particular have become so prevalent that a 2021 research project described “TikTok tics” as a “mass sociogenic disease” and a “pandemic within a pandemic”. According to this study, by the Department of Neurological Sciences at Rush University Medical Center in Chicago, Tourette’s recent trend is directly linked 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 study subjects identified as female, and they frequently developed tics seen in other TikTok videos. Their average age: 18.8 years.

A recent analysis by Phil Reed, PhD, professor of psychology at Swansea University in the UK, noted that people claiming to be sick on social media tend to be younger than their offline counterparts. Most people with signs of MBI are teenagers, while patients with factitious disorder outside the internet are often in their 30s and 40s. According to Feldman, a significant number of people on social media also show symptoms of a personality disorder such as narcissistic personality disorder and borderline personality disorder. “I think depression and personality disorders…are salient underlying factors in almost all cases of medical deception,” he says.

Signs of MBI aren’t easy to spot, and most laypeople on social media don’t look for them either. After all, it’s hard to imagine people pretending to have, say, terminal cancer when they don’t have it. But there are red flags, such as:

  • Symptom descriptions that appear to have been copied from health sites
  • Near-death experiences followed by incredible recoveries
  • Easily refuted claims related to the simulated disease
  • A sudden medical emergency that brings attention back to the patient
  • An online spokesperson, apparently a friend or relative, who speaks exactly like the patient – because that’s exactly what they are

If you’re feeling compassion and offering support online to someone you think is really sick, finding out you’ve been duped can be very hurtful. The degree of that pain “depends on how involved the person who was cheated has become with the poser and their apparent struggles,” Feldman says. “Most will just see it as a learning experience and be more wary of it going forward. But there have always been those who spend a lot of time online with the poser. … I view them as codependent and empowering. In such cases, he recommends therapy.

Backlash against counterfeiters

Outrage erupted around the world when Belle Gibson was exposed as a fraud, and a woman who was swindled into spending up to 12 hours a day advising someone she believed had cancer had a similar reaction. When the deception was revealed, she described the experience as “emotional rape”.

Today, more and more people know about Munchausen from the internet, as evidenced by r/IllnessFakers, a message board where Reddit users point to what they believe to be medical deception, often ridiculing people with MBI by calling them “Munchies”. But that too poses a danger. Many of those targeted by the chat site turned out to be genuinely ill.

And don’t the counterfeiters have a disease, even if it’s not the one they claim to have? “I wouldn’t want to paint every MBI setter with such a wide brush,” says Feldman. “However, if MBI behaviors are emotionally rewarding, have the potential to be self-destructive, and/or impair the poser’s social or occupational functioning, I would indeed say they have a disease.” Referring to the title of his first book, patient or suitorhe says that “in such cases, the posers are both patients and suitors.