On March 20, Hulu premieres its original anthology series “The Act,” the first season of which plays out the true story of Dee Dee Blanchard, who convinced her daughter Gypsy Rose Blanchard that the girl suffered from several illnesses and conditions, including cancer.
When the Blanchard case was first reported, it captured national attention for a seemingly endless number of reasons (one being that the case ended in Dee Dee Blanchard’s murder, arranged by her daughter, who is now serving time).
Factitious disorder is recognized by the American Psychiatric Association, and there are several types. The most commonly known one is factitious disorder imposed on self, or Munchausen syndrome, in which an individual purposely misleads others into thinking he or she has a serious physical or mental illness. There’s also factitious disorder imposed on another, or Munchausen by proxy, in which a person ― often a parent or caregiver ― fabricates an illness in another. In “The Act,” Dee Dee Blanchard is believed to have Munchausen by proxy because she convinced others that her daughter was seriously ill.
The Blanchard case is not the only time someone felt compelled to fabricate an illness. There are several psychological factors that could contribute to someone faking a condition as serious as cancer.
The Mental Health Disorder That’s Based On Lies
Although uncommon, factitious disorder has been reported around the world. “Factitious disorder itself is estimated to be present in 1 percent of people who are hospitalized in general hospitals,” Feldman said. “It’s more a public health issue than anyone has recognized.”
People with Munchausen syndrome will often act in ways that lead them to be seen as a patient, he said. They’ll schedule doctor appointments, feign sickness or injury, go to therapy groups or talk with friends about their supposed illnesses. Feldman, who interviewed dozens of people with Munchausen syndrome for his book, said that patients often talked about the feeling as an addiction or compulsion. These patients struggle to “resist the pull of obtaining attention or sympathy,” he said.
Munchausen by proxy is often associated with the traits of a martyr, he said. The “caretaker” often seeks out praise, compassion and sympathy.
For some, feigning an illness helps them feel in control. This may feel good for people who lack a sense of self, Feldman said, since as a “patient,” there are very clear expectations for how to structure one’s time. This could be spending scheduled periods in a hospital or clinic or, as Feldman is increasingly seeing, spending more time in front of a computer learning about treatments for the illness they do not actually have.
“It’s more a public health issue than anyone has recognized.”
People with a factitious disorder differ from those with health anxiety (known more commonly as hypochondria) in that they don’t believe they are ill. Often, it is the attention and sympathy these patients receive from others that compels them to lie. “They have found this unfortunate way of getting needs met, and they stick with it,” Feldman said.
He added that individuals with factitious disorders tend to also have personality disorders, which involve unhealthy thinking and behavioral patterns. These are different from mental illnesses like bipolar disorder, though the two can be closely linked or often misdiagnosed. A personality disorder, according to Feldman, “refers to maladaptive ways of trying to get your needs met. They’ve found a way to counter some of the isolation and lack of empathy that is expressed toward them.”
Though people with a factitious disorder may feign any kind of sickness in themselves or another, cancer is one that comes up a lot. One of Feldman’s first cases of a patient with factitious disorder was a 35-year-old woman who claimed to have terminal breast cancer. She was able to get effective mental health treatment.
When Fabricating Cancer Isn’t Mental Illness
It’s also important to note that a person who fakes cancer doesn’t necessarily have a factitious disorder. Fabricating or exaggerating any illness to escape responsibility or seek gain ― which may be drugs, financial support or a way out of a bad situation ― is called malingering, Feldman said.
“Malingering may sometimes come up in a mental health office, but it’s not a mental illness,” he said. “Malingering is also different in that if you understand something about a person’s life like their financial state … you’d understand why they would malinger.”
In recent years, there have been multiple cases of people fundraising online, sometimes thousands of dollars, for illegitimate cancer diagnoses. Take former blogger Belle Gibson, who claimed to have cured her brain cancer with a specific diet, raised funds for charity (which she then kept) and built her wellness brand in 2015. It was later revealed that her illness was a scam.
“Sometimes people find that the experience of getting a lot of concerns from others to be a very heartwarming thing. It feels really good to get attention from other people, and this is a way they know they can get attention.”
These phenomena continue to happen likely because of the ease with which people can emotionally manipulate others, according to Marni Amsellem, a licensed psychologist based in Connecticut.
“People have such strong reactions for these kinds of hoaxes because it really does pull at their heartstrings,” she said. “Everybody is touched by cancer in some way.”
Even a person who is malingering may experience the emotional benefits that come with getting attention and care from others.
“It might seem sick to the outside world, but an attention-seeking component might be at play,” Amsellem said. “Sometimes people find that the experience of getting a lot of concerns from others to be a very heartwarming thing. It feels really good to get attention from other people, and this is a way they know they can get attention.”
Treating Or Managing A Factitious Disorder
Treating a person with a factitious disorder can be difficult. Though people who live with a condition like Munchausen syndrome may seek treatment for an illness they’re feigning, they might not seek help for their actual mental health issue.
But there are options, and treatment is definitely possible. Psychotherapy or behavioral therapy is often the first medical method suggested for someone with a factitious disorder, according to the Mayo Clinic. This type of counseling works to help patients change their thinking patterns and behaviors.
Feldman suggests a kind of addiction treatment for patients, especially those who “often describe the powerful ‘high’ or feeling of exquisite release and relief associated with successful deceit, so much so that they can’t seem to stop, even when the lying is ruining their lives,” he writes in his book.
Addiction treatments can help some factitious disorder patients, he says, adding that “several patients, by themselves, have tailored and ‘worked’ programs to overcome factitious disorder.”
“Living With” is a guide to navigating conditions that affect your mind and body. Each month, HuffPost Life will tackle very real issues people live with by offering different stories, advice and ways to connect with others who understand what it’s like. In March, we’re covering cancer. Got an experience you’d like to share? Email firstname.lastname@example.org.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside the U.S., please visit the International Association for Suicide Prevention for a database of resources.