If they are driven by an obvious secondary gain โ often financial โ then their behaviour is categorised as malingering, a term originally created to describe those who feigned illness to avoid military service.
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Ashkar points out these are different to people suffering from hysteria or delusions, who genuinely believe themselves to be sick.
But Dr Chris Millard, a senior lecturer in the history of medicine and medical humanities at the University of Sheffield, says placing perpetrators into one of these two categories isnโt always so simple.
โHuman beings are super complicated, and I think humans themselves are very bad at telling you what their motives are, even when theyโre being honest. So when theyโre being dishonest, itโs absolute carnage,โ he says.
Both Riley and Gibson profited from their ruses, but they also enjoyed fame, praise for their bravery and resilience, and sympathy. One might surmise that if their motives were purely financial, there would be far easier ways to make a quick buck.
โThis is where it starts to get difficult because youโre saying, well, the only thing we can get this person on, the only way that we can actually stop them from doing something is by convicting them of fraud. That doesnโt mean thatโs why theyโre doing it,โ says Millard.
Millard believes viewing faking illness as a need that permeates every aspect of someoneโs life is the most accurate. He points to Gibson, who continued to lie even after getting caught.
โEven though sheโs defrauded and hurt many, many people, I find her a very tragic case because itโs really clear that there is some need that we canโt really define very well that is not being met or is not being managed properly,โ he says.
How common is factitious disorder?
Munchhausenโs is an incredibly rare disorder โ some estimates put it at one per cent of the population. But Ashkar says accurately gauging its prevalence is tricky since many people who pretend to be unwell will be diagnosed as legitimately unwell in the health system.
Looking at recent, high-profile cases of medical deception, one might assume Munchhausenโs is the domain of young women. But is this true?
There is conflicting research on whether factitious disorder is more common in men or women. But Ashkar says the โbestโ studies suggest it is more prevalent in women. A systematic review from 2016 found that 66.2 per cent of those sampled with factitious disorder were women.
Millard suspects Munchhausenโs gendered associations might also be symptomatic of โthe kind of young, photogenic women who attract certain kinds of attention in online spaces. Part of this is the glossy image of the wellness industry, which has been exploited by some of these peopleโ.
Faking it in the internet age
While people have been pretending to be sick long before the internet, the digital age has expanded the opportunities.
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Such scams even have a name โ Munchhausenโs by Internet โ a term coined by American psychiatrist Dr Marc Feldman. The multiplication of virtual support groups for any and every illness, Feldman writes in an online article, โprovide an inexpensive, convenient, and readily accessible forum for people who choose to misrepresent themselves as ill.โ
Millard says these groups operate from a baseline of trust that people like Riley and Gibson easily exploit.
Can we still trust people who say they are sick?
So, what do cases like Rileyโs and Gibsonโs say about how we should approach stories of illness online?
Millard thinks leading with distrust, or cynicism, is unhelpful, partly because there are no โreliable red flagsโ for factitious disorder, but also because people in the medical system today โ particularly women โ are already often ignored.
โA wholesale withdrawal of trust from people trying to access healthcare will not help anyone โ not the vast majority of patients struggling to be heard even in the best of times, and not chronic fakers,โ he says.
And as difficult as it may be, Millard thinks we need to treat people like Riley with sympathy, since they also need help.
โWhen it is discovered that someoneโs problem is not the one they present with but is to do with a deep unmet emotional need, we need to be more agile in changing the therapeutic approach and try to avoid blame as much as possible,โ he says.
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