Münchausen by Internet: On Lying Online

If these stories sound too implausibly tragic to be true, that's because they are. Casey and Brett and J.S. are all false identities created by people seeking sympathy online, in the process duping followers and newfound friends on blogs and illness-support forums. Countless others, most of them women, engage in this particular brand of deception. But despite what gossip-blog, Catfish-esque sensationalism may have you believe, many of these elaborate, escalating fabrications aren't necessarily done with malicious intent; rather, they're likely a manifestation of mental illness.

Münchausen syndrome is a factitious disorder in which people feign, exaggerate, or create medical problems--sometimes to the extent of self-harm, like poisoning their blood with injections of feces or gasoline--in order to gain compassion. Similarly, Münchausen by Proxy is when caregivers (usually parents) create physical health problems for those in their care (usually their children). Münchausen by Internet (MBI) is a mostly unrecognized offshoot of these. Those who engage in it play out their illnesses and struggles online, for a vulnerable audience going through their own losses--instead of for medical professionals--without necessarily making themselves sick.

In 1998, Dr. Marc Feldman, a psychiatrist and leading expert in the Münchausen field, was the first to identify MBI. In his years of study he has noticed that Münchausen patients fit a specific profile.

"Obviously, there are exceptions, and some of the more egregious, sadistic cases are carried out by men, but the bulk of the cases--the run of the mill Münchausen by Internet, if you will--seems to be carried out by women," he explained. Also noted: These women often tend to be white, in their late-teens to early-30s, living in the middle of nowhere and suffering from other mental illnesses.

One of the better-known Münchausen by Internet cases in recent years is that of J.S. Dirr. As a cancer crusader, J.S. maintained a Facebook page, "Warrior Eli," chronicling his son's kidney condition. When he wrote on Mother's Day that his wife had died, the post reached more than 6,000 fans overnight. Skeptics eventually exposed J.S. as Emily Dirr, a 22-year-old former medical student from Ohio who had been fabricating identities for more than 11 years.

Dirr's commitment to the fabrication was impressive, to put it mildly--she had reportedly created 71 Facebook profiles, otherwise known as "sock puppets," to verify J.S.'s identity through comments and photo tagging. Previously, she had written blogs as J.S., documenting his life as a Canadian Mountie and his exploits with ex-girlfriends. As J.S., she'd also allegedly dabbled in online affairs and a texting friendship with a teenage girl.

Even though the entire Warrior Eli saga went viral, it wouldn't be hard for Dirr to slip back into the online shadows under a new pseudonym--which is what many Münchausen by Internet engagers do. With no criminal repercussions for screwing with people's emotions, the Internet has become a safe space for attention-seekers and the often undiagnosed mentally ill.

"When men act out, they tend to do it in overtly criminal ways and end up in prisons," said Feldman. "When women act out, it tends to be within systems. It also seems that women feel freer to use social media and get their needs met through that avenue instead of being overtly sociopathic."

While most MBI cases are tamer than Dirr's, and thus more likely to go undetected, there are instances where fabrications become almost unimaginably serious and layered. Taryn Harper Wright, one of the key figures in exposing the Warrior Eli hoax, now runs a blog devoted to untangling the complicated narratives surrounding those who construct false tragedies to garner sympathy online. Using tips and evidence sent to her by volunteers and readers, she has since uncovered nearly 20 more deceptions, including the story of Iraland Ramano, whom she outed as 18-year-old named Brianna Johnson in Ohio.

As Iraland, Johnson managed to convince scores of young online supporters that she was ill with multiple cancers. Her new friends sold "Hope for Iree" bracelets at their schools and made candle bags to raise awareness; one texted back and forth with her multiple times a day. Iraland's crises seemed to escalate whenever she wasn't getting her friend's undivided attention, and, eventually, her ongoing tale of tragedy came to include the death of her boyfriend and his father. In another widely covered case, a woman named Joanie Faircloth accused Conor Oberst of rape and later recanted last year. In a suit since dropped, Oberst's lawyers claimed Faircloth wasn't new to telling untruths, previously posing as a cancer patient online, as well as a boy named Zac who eventually committed suicide.

While Johnson, Faircloth, and many of these "hoaxers" have never been publicly diagnosed with a disorder, there is a pattern of deception that underpins their severe behavior, a compulsion to keep getting attention within a means that feels most secure to them--whether that's behind a computer screen or in the confines of a hospital. Feldman asserted that Münchausen is not defined by simply faking illness, but about faking victimization, and those manipulations can turn to accusations of rape, stalking, suicide, and sexual abuse. "Cases seem to unfold in escalating or renewed crises," he said. "And I think it's intended to keep people engaged."

At the risk of gender-stereotyping, there is something to be said about women's inclination toward narrative: The way that more women than men watch soap operas, episodic dramas, and reality shows; the way women read eroticism (Fifty Shades of Gray) and men skew more visual (heading straight to clips of Internet porn); the way a woman will share personal, somewhat-meandering stories in the comments section of a website, and men will cut straight to why the article or the writer is right, wrong, or downright asinine. "Men demand and take attention and sympathy," noted Feldman. "Women are a little more passive and hope it comes to them. But with the anonymity of the internet, women create a backstory that will inevitably lead to some attention and caring, so they do it through subterfuge, rather than acting in overt ways."

According to Feldman, nearly all those who engage in Münchausen by Internet have personality disorders. Historically, studies have shown that the majority of those diagnosed with borderline (marked by unregulated emotions, impulsive behavior, and unstable relationships) and histrionic (greater dramatic swings, extremely distorted self-image) personality disorders are women. The National Institute on Mental Health also found that 85 percent of borderline patients meet the criteria for another mental illness. Why women are susceptible to certain personality disorders has been debated for decades, but it's most likely a combination of biological and environmental factors, including possible sexual abuse in childhood. There may be social factors, as well: According to a 2013 study, women are 20 to 40 percent more likely to have general psychological disorders like depression and anxiety than men, and that women's negative views of themselves may make them vulnerable to mental health problems.

Wright, the hoax-outing blogger, believes depression definitely plays a role in an MBI engager's motivation. "It's like they're so depressed and they want to be someone else so badly that they create these universes where they make friends and interact in social settings without taking many risks," she said.

Another disturbing finding is that many of these Münchausen by Internet women are studying to be, or are already in, the medical profession. A handful of people Wright has written about have had some medical training, including Dirr. "They have a natural fascination with medical matters that often dictate their career choice," said Feldman, who added that this interest often begins at a young age. Wright noted that some of the more harmless "hoaxers" she confronts (and doesn't necessarily post about on her blog) seem to romanticize the illness stories they read about in John Green books, like The Fault in Our Stars, or the one they hear in Taylor Swift's song "Ronan," which is about a young boy who dies of cancer. She added that these bloggers don't really understand that they "have people on the other side of these computer monitors that are reading this, completely invested in what they're saying, and are mourning them."

But possibly the greatest MBI tragedy of all could be its lack of recognition by the medical community at large--which means that hardly anyone who suffers from it is able to get help. The American Psychiatric Association's latest Diagnostic and Statistic Manual on Mental Disorders (DSM-5) acknowledges both Münchausen (which is diagnosed in about one percent of all patients admitted into hospitals) and Münchausen by Proxy as mental illnesses, but it doesn't recognize Münchausen by Internet--or any internet-related disorder, for that matter. This could be because Internet disorders are considered too abstract and marginal, or because the better-known mental illnesses like bipolar disorder, depression, and autism are competing for attention and funding. "I think, unlike a lot of other mental disorders, people don't have sympathy for those who engage in Münchausen by Internet or Münchausen syndrome," said Feldman. "They view it as a voluntary behavior that these people just have to stop doing."

Though an MBI engager's acts may be conscious and volitional, she may not necessarily understand why she's doing it, feeling overcome with anxiety until she breaks down and releases her negative feelings by faking an illness, said Feldman--much like an addiction or compulsion. In this way, engagers aren't simply evil trolls, as is often carelessly implied, but people in need of psychological attention. "They are not so much trolling [in the traditional internet sense], as they are trolling for sympathy and respect," Wright said. "I don't think they are victimizing people in their own heads. They are creating this universe and trying to inspire people with this story of horrific cancer." In other words, MBI engagers simply want to live in their ultimate, crafted narrative.

Karen never engaged in Münchausen by Internet, but she did repeatedly ingest so much Drano that she eventually had to have her bladder removed. In a phone interview, Karen explained that the main reason she kept hurting herself is, at heart, the same reason many seek attention: to feel loved. "I thought I found the perfect way to get love without doing anything immoral," she said. "I didn't want to be promiscuous or drink or do drugs. I didn't want to do things people thought were bad to get my needs met."

Karen's need for love was intense and dire. As a teenager, she lived in an institution for mostly autistic children, where she was abused. She learned there that self-inflicted pain could build a shield around her--if she kept up the bruises herself, her bullies would lay off out of fear of getting into trouble. In college, she was in a biking accident and was sent to the hospital, where, as she put it, "I thought I found heaven. The nurses would sit down and give me advice about things that college kids want advice about. They'd show me pictures of their families, eat lunch with me." Though the hospitalization wasn't intentional, "when they were going to discharge me, I was thinking, 'I just don't want to go.' I knew that I wanted more."

Over the next 15 years, she would inject herself with feces to cause sepsis or ingest capsules of household cleaner to cause stomach ulcers whenever she felt overwhelmed with life. "I just didn't want to be alone," she says. She wasn't interested in a particular doctor's or nurse's attention, but rather with the sense of feeling protected.

Her first attempt at stopping was when, after injecting herself with bacteria while already naturally sick, her temperature reached 107. Scared, Karen told a doctor about what she had been doing. Her physician had never been faced with a confession like this before and, with good intentions, asked her colleagues for advice. However, word quickly spread around Karen's town about how she was hurting herself, and no medical professional seemed to know what to do with her. She wouldn't find out what Münchausen was until she ran across Feldman's book Patient or Pretender in a bookstore months later. Hopeless, she reached out to him, and Feldman counseled her over the phone. Karen says for years she didn't hurt herself, relapsing only once. When she relapsed a second time, she realized she wasn't getting the same thing out of it anymore, so she stopped and hasn't had the urge since. That was more than 15 years ago.

As Karen sees it, what helped her get to the point of recovery and stay there was a combination of God, Feldman, and finding a small group of people she can reach out to for support. In other words, she found comfort in what she had been seeking all along: the compassion and acceptance of others.

But before Karen got better, the gossip got so bad in her tiny hometown--a co-worker called the cops to have her committed--that she had to start a new life somewhere else. Many Münchausen patients live in remote areas, and the oversimplified explanation for Internet fakers is too often "boredom." But a mental illness doesn't manifest and grow worse out of boredom so much as it does out of the fear of having to hide that illness; out of not being accepted in a community if you're deemed a "weirdo" or "psycho;" out of zero resources or medical professionals trained and willing to see you. According to Feldman, treatment doesn't have to be with a Münchausen expert, per se, just a good psychotherapist with experience in personality disorders.

These days, Feldman rarely hears from Münchausen by Internet engagers themselves, but that doesn't mean there are any less cases. Wright said that, of those she has confronted, she believes a few have stopped. She isn't sure if they've received the professional help she's suggested. She does, however, give them an idea for both quelling their compulsion and breaking the stigma surrounding it: "For a while, I'd hear from [someone I outed] who'd say, 'I just really want to start another blog. I really need that support,'" she recalled. "And I'd tell them, 'Write about being a Münchausen patient. That's much more interesting than being a cancer patient--people actually would support you if you wrote about what was going through your head when you want to do this stuff.'"