Australian blogger Belle Gibson has been exposed for fabricating her tragic cancer story. But her strange behaviour is more common that you’d think – faking disease in return for online fame is now a recognised medical condition

How would you fake cancer? Shave your head? Pluck your eyebrows? Install a chemo port into your neck? These days you don’t need to. Belle Gibson’s story is a masterclass on faking cancer in the modern age. She fooled Apple, Cosmopolitan, Elle and Penguin. She fooled the hundreds of thousands who bought her app, read her blog and believed that her story could be their story.

Diagnosed with a brain tumour aged 20, Gibson had four months to live. She blogged her journey of radiotherapy and chemotherapy, treatments she shunned after eight weeks. Instead, she cut gluten and dairy and turned to oxygen therapy, craniosacral treatments and colonic irrigation. Against all odds, she made it. Her followers were inspired. If Belle could make it, maybe they could too.

Gibson launched The Whole Pantry app in 2013, filled with healthy living tips and recipes. She promised a third of proceeds from the 300,000 downloads ($3.79 per download) to charity. Elle named her “The Most Inspiring Woman You’ve Met This Year”, Cosmopolitan awarded her a “Fun, Fearless Female award” and Penguin published her cookbook. Apple pre-installed her app on Apple Watch and flew her to its Silicon Valley launch.

Then cancer re-emerged, and Gibson announced on Instagram: “It hurts me to find space tonight to let you all know with love and strength that I’ve been diagnosed with a third and forth [sic] cancer. One is secondary and the other is primary. I have cancer in my blood, spleen, brain, uterus, and liver. I am hurting.”

Facebook Twitter Pinterest Gibson on Australia’s Sunrise breakfast show in 2014

Last week, Gibson admitted it was all a lie. “No. None of it’s true. I am still jumping between what I think I know and what is reality. I have lived it and I’m not really there yet.”

She is now being investigated over the disappearance of $300,000 of promised charity donations. Months earlier, she spoke of her four-year-old son and the short time they had left together: “[Oliver] sees me on days that I can’t get out of bed. The only thing that breaks me is [the idea of] not being able to see Oli grow. He’s so incredible I just want to squish him all day forever. I don’t want those moments to end. I’m just going to miss him.”

The diagnosis of Münchausen syndrome has dominated analysis of Gibson’s case. It comes under the rubric of a wider term, factitious disorder: the intentional production (feigning) of disease in order to assume the role of a sick person. A 2011 publication, Innovations in Clinical Neuroscience, suggested that 9% of inpatients receiving complex medical and surgical treatment suffer from some form of the disorder. Münchausen is the most severe form of factitious disorder, accounting for about 10% of cases. The behaviour of this group is dramatic: visiting different hospitals with various aliases, injecting faeces into the veins to induce sepsis, eating rotting food to perforate the bowels.

One patient regularly attends London hospitals with a convincing story of stroke. He is seen by neurologists and undergoes scans, lumbar punctures and angiograms. Sometimes he tells us he is a stunt car driver, sometimes a pilot. His name changes, often. He is not a hypochondriac. He knows he has not had a stroke in the past, he is not concerned that he might have one in the future. But he wants to be a patient. Every few months, he gets his wish.

Sick note: Faking illness online | Münchausen by internet Read more

The National Institute of Allergy and Infectious Diseases reported that 9% of cases of fevers of unknown origin or recurrent infections were factitious. One study found that 3.5% of 3,300 specimens submitted as urinary stones were artefacts such as tiny pebbles.

Malingering is a distinct diagnosis from factitious disorder. Rather than solely seeking to inhabit the sick role (an internal incentive), malingerers are driven by external incentives: money, drugs, evading criminal responsibility or work. One of my patients (“David”, 38) began by googling Huntington’s disease. He had lost his job and needed money. His limbs jerked, he drooled, slurred his speech and soiled his bed. David received disability benefits and 24-hour care from friends and family, with a steady stream of donations and food. Macmillan palliative care nurses visited twice daily. His three-year-old daughter mimicked his speech and needed intensive speech therapy. Then a family member showed me video footage from a birthday party – the day David stood up, spoke articulately and promised to take the family out for dinner. By evening, he had relapsed into his bed-bound state. The deception was uncovered.

Factitious disorders and malingering can overlap. External incentives might not drive the initial behaviour but can follow thereafter. Gibson might have initially enjoyed playing the sick role. But she didn’t turn away the money that flowed afterwards.

“Proving” an illness these days requires no head-shaving, eyebrow-plucking or chemo port. Instead, start a blog and get to know Photoshop.

Doctor Mark Feldman, clinical professor of psychiatry at the University of Alabama, coined the term Münchausen’s by internet (MBI) in 2000. In some cases the deception begins online, in others the internet propels the deception to new levels.

“Limeybean” was an 18-year-old Londoner diagnosed in 2005 with tuberculosis, the disease that killed her father and twin brother. She fought hard, posted throughout on LiveJournal, and her virtual community gathered around. But she succumbed, her death announced on a friend’s MySpace page. A community mourned. Before long, a medical student (username: snellios) investigated and the fraud was exposed.

Limeybean eventually returned from the dead and confessed, not with the expected degree of contrition: “All apologies. So we’re clear, I had never intended for things to go this way. I had not meant to ‘die’ from the beginning, but I wanted an escape and it gave me one should I ever want to leave. I’ve always had a problem when it comes to telling the truth on the internet, to be honest. After realising the effect my bravery in my illness had on people, I then used it as a vehicle to try and get some of the idiot emo kids on LJ [LiveJournal] to buck up and realise they don’t really have it all that bad … the lie was worth something, wasn’t it? How bad is a lie if it helps?”

The internet is a ripe setting for factitious disorders. Evidence is easier to falsify, medical knowledge is easy to source. A “professional patient” can convincingly inhabit the sick role within hours. Adopting new personae is afforded by the invisible cloak of a computer screen. During a coma, a nonexistent mother posts on the sufferer’s behalf. A fake grieving friend informs the community of a tragic death. The fraudster forges a new identity, finds a new friendly forum to infiltrate, and the fabrication starts all over again.

The patient role for those with factitious disorders is attractive, even addictive. With it comes attention, nurturing and caring from others. Gibson’s friends worked around the clock, rostering shifts to sleep beside her when she seemed unwell.

‘My sense is that Gibson was particularly predatory, engaging more people and enlarging the deceptions over time.’

Various psychological theories have been proposed including unconscious motivation (childhood deprivation or trauma) creating a positive experience of the sick role: emotional upset was kissed better, emotional wounds were bandaged. However, early trauma is often impossible to verify. IQ is normal or high in most patients and personality disorders are common: borderline personality disorder in up to a half and narcissistic personality disorder in up to a third. The most severe cases are linked with another personality disorder: sociopathy (formally known as anti-social personality disorder) characterised by a pervasive pattern of disregard for and violation of the rights of others. Its hallmarks include deceitfulness, manipulation, disregard for the safety of others and lack of remorse. This deceit entails repeated lying, use of aliases or conning others for personal profit or pleasure.

I asked Dr Feldman to comment further on Gibson’s case. “My sense is that she was particularly predatory in her behaviours, engaging more people and enlarging the deceptions over time,” he says. “She is more sociopathic than most MBI patients.”

Internet sites crush physical barriers but abolish physical cues that help us to assess trust and reliability. For the seriously ill, hope lives in a blogger who has overcome insurmountable challenges. We wish that we could be that person, that that person could be us. The narcissist revels in this, the sadist capitalises upon it.

Munchausen by internet can be bad for your health forum | Marc D Feldman Read more

Our culture embeds heroism in suffering. The vernacular of illness is the language of war. Even when the narrative ends with death, therein lies perceived beauty. As Edgar Allen Poe wrote, “the death of a beautiful woman is, unquestionably, the most poetical topic in the world”.

When there is a suggestion of fabrication, we turn away.

Elle received this email:

It has come to my attention that you have published a story about a girl I have known my whole life. Her name is Belle Gibson, creator of “The Whole Pantry” app + book. And a so called “Terminal cancer patient”. Unfortunately, there are a few things you might need to know before you consider publishing more about this woman. She’s a compulsive liar. In fact, she got so tangled in her own web of lies living in Brisbane, she moved to Melbourne to start a new life of lies – “the cancer lie” this time. For one – This girl isn’t 26 years old. She was born in 1991, class of 08, Wynnum High School in Queensland. My younger brother was in her form class. Secondly, she never had/nor does she have currently have any form of cancer (Where’s the proof?) I’ve known Belle since her childhood (and am close with her mother) and she has always had a problem with fabricating stories from nothing on a regular basis. It’s one thing to act as if she can cure “her cancer” by eating organic (which simply isn’t true) but to give false hope to people who are ACTUALLY fighting cancer is nothing short of evil. You MUST be aware of this before you publish stories about this woman. She is selling her fake sob story in order to profit from her app + book sales. She is a wolf in sheep’s clothing & a master manipulator.

Sincerely, Sick of seeing her lies published :)

Elle reported that they did some further digging, “returning only a few obscure blog posts that weren’t linked to any names or contact information we could use to follow up. So we left it, writing off the email as a bunch of lies.” Cosmopolitan received the same message and later wrote: “Not once did we truly think the claims in the email could be real. Because nobody would lie about having cancer. Would they?” Penguin published her book and did not question her diagnosis: “We did not feel this was necessary as The Whole Pantry is a collection of food recipes, which Penguin has published in good faith.” However, the 3,000-word preface outlined her cancer diagnosis and the treatments she had refused.

When asked who had diagnosed her, Gibson replied: “Dr Phil.”

Some groups are unmasking hoaxers, vigilante style. The Warrior Eli Hoax Group investigated the case of a fictional child with cancer (Eli) and his equally fictional family. The fraud detailed the death of Eli’s mother, Dana, a trauma surgeon, in a car crash. She survived long enough to deliver her baby. Her husband, JS, whose twin brother had been murdered, was left with 11 children.

He blogged for more than a decade, gathering more than 6,000 followers. JS was finally unveiled as a fake, believed to be an Ohio university student. By this time, “JS” had invented at least 71 fake personalities and had online affairs and cybersex with women who were moved by his plight.

But even when unmasked and facing opprobrium, the fraudster frequently just moves on. Belle Gibson had form. In 2009, she posted on a skateboarding forum on her heart surgery: “The doctor comes in and tells me the draining failed and I went into cardiac arrest and died for just under three minutes. I have the most intense bruising from the paddles when they electrocuted me back to consciousness. They’re amazed I’m sitting up testing already and claim miracle.”

Policing every member of a largely empathic, trusting forum seems unrealistic and unfair. Mumsnet co-founder Justine Roberts has stated: “It’s part of our philosophy to take people at face value. We’d rather be taken in than deny support and advice to someone who’s real.” None of this abdicates our responsibility as doctors to treat these patients either. They are sick, albeit it in a very different way than claimed. Münchausen can be impossible to treat if patients refuse to acknowledge the deception, let alone see a psychiatrist. There is also the tricky question of whether those who engage in MBI are patients or perpetrators. Feldman says: “Sometimes they are both, but in the Gibson case, the audacity of her ruses and the [alleged] misappropriation of monies may make the word ‘perpetrator’ more appropriate.”

Meanwhile, Belle Gibson currently faces no criminal changes. Instead, only a consumers affair investigation lies ahead. The full implications of her deception are hard to define. Financial ramifications aside, did any followers forsake proven medical treatments simply on the basis of her story? At the very least, Gibson misled potentially vulnerable followers who had no reason to doubt her, validated as she was by mainstream media. Belle Gibson’s masterclass is over, but others will follow.