Community Munchausen's by Internet (Malingerers, Munchies, Spoonies, etc) - Feigning Illnesses for Attention

[Aunt Carol]

Back with Jamie Bruce part 3.

Contact dermatitis to whatever they clean the BP cuffs with = major MCAS action.
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This photo isn't great, but it doesn't show a rash, just a normal line where the cuff compressed.

If her ED is using reusable blood pressure cuffs, they're cleaning them with the same wipes they use to clean that reusable oximeter. No finger rash?

Lol this one thinks her SpO2 going up is a bad sign?
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She's trying to show off her heart rate of 133--after climbing stairs.

Eats a sandwich, doesn’t feel good, horrible pain, can barely breathe, now at the ER. Doesn’t really update. Gallbladder attack or malingering? You decide!
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The white blood pressure cuff here is single patient/disposable.

Gets a sample of this electrolyte solution stuff. In the comments, an MLM hun would like to sell her Shakeology.
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Haha, wait a minute. If you see a (real) banana bag hanging, there's nearly always an alcoholic in the bed/gurney below. It's like a sickly yellow party balloon.

Whoever named this product is telling tales on themself. (Or really knows their market.)

 

[Dnein]

@Kate Farms Shill - migraine aura and absence seizures are two different things. Unless the neurologist witnesses an event, they're relying on the patient/family account. Focal epilepsy can be absence like, and non-classical migraines can sound a lot like focal epilepsy. Silent Migraines, occular migraines, etc. An EEG is a pretty cheap, low risk test and an abnormal result is super helpful for zeroing in on epilepsy.
All of that depends on the person experiencing them not being a big fat liar that lies though.

Neurology and Rheumatology are unfortunately bombarded with liars. I think they all turn into jaded, exhausted skeptics with a few years.

For every one undiagnosed condition labeled fibro, you have nine with pain from being obese or sedentary (or both), opioid reliance, or attention seeking labeled fibro in the wastebin. For every person with genuine migraines, you have nine headachers, "induces migraines with triptan abuse", or "migraines are just a good excuse" types claiming they have migraines.

Then we start with the epilepsy role playing and it gets nauseating. It must really suck to have nothing on an EEG and no genuine symptomology, but a patient refuses to stop pushing and play acting and twitching limbs. It's just true that EEGs can miss things, and what can you do, throw out that one legit patient in the swimming pool full of bullshit bathwater? There's even safety issues revolving around missing patients with seizures, like failing to stop them from driving.

I really feel bad for these doctors. These areas really are in their infancy, especially compared to other specialties, and they have to spend all that time sifting through deception like fucking interrogation room detectives instead of ironing out the science. You have a couple imperfect testing protocols to play Wheel of Autoimmunity, a rarely conclusive MRI to chuck at migraines, or an EEG that may or may not catch a seizure. Otherwise, good luck!

 

[Thomas Eugene Paris]

Funny story there...

HeroicK9s once had a client dog named Scout who they were working with for months on reactivity and dog aggression. Note that they're already starting to medicate her with CBD.
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After five months of working with Scout, she escaped from her owners' home and attacked another dog. Scout had to be put down.
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I'm not going to say that HeroicK9s shitty training is the only thing that led to Scout's death, but it's definitely a large factor.

They both also have a personal history of having "service dogs" who act aggressively toward other dogs and humans. I know dogs aren't robots and will sometimes have bad days, but aggression in a service dog should be completely unacceptable.

Spoiler: Receipts

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Unfortunately this is all I have on Eli's aggressive service dog, Benjamin. The "incident" that took him out of service dog work was actually Bennie lunging and biting the vest of another service dog during a meetup.
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Mazikeen is Eli's current service dog. She's an aggressive breed mix who needs an e-collar on high just to work. She's also being trained in bitesports (schutzhund) because a service dog who attacks people is a wonderful idea.

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There's way more than this thanks to the good people of reddit chronicling Jaye's lies for years. Hero was his first service dog, and was known to be aggressive.
Akira the shepherd is the service dog who he had after Hero, and she is the one that growls at people.
And of course there's Dante the "family protection dog" who is trained to bite people for fun. They bring him in public like a service dog.
Chainbreaker is also a service dog, but IIRC has been trained in bitesports too, because why the hell not?

Would you trust a dog training business who treats their clients like this? And even their own dogs? What about a business that has had animal control pay them a visit more than once due to people (assuming their clients) claiming abuse, hoarding, etc?
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During the 37 minute update video, Emilee was talking about medications she had been given. She mentioned being given trazodone, and said it was funny "because we give that to our reactive and aggressive dogs."
I'll get a clip of it later.

Paging @Ginger_beer, what say you about these fake dog trainers trying to engage anxious, aggressive dogs in bitesports?

 

[Ginger_beer]

Paging @Ginger_beer, what say you about these fake dog trainers trying to engage anxious, aggressive dogs in bitesports?

I think their ancestors should have been neutered going back three generations (the humans, not the dogs, but those too). There's nothing wrong with crosstraining a service dog in bitesport. Schutzhund is a *sport* with strict rules and the dogs know it's play. Most won't bite anywhere than on a visible sleeve on a forearm. It's not a free-for-all, and even a dog which is fully trained as a PPD should be *more* reliable (i.e. only bite when told, only on a designated target, and disengage when told) than a dog with no bite training.

Spoiler: Cut because I do go on.

That said, a people or dog aggressive dog should be muzzled in public, and if they're seriously aggressive and/or reactive they shouldn't be working as a service dog. Period. Trainers who make it about how "skillful" they are to train a reactive dog as an SD are dangerous egoists and should be avoided. Handlers who think they're special because they want to use an unsuitable animal as an SD are personality disturbed idiots who need a reality check and a cranio-rectal-extraction. (I don't care how overflowing with compassion you think you are, if you're endangering other people or animals, and forcing your anxious dog into situations which terrify them because you think you're fucking Mother Theresa I'm going to call you an abusive asshole. I'm not saying every reactive dog should be destroyed, but there's a common sense line between rehabilitation and living in an appropriate, manageable environment, and unrealistic expectations for an individual dog or a breed.

That said, anything in the herding/working line could potentially make a wonderful SD provided they're properly assessed and trained. Individuals will wash, but a GSD is meant to be an all around dog, whether that's guarding the home, herding the flock, or serving as a handler's eyes and ears and hands at need. They are the OG seeing eye dog breed after all! Same with the Belgian shepherds (all of the varieties) and the Dutch shepherd, etc. Ones specifically bred for sport/military/police may be too high strung for SD work, but they also might be fine. PL: My current GSD (SVV2, FH1, working on our RH) noticed that I can't hear certain sounds very well (I'm slightly hearing impaired in one ear, professional hazard) and started spontaneously alerting me to things like notification chimes and the kettle clicking off from the time he was six months of age. I've never formally trained him as an SD but he'd make a fantastic service dog -- people social, dog social, adores children and small animals. He's CzechXWGWL and his sire was the top IPO bitesport dog in the world for about five years (Trojan von der Staatsmacht) -- that's not a dox, Trojan was a very popular sire and has hundreds of offspring. The titles I'm citing aren't a boast, it's to make a point -- the dog is proven in bitesport, from hard working lines (police, the legendary Czech border patrol kennel, etc.), has first degree relatives doing police and military work, and I'd trust him not to bite unless I give the command far more than the average pet dog which has never been tested. His reaction to someone being upset (grief or anger) off the sporting field is to lie on their lap or their feet and try to calm them down and console them. He does not switch to aggression as a default at all.)

For anyone who is curious, here's a good English language video explaining why bitesport is taught. The TL: DR is that if a dog isn't suitable for SD work then they should be washed out and rehomed as pets. Same with dogs who aren't capable of bitesport in a sport home. Anyone who doesn't do this is an abusive asshole. If anyone wants to hear my blather I'll be happy to expound (in messages if needed so we don't shit up the thread) but FYI I'm currently at a sport trial and only have spotty internet so it might take me a while to respond.

 

[Jimmy Dean Bowl]

@Kate Farms Shill Thank you everything you do to bring these crazy women to our attention, you efforts are certainly appreciated. I agree that Jamie has a very punchable face, she always looks so damn smug and pleased with herself.

Spoiler: Gymnastics sperg

I was thinking about her 'gymnastics career' (she previously claimed to be trained from 2-11 at an elite academy, now claims 3-11).

We saw in a previous saga that Jamie's first front handspring was documented on Instagram at age 15, four years after she left the academy.
Yet an academy trained gymnast should have been able to front handspring before age 11, most are able to do it between age 8-10.
There are even 7 year old kids with excellent core strength that can achieve front handspring.

It is a level 4 skill, and must be mastered in order to progress to level 5 where more complex floor and vault skills cannot be achieved without it. In other words, Jamie would not have been able to do any even slightly challenging vault or floor work before mastering front handspring.
Ergo, she was not a very good gymnast, and certainly didn't compete after about age 10.

Jamie has misrepresented herself in a hilarious way, "I've been a gymnast for 13 years and I've only just mastered a front handspring" really isn't the flex she thinks it is.

I believe Jamie attended gymnastics classes as a child, but maybe from 5/6 - 11 as this fits with her general skill level and with what we saw photographic evidence of.
I also don't believe she was part of an academy, as they would have trained her ass much better.

Apologies for the sperg. I was a gymnastfag and a coach many moons age so she made me snigger and seethe.

 

[JanuaryViolet]

Holy shit @Kate Farms Shill. I bow to your awesomeness. Thank you.

 

[std::string]

Haha, wait a minute. If you see a (real) banana bag hanging, there's nearly always an alcoholic in the bed/gurney below. It's like a sickly yellow party balloon.

Don't forget the sick princesses with AN! They get them too and I think she falls into this camp.

Elevated liver enzymes, gallstones, POTS secondary to hypovolemia, bradycardia at rest. Those are all potential AN sequelae.

If you presented a case like that then I think 90% of EM physicians would be able to suss it out, but when you're a munchie and your chart has more fucking pages than War and Peace then you can get away with shit.

 

[Catmannjew]

EEGs can miss things, and what can you do, throw out that one legit patient in the swimming pool full of bullshit bathwater? There's even safety issues revolving around missing patients with seizures, like failing to stop them from driving.

It is very common for EEG to pick up nothing on a true to god epileptic. When you do catch something it is dependent on a few variables or of it was a false positive (so to speak.) I know someone who has epilepsy where this did happen, there was a spike on a random part of the brain that wasted a bit of time as there was never a spike before. Meds can cause these spikes.

For non epileptics, they are a waste of time due to how unreliable they really are. But are a great way to kill a weekend and get that 'sick' look without any invasive test or any real results. If you can score the four day long test or buy yourself a bed your malingering looks super serious and will turn up nothing.

 

[TheBigZee]

Gaines went private. Hope someone was following.

 

[buoyverificationfuel]

Someone has been lurking and saw the bitework discussion! Hi Jaye, dogs aren't a personality trait.

 

[Drain Bamaged]

Notes from Drain Bamaged: This article observes imitative Tourette Syndrome and DID content among adolescent TikTok users. It is more recent than previous articles I shared here. As usual, I have separated major sections into different spoiler sections and removed most in-text citations for ease of reading. There are spoilers within spoilers. Where you see () is where an in-text citation is located in the original article. The original article is 9 pages with references and 7.5 pages without references. If you only want to read quotes I have deemed as entertaining skip to the spoiler with the name “Thoughts and Highlights” at the end of this post or the “Case presentation” spoiler within the “Introduction” spoiler.

Spoiler: Paywall bypass

In this instance, I was able to bypass the paywall because a Reddit user by the name of kadangit publicly posted their Google Drive link to the article. Supposedly they received the article through their college’s library database. This subsection of Reddit is controversial due to the content posted to it, which means the post or subsection of Reddit may be deleted at any time. I have no control over kadangit’s actions, past or future, regarding this document within their Google Drive. I have no control over the moderators of Reddit if they decide to delete the website’s subsection as a whole. The link kadangit publicly shared to their Google Drive can be found here: https://drive.google.com/file/d/1bjK8chA43Gm6t5B85C1lKNHkL4xeCWJR/view and their public Reddit post which shares said link can be found here: https://www.reddit.com/r/fakedisord.../?utm_source=share&utm_medium=web2x&context=3

Title: The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen’s by internet as explanatory models for social media associated abnormal illness behavior

Spoiler: Author and article information

Andrea Giedinghagen Clinical Child Psychology and Psychiatry 2023, Vol. 28(1) 270–278 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/13591045221098522 journals.sagepub.com/home/ccp Department of Psychiatry, Division of Child and Adolescent Psychiatry, Washington University in St Louis School of Medicine, St Louis, MO, USA


Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Spoiler: Abstract

This paper explores the recent phenomenon of adolescents presenting en masse (both online and in clinical settings) with symptoms seemingly acquired from viewing illness-related content posted by social media influencers. The most frequently reproduced illnesses have included Dissociative Identity Disorder (DID) and Tourette Syndrome. It discusses evidence that the recent spate of new-onset, severe tics are a form of Mass Psychogenic Illness facilitated by social media networks (a phenomenon labeled Mass Social Media Induced Illness). It then suggests that many of those self-diagnosed with DID may be manifesting a similar, technologically-facilitated conversion phenomenon. It then explores another explanatory model: that these simulacra of DID and Tourette Syndrome may also arise via a mechanism more closely resembling social media facilitated Factitious Disorder. Similar presentations, of individuals falsifying cancer, have previously been labeled Munchausen’s by Internet. It then proposes an overarching construct, Social Media Associated Abnormal Illness Behavior (SMAAIB), that is agnostic regarding phenomenology. Within this framework, it explores the ways in which de-commodifying attention, connection and care (measured once in appointments and admissions, now in ‘likes’ and ‘shares’) and obtaining a full picture of the patient’s psychological, sociological and cultural grounding can offer deeper understanding and ultimately a path to wellness.

Spoiler: Keywords & Abbreviations

Keywords:
Factious disorder, internet, conversion disorder, social media, dissociative identity disorder, TikTok, Munchausen’s by internet, mass social media induced illness

Abbreviations:
DID: Dissociative Identity Disorder
MBI: Munchausen’s By Internet
MPI: Mass Psychogenic Illness
MSMI: Mass Social Media Induced Illness
SMAAIB: Social Media Associated Abnormal Illness Behavior
FD: Factitious Disorder

Spoiler: Introduction

Mass Psychogenic Illness is a form of conversion disorder that spreadly rapidly in cohesive social groups and has been recognized for centuries (). In the last two decades, the Internet has enabled spread of such symptoms among people who have never met, but who share a digitally-enhanced sense of belonging (). In the context of the COVID-19 pandemic and associated drastic increase in screen time, numerous clinicians have noted the spread of what appear to be functional tics, and labeled these either “TikTok Tics” or “Mass Social Media Induced Illness” (). There has been a similar trend in presentations with reports of Dissociative Identity Disorder (DID) among individuals who have viewed online content related to this diagnosis (). While it is possible that these are all conversion phenomena, there is also some evidence–though thus far only explicated in the lay press–that these may be deliberately manufactured, or a form of factitious disorder (). Similar online presentations of falsified physical illness have previously been labeled Munchausens By Internet, a title we suggest applies here as well (). Treating this phenomenon involves understanding the motivations for assuming symptoms–whether with conscious intent or no. We suggest Social Media Associated Abnormal Illness Behavior (SMAAIB) as an overarching construct to capture both voluntary and involuntary productions of such symptoms that is psychologically driven.

Spoiler: Case presentation

Ginger is a 16 year old girl you have been following monthly since age 8, when she began therapy and fluoxetine to address social anxiety and school refusal. Today she presents for a followup appointment. While now attending school regularly, she is on social media nearly all of the time she is not in school.


When you speak to Ginger alone she tells you, “I think you should know, we have Dissociative Identity Disorder. There are 33 of us in the system. This is Ace, the protector, talking to you. I’m a 20-year-old asexual man. But there’s also Rebel, our gatekeeper, who’s 17. Baby is a trauma holder, she can’t talk…”


Ginger’s mother affirms the patient has been using this vocabulary with her as well, and viewing posts with hashtags like #system and #dissociativeidentitydisorder. Ginger has also begun posting about her “system” on TikTok. In one video she beams at the camera, “Hi, I’m Ginger, the host!’ then drops her head only to pop back up again sucking her thumb (a caption reads “I’m Baby”), then showing a sneering face (captioned “Rebel”). Another post is text-only: “I’m switching so often that I’m failing math–Rebel came out while we were taking a test and he doesn’t pay attention so we failed.” Ginger’s mother denies seeing any of the ‘switching’ Ginger describes, adamantly denies any history of trauma (which you have also never heard of in the long course of her treatment), and denies any failed tests.


“Is she just making this up?” Ginger’s mother asks. “Is this real? Did she catch this online somehow?”


Footnote: This case is not based on any single patient seen at the author’s clinic, but rather a fictional case based on common presentations of this type.

Spoiler: Mass psychogenic illness goes online: Conversion.com

Our search for an explanation for Ginger’s presentation begins with a phenomenon documented for centuries: Mass Psychogenic Illness. A form of conversion disorder, it involves the “rapid spread of illness or symptoms affecting members of a cohesive group, originating from a nervous system disturbance…whereby physical complaints that are exhibited unconsciously have no corresponding organic etiology” (). Historically, sufferers blamed toxins or evil spirits; awareness of illness in others with whom one socially identifies is the trigger in Bartholomew and Wessely’s (2002) modern model. Wessely (1987) differentiates between “mass anxiety” and “mass motor hysteria” subtypes, the latter marked by motor symptoms spreading among individuals in stressful environments.


Once, Mass Psychogenic Illness only occurred in geographically distinct clusters. “Motor hysteria” outbreaks occurred in strict German schools during the late 19th century: students developed tremor and agraphia during school hours but were unaffected during gymnastics classes or at home. Consistent with later, similar epidemics, spread was from higher-status ‘index cases’ and occurred within the confines of (geographically limited) social networks (). Sufferers were overwhelmingly young and female. Recent case-control studies show associations between trauma history and hypnotizability–a proxy for suggestibility–and susceptibility to Mass Psychogenic Illness (). With the development of mass media, however, such epidemics began to spread without physical proximity. This was first widely noted in the context of “motor hysteria” among a group of high school girls in LeRoy, New York in 2011. Videos and news stories of girls’ tics, slurred speech and astasia/abasia circulated widely. Individuals who viewed the girls’ movements online then posted videos or descriptions of themselves experiencing nearly identical symptoms. As a neurologist associated with this case stated in Bartholomew et al.’s (2012) study, “One individual posts something, then the next person who posts something not only are the movements bizarre and not consistent with known movement disorders, but it’s the same kind of movements. This mimicry goes on with Facebook.”


Recently Müller Vahl et al. (2021) described a similar phenomenon, christened Mass Social-Media Induced Illness (MSMI). It, too, involved social-media driven transmission from a hight-status index case, but within social networks spanning continents. The proposed “virtual index case” is a popular German Youtube influencer who posts extensively about his Tourette Syndrome. Like cases within the Leroy cluster, viewers saw his, or other videos inspired by his experience. They then exhibited movements and vocalizations that were similar, but more bizarre, and inconsistent with Tourette Syndrome. In some cases the similarities were striking. Olvera et al.’s (2021) study of individuals posting about their tics on TikTok in March 2021 found 53% had a vocal tic of saying ‘beans’ (even non-English speakers; after review of many videos the research team found this is a vocal tic of an extremely popular British Youtuber). Movements were more extreme–complex and destructive (like throwing items), copropraxic, more frequent, and more numerous in type than typical for Tourette Syndrome (). This digital heir of the “mass motor hysteria” subtype of mass psychogenic illness–and it is spreading.

Spoiler: A growing trend, and growing doubts

The COVID-19 pandemic and subsequent lockdowns dramatically increased U.S. adolescents’ time online, in one study reaching almost 8 hours per day (). Much of that time was spent on social media: in Fall 2020, 69% of US adolescents used TikTok at least once a month and in 2021 Oberlo reported 90% of TikTok users log in at least daily (). Just as Müller-Vahl et al. (2021) found a relationship between “virtual index cases” and purported MSMI Tourette Syndrome in Europe, it seems a DID variant of MSMI is on the rise in the United States. Across the United States, psychiatrists and psychologists have noted dramatic increases in presentations like Ginger’s. In our own clinic, prior to 2021, there were no such cases. In January they began appearing, and in September 2021 alone we saw as many as we saw in the previous 6 months. Some individuals were already in care but disclosed new-onset DID concerns, while others presented for the first time with “Dissociative Identity Disorder” as a chief complaint. Several potential “index cases” exist: handful of DID influencers have hundreds of thousands of followers, and one account has over a million. These accounts record daily the daily lives of people who purport to have dozens of alters, switching upwards of 50 times per day. Some even delineate these switches with changes of clothing, wigs, or nametags (). As of December 2021 #did had 1.3 billion views. Several videos under the #system hashtag had almost 2 million ‘likes’ as of September 2021 (). Like patients with MSMI-driven “tics,” adolescents with MSMI DID present like the influencers they follow, but with more extreme/exaggerated symptoms and an absence of the subtler/less well-known symptoms or comorbidities. Many cases resemble what has been labeled “imitative” DID: “Most of the imitating behavior we see is unconsciously motivated: these patients are truly confused about who they are. They cling to the DID model because it structures their inner world…it is not so much the general assumption of the sick role but of a specific sick role: DID.” ()


Once an adolescent views DID content, algorithms funnel them related posts. This is the first thing users see on their individualized landing page: the For You page, featuring videos for each user based on past viewing patterns. Exposure intensifies. Adolescents not only passively consume content: they create it, serving as potential secondary virtual exposures for others. A 2019 survey showed that while 68% of monthly active TikTok users watched someone else’s video, 55% uploaded their own ().


While the MSMI model assumes this phenomenon is driven by an involuntary mechanism, popular press headlines like “My Teen is Faking a Disability on TikTok” attest to other ways of understanding presentations like Ginger’s (). In this article a father writes to a parenting columnist about his child, who is posting videos on “Disability TikTok” about a disease for which neither father, nor therapist, nor pediatrician have ever seen evidence. It would be highly unusual for an organic or even conversion phenomenon to manifest solely in online posts, with no symptoms evident in everyday life. Stories like “Inside TikTok’s Booming Dissociative Identity Disorder Community,” () and “Is Illness Appropriation TikTok’s Most Troubling New Trend?” () have captured growing societal concerns about such cases, raising the possibility adolescents may be volitionally reproducing symptoms.


Notably, 64% of Tiktok posters in Olvera et al.’s (2021) sample from March 2021 included some statement on their channel addressing allegations of faking–some even producing doctor’s notes as evidence. The online sphere rings with such accusations, which are then derided by the accused as “fakeclaiming” and “gatekeeping.” For good or ill, within the closed ranks of these illness communities, any action short of implicitly accepting any individual’s self-diagnosis is seen as cyberbullying (). Even physicians questioning diagnoses are seen as invalidating or gaslighting (we will leave aside for now the view–held by many, professionals and laypeople–that ALL presentations of DID are spurious) ().

Spoiler: Munchausen’s by internet as alternate explanatory model

MSMI is not the sole explanatory model for such behaviors. Some presentations, like Ginger’s or the Slate letter writer’s, suggest deliberate manufacture as possibilities. Malingering means the goal is to gain some material advantage; worth considering given 64% of TikTok tic posters in Olvera’s study had merchandise related to their tics, or stated they were available for paid appearances (). Presentations with the sole goal of increasing ‘views’ would also be considered malingering. If a poster’s motivation is to assume the sick role, Factitious Disorder is the appropriate diagnosis. Typically providers think of Munchausen’s by Proxy when considering manufactured illness in pediatric patients, but children and adolescents do feign illnesses themselves at rates equivalent to the adult population (). Factitious Disorder patients may falsely report diagnoses, claim symptoms that are not actually occurring, or physically induce illness or injury (). Improbable (or impossible) presentations, particularly if they do not follow the natural history of an illness–a 16 years old with no trauma history developing dozens of wildly disparate personalities over the course of a month for instance–suggest Factitious Disorder at least as much as MSMI. Unusual familiarity with specialized medical terminology or evidence of fabrication are similarly suggestive. Both MSMI and Factitious Disorder are more common in female patients, and both are highly comorbid with other psychiatric conditions ().


“Munchausen’s by Internet” (MBI) is the online analogue of Factitious Disorder, first characterized by Dr. Marc Feldman and focused on false claims of physical illness–usually to access online support groups for cancer (). The characteristics he identified in those patients decades ago still hold true for factitious online psychiatric presentations, and could be extended to in-person behavior by those with symptoms “acquired” via online exposures (). First, individuals with MBI frequently duplicate material from online sources like social media posts. Second, illness characteristics are often exaggerated and extreme–adolescents with long coprolalic outbursts, or Ginger’s thirty-three “alters”. Obviously falsifiable claims are a strong indicator. ().


Several features are concerning for factitious DID more specifically. Bringing “proof” of a dissociative diagnosis to consultation (or posting doctors’ notes, as in Olvera’s cohort), absence of a comorbid PTSD, or telling people outside close confidants/therapists about a DID diagnosis may raise suspicions (). It is particularly notable if DID becomes a frequent topic of conversation or primary focus of relationships (). Factitious or imitative presentations of DID tend to change as an individual gains information (or misinformation, since social media is rife with it) about DID (). Individuals with factitious DID also tend to be highly dramatic (many switches, many dramatically different alters) and frequently use the DID label as an excuse for avoiding unpleasant activities or consequences (). They may also show disappointment or anger–even ‘firing’ a physician–when DID is ruled out (). Note commonalities among DID posters, who ipso facto are sharing with many others and making this aspect of their lives a focus of interactions, if not an identity itself. Rapid-fire switching is frequently the topic of posts, and anyone questioning the self-diagnosis is seen as invalidating at best and abusive at worst ().

Spoiler: The impact of medium

Munchausen’s by Internet (MBI) is unique from FD both in medium and audience. The online medium makes simulation easier; according to Walther’s (1996) Hyperpersonal Model of Communication, the infinite editability of online messages (including videos and photos) allows unprecedented ability to optimize the impression one makes on others. MBI sufferers generally crave care per se rather than the medical care of a doctor, and so the audience is also different. Rather than ‘performing’ illness for a physician to gain care, MBI involves performance in a broader online space. The function of such disclosure differs from the so-called dyadic disclosure that occurs between two individuals, and has been termed “broadcasting disclosure” (). In classical self-disclosure theory, broadcasting disclosure is associated with sharing of relatively innocuous information; however the online world allows a group of thousands to assume the intimacy of a classroom. Adolescents disclose distress or other intimate information on social media in a broadcasting context when seeking support, underestimating the risks of disclosure and overestimating intimacy (). On platforms where disclosure of mental illness is associated with greater feedback and community response, adolescents may feel the immediate emotional rewards outweigh the long-term risks (). This is particularly true among individuals like Ginger who prefer online interaction and frequently self-disclose online ().


Both MSMI and MBI are the result of a deep desire to be ‘seen.’ Online disclosure, particularly of illness (or manufactured illness in the case of MBI), fosters a sense of intimacy that may exceed that possible in face-to-face communication (). Receivers of online disclosures may be more likely than receivers of face-to-face disclosures to attribute this to interpersonal closeness rather than other motives (). A sense of relational intimacy develops more quickly online than in face-to-face interactions, with reciprocal reinforcement of greater trust/idealization and greater disclosure (). The online space is primed for rapid (felt) intimacy-building, and MSMI may occur when symptoms are unconsciously adopted to support belonging, while MBI occurs when symptom adoption is conscious.


MSMI and MBI are also both efforts to be seen within an algorithm-driven social context that rewards the most extreme symptoms with views; the Darwinism of the Algorithm, we might call it. This is a social context where disclosures of distress result in “notes” of caring, even if only from a stranger a continent away. MSMI sufferers who may have a few close connections in their daily lives can belong to a ‘cohesive group’ even if only through acquired symptoms (). Adolescents struggling with identity diffusion and an aching desire to be different may find both an explanation for their feelings and a sense of specialness from imitative DID (). In both cases, perception of connectedness is essential and assumed symptoms (such as being 'not oneself') must be emotionally salient to the group: "If a belief is to be propagated and sustained over a long period...all involved must be able to identify with the behavior chosen. Without the perception of a common shared quality the episode will either be transient or may not take place at all." ().

Spoiler: Social media associated abnormal illness behavior

We propose the term Social Media Associated Abornal Eillness Behavior (SMAAIB) to collect both MSMI and MBI presentations under a construct that is agnostic regarding phenomenology. Abnormal illness behavior has been described as: “the persistence of a maladaptive mode of experiencing, perceiving, evaluating and responding to one’s own health status despite the fact that a doctor has provided a lucid and accurate appraisal of the situation…with opportunities for discussion, negotiation, and clarification based on adequate assessment of all relevant biological, psychological, social and cultural factors.” () Of course this assumes interaction with an idealized physician, with standards that even the best physicians inconsistently attain. Similarly many individuals (with MBI particularly) do not seek out physicians at all, or encounter them only coincidentally.


Both falsely refusing and inappropriately leveraging the sick role fall under the SMAAIB construct, and the very definition offers instructions for management. SMAAIB includes somatically and psychologically focused illness behavior, and may be volitionally or involuntarily produced. It includes both the adolescent with MBI filming consciously produced tic-like outbursts due to an overwhelming desire to be seen and the highly suggestible MSMI patient yelling and throwing items after months of watching Tourette Syndrome content in the isolation of COVID-19 lockdown. It includes the patient with MSMI marked by DID-like symptoms (what Draijer & Boon, 1999, would call “imitative” DID)--firmly convinced this diagnosis explains her adolescent search for identity–and the MBI TikToker finally getting the attention he craves.


In these cases it is essential to build rapport–not only to understand, but to enable recovery. This involves not only providing the physician’s explanatory model for SMAAIB (of whatever type), but also discussion of the patient’s model, and negotiation between the two (). It is also essential to understand not only biological but also psychological, social and cultural contributions to the presentation. Providing care, understanding and face to face interactions outside the artificial hyperpersonal setting of social media is necessary. In cases of SMAAIB, healing comes first by disconnection, then connecting anew: disconnecting (in part) from social media, and disconnection of attention and belonging from illness representation. Connection necessarily follows, unpredicated on illness behavior: between adolescent and treater, adolescent and parents, and the adolescent with themselves. Health emerges when adolescents are supported for who they are as whole human beings, not diagnoses.

Spoiler: References

Bartholomew, R. E., & Wessely, S. (2002). Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears. The British Journal of Psychiatry: The Journal of Mental Science, 180(4), 300–306. https://doi.org/10.1192/bjp.180.4.300


Bartholomew, R. E., Wessely, S., & Rubin, G. J. (2012). Mass psychogenic illness and the social network: Is it changing the pattern of outbreaks? Journal of the Royal Society of Medicine, 105(12), 509–512. https:// doi.org/10.1258/jrsm.2012.120053


Bazarova, N. N., & Choi, Y. H. (2014). Self-disclosure in social media: Extending the functional approach to disclosure motivations and characteristics on social network sites. Journal of Communication, 64(4), 635–657. https://doi.org/10.1111/jcom.12106


Brown, S. L. (2021 September 13) Care and feeding: My teen is faking a disability on TikTok. Slate. https:// slate.com/human-interest/2021/09/teens-secret-lives-social-media-tiktok-parenting-advice-from-care-andfeeding.html


Draijer, N., & Boon, S. (1999). The imitation of dissociative identity disorder: Patients at risk, therapists at risk. The Journal of Psychiatry & Law, 27(3–4), 423–458. https://doi.org/10.1177/009318539902700304Giedinghagen 277


Ehrlich, S., Pfeiffer, E., Salbach, H., Lenz, K., & Lehmkuhl, U. (2008 ). Factitious disorder in children and adolescents: A retrospective study. Psychosomatics, 49(5), 392–398. https://doi.org/10.1176/appi.psy.49. 5.392


Feldman,M.D.(2000). Munchausenbyinternet: Detecting factitious illness and crisis on the internet. Southern Medical Journal, 93(7), 669–672. https://doi.org/10.1097/00007611-200007000-00005


Gioia, F., & Boursier, V. (2021). Young adults’ attitudes toward online self-disclosure and social connection as predictors of a preference for online social interactions: The mediating effect of relational closeness. Atlantic Journal of Communication, 1-17. https://doi.org/10.1080/15456870.2021.1952205.


Griffith, F. J., & Stein, C. H. (2021). Behind the hashtag: Online disclosure of mental illness and community response on tumblr. American Journal of Community Psychology, 67(3–4), 419–432. https://doi.org/10. 1002/ajcp.12483


Hian, L. B., Chuan, S. L., Trevor, T. M. K., & Detenber, B. H. (2004). Getting to know you: Exploring the development of relational intimacy in computer-mediated communication. Journal of ComputerMediated Communication, 9(3), JCMC935. https://doi.org/10.1111/j.1083-6101.2004.tb00290.x


Jiang, L. C., Bazarova, N. N., & Hancock, J. T. (2011). The disclosure–intimacy link in computer-mediated communication: An attributional extension of the hyperpersonal model. Human Communication Research, 37(1), 58–77. https://doi.org/10.1111/j.1468-2958.2010.01393.x


Lucas, J. (2021). Inside Tiktok’s booming dissociative identity disorder community. https://www.inputmag. com/culture/dissociative-identity-disorder-did-tiktok-influencers-multiple-personalities


McHugh, P. R. (1995). Resolved: Multiple personality disorder is an individually and socially created artifact. Journal of the American Academy of Child and Adolescent Psychiatry, 347(7), 957–963. https://doi.org/ 10.1097/00004583-199507000-00020


Mohsin, M. (2021). 10 TikTok statistics you need to know in 2021. https://www.oberlo.com/blog/tiktokstatistics


Müller-Vahl, K. R., Pisarenko, A., Jakubovski, E., & Fremer, C. (2021). Stop that! It’s not Tourette’s but a new type of mass sociogenic illness. Brain: A Journal of Neurology, 145(2), 476–480. https://doi.org/10.1093/ brain/awab316


Nagata, J. M., Cortez, C. A., Cattle, C. J., Ganson, K. T., Iyer, P., Bibbins-Domingo, K., & Baker, F. C. (2021). Screen time use among US adolescents during the COVID-19 pandemic: Findings from the adolescent brain cognitive development (ABCD) study. JAMA Pediatrics, 176(1), 94–96. https://doi.org/10.1001/ jamapediatrics.2021.4334


Olvera, C., Stebbins, G. T., Goetz, C. G., & Kompoliti, K. (2021). TikTok tics: A pandemic within a pandemic. Movement Disorders Clinical Practice, 8(8 ), 1200–1205. https://doi.org/10.1002/mdc3.13316


Ostendorf, S., Müller, S. M., & Brand, M. (2020). Neglecting long-term risks: Self-disclosure on social media and its relation to individual decision-making tendencies and problematic social-networks-use. Frontiers in Psychology, 11, 543388. https://doi.org/10.3389/fpsyg.2020.543388.


Pietkiewicz, I. J., Ba´nbura-Nowak, A., Tomalski, R., & Boon, S. (2021). Revisiting false-positive and imitated dissociative identity disorder. Frontiers in Psychology, 12, 637929. https://doi.org/10.3389/fpsyg.2021. 637929.


Pilowsky, I. (1990). The concept of abnormal illness behavior. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 31(2), 207–213. https://doi.org/10.1016/S0033-3182(90)72197-4


Pulman, A., & Taylor, J. (2012). Munchausen by internet: Current research and future directions. Journal of medical Internet research, 14(4), e115. https://doi.org/10.2196/jmir.2011


Sapkota, R. P., Brunet, A., & Kirmayer, L. J. (2020). Characteristics of adolescents affected by mass psychogenic illness outbreaks in schools in nepal: A case-control study. Frontiers in Psychiatry, 11, 493094. https://doi.org/10.3389/fpsyt.2020.493094.278 Clinical Child Psychology and Psychiatry 28(1)


Shepherd, H. (2021). Is illness appropriation TikTok’s most troubling new trend? https://i-d.vice.com/en_uk/ article/pkb397/illness-faking-accusations-tiktok (Accessed 10 Feb 2021).


Thomas, A. (2001). Factitious and malingered dissociative identity disorder: Clinical features observed in 18 cases. Journal of Trauma & Dissociation, 2(4), 59–77. https://doi.org/10.1300/J229v02n04_04


Walther, J. B. (1996). Computer-mediated communication: Impersonal, interpersonal, and hyperpersonal interaction. Communication Research, 23(1), 3–43. https://doi.org/10.1177/009365096023001001 Walther, J. B. (2007). Selective self-presentation in computer-mediated communication: Hyperpersonal dimensions of technology, language, and cognition. Computers in Human Behavior, 23(55), 2538–2557. https://doi.org/10.1016/j.chb.2006.05.002


Wessely, S. (1987). Mass hysteria: Two syndromes? Psychological Medicine, 17(1), 109–120. https://doi.org/ 10.1017/S0033291700013027


Yates, G. P., & Feldman,M.D.(2016). Factitious disorder: A systematic review of 455 cases in the professional literature. General Hospital Psychiatry, 41, 20-28. https://doi.org/10.1016/j.genhosppsych.2016.05.002.


Zhao, P., Lapierre, M. A., Rains, S. A., & Segrin, C. (2021). When and why we disclose distress on SNSs: Perceived affordances, disclosure goals, and anticipated negative evaluations. Computers in Human Behavior, 125, 106964. https://doi.org/10.1016/j.chb.2021.106964.

Spoiler: Thoughts and Highlights

I should have thought to blame my imaginary friends for my poor schoolwork as a teenager. Maybe one day I too can profit from making a fool of myself on the internet. For now, I continue to do it for free, as demonstrated by this post.


The provided case example of imitative DID is a highlight itself.


”...’Motor hysteria’ outbreaks occurred in strict German schools during the late 19th century: students developed tremor and agraphia during school hours but were unaffected during gymnastics classes or at home.”


“....a popular German Youtube influencer who posts extensively about his Tourette Syndrome. Like cases within the Leroy cluster, viewers saw his, or other videos inspired by his experience. They then exhibited movements and vocalizations that were similar, but more bizarre, and inconsistent with Tourette Syndrome.”


“...study of individuals posting about their tics on TikTok in March 2021 found 53% had a vocal tic of saying ‘beans’ (even non-English speakers; after review of many videos the research team found this is a vocal tic of an extremely popular British Youtuber).”


“...handful of DID influencers have hundreds of thousands of followers, and one account has over a million. These accounts record daily the daily lives of people who purport to have dozens of alters, switching upwards of 50 times per day. Some even delineate these switches with changes of clothing, wigs, or nametags ().”


“...a father writes to a parenting columnist about his child, who is posting videos on “Disability TikTok” about a disease for which neither father, nor therapist, nor pediatrician have ever seen evidence. It would be highly unusual for an organic or even conversion phenomenon to manifest solely in online posts, with no symptoms evident in everyday life.”


“...have captured growing societal concerns about such cases, raising the possibility adolescents may be volitionally reproducing symptoms...Notably, 64% of Tiktok posters in Olvera et al.’s (2021) sample from March 2021 included some statement on their channel addressing allegations of faking–some even producing doctor’s notes as evidence.”


“...any action short of implicitly accepting any individual’s self-diagnosis is seen as cyberbullying (). Even physicians questioning diagnoses are seen as invalidating or gaslighting…”


“Malingering means the goal is to gain some material advantage; worth considering given 64% of TikTok tic posters in Olvera’s study had merchandise related to their tics, or stated they were available for paid appearances (). Presentations with the sole goal of increasing ‘views’ would also be considered malingering.”


“Factitious or imitative presentations of DID tend to change as an individual gains information (or misinformation, since social media is rife with it) about DID (). Individuals with factitious DID also tend to be highly dramatic (many switches, many dramatically different alters) and frequently use the DID label as an excuse for avoiding unpleasant activities or consequences (). They may also show disappointment or anger–even ‘firing’ a physician–when DID is ruled out ()…Rapid-fire switching is frequently the topic of posts, and anyone questioning the self-diagnosis is seen as invalidating at best and abusive at worst ().”


“The online space is primed for rapid (felt) intimacy-building, and MSMI may occur when symptoms are unconsciously adopted to support belonging, while MBI occurs when symptom adoption is conscious.”


“MSMI and MBI are also both efforts to be seen within an algorithm-driven social context that rewards the most extreme symptoms with views; the Darwinism of the Algorithm, we might call it.”


"Health emerges when adolescents are supported for who they are as whole human beings, not diagnoses."

 

[Sparkling Yuzu]

“...study of individuals posting about their tics on TikTok in March 2021 found 53% had a vocal tic of saying ‘beans’ (even non-English speakers; after review of many videos the research team found this is a vocal tic of an extremely popular British Youtuber).”

Hahaha, I guess we aren't the only ones who recognized that fake ass tic being trendy AF on tiktok a while ago.

 

[Jimmy Dean Bowl]

That entire article is gaslighting the vulnerable DID community! Terrible awful dreadful stuff.
DID genocide.

 

[Reddit Refugee]

Courtesy of the BBC: Nil-by-mouth foodie: the chef who will never eat again (link) (archive)

I was just in the middle of making an account and writing something up about this one. Been lurking a good while but this one in particular really grinds my gears. On this note if I am doing something wrong or incorrectly please shame me.

Fully recovered eating disorder? Check (“but it was only for less than a year!”). Hypermobile Ehlers-Danlos? Check. Gastroparesis? Check (but strangely, the article mentions this as a separate but linked condition and her nil-by-mouth-ness is a result of hEDS in her bowel wall). Several suicide attempts? Check. Sectioned? Check. Sepsis? Check x 9. And whilst not stated outright nor tagged in her hashtag soup on her health posts, descriptions for POTS and CCI/Chiari are dropped into a little corner of the article. Notably the article mentions a time when she developed stomach pains that put her back into eating disorder inpatient treatment and getting abuse from the other staff and patients for not finishing her dinners. Oh, and a dead sister.

She runs a recipe page on the gram since lockdown in England began and...it looks really good. Supposedly all she can do is sniff, no yums for our warrior here. Hence no surprise that the Beebs picked this tragic tale up, but getting into the news has been a badge of honour for our other munchies. It’s mostly recipes scattered with a few health posts but the posts and stories are very OTT. She’s not typical but coming across the munchie triad whilst minding my own business really made me raise my eyebrows. With hundreds of new followers and attenshuns pouring in from this morning’s article I’m hedging my bets that we are about to witness the birth of a beautiful baby calf.

Screenshots below for your reading displeasure. What got me in particular was one story post that has a box of Abstral (sublingual fentanyl) in the background which is meant to be only prescribed occasionally to cancer patients with opioid tolerance. All on top of a hospital blanket which means she’s either kept props for photos or they’re letting her take it herself. Unusual given that it’s not simple tramadol or codeine, it’s fentanyl.

The ana chef that prompted me to make an account on this site has got herself a feature on Nas Daily. Nothing new but more media appearances. I still feel that making a media appearance about your health condition is a badge of honor. Illness confirmed by True and Honest journalists because of course you need that sort of validation and attention.

I took a quick browse of her Instagram (@the.nil.by.mouth.foodie) to remind myself of her and turns out she is looking forward to starting enteral feeding again. Perhaps there is redemption after all. But then her two most striking health posts are really all about how patients know so much better (despite it being nobody's fault but her own that she did not ensure her tubes were secured) so maybe not.

 

[OK_Cogitator]

Hahaha, I guess we aren't the only ones who recognized that fake ass tic being trendy AF on tiktok a while ago.

Was the OG beans kid legit (I believe she, at least, was)?

Also, quickly, I've not been able to read/contribute as much as I'd like lately (I wish I could medsperg about my transfer, alas...) but I wanted to say a great many of you have made some fun/interesting posts lately, and not just the obvious board core, but a whole lot of newer accounts on top of that. Thanks for the reading, homies.

Imma slink back to the lab, but if anyone wants additional takes on any med specifics, just tag me and I'd be happy to take a look when I can.

 

[Ginger_beer]

Someone has been lurking and saw the bitework discussion! Hi Jaye, dogs aren't a personality trait.
View attachment 4461068

Normally I wouldn't make fun of someone posting their training progress, but these people claim to be accomplished and show a heel like that? Paired with a completely nonsensical send over obstacle without a transition? LOL. Both the dog and the handler need a lot of work before they can post anything as a boast.

Edited to add: I also looked at the "trainer"'s website, and there are more red flags in a communist parade. The dogs are somewhat decent stock (why no pedigrees, do they not know how to research/post them?) for the most part, but with no titles past the basic CGC and Trick Dog title they're literally not qualified for anything. The trainers are even *more* unqualified, which shouldn't be possible, but there it is.

 

[buoyverificationfuel]

The dogs are somewhat decent stock (why no pedigrees, do they not know how to research/post them?) for the most part

As far as I remember, most of their dogs are backyard bred. There's no pedigree, period. Mazikeen was a craigslist puppy.

About and qualifications for anyone else interested.

 

[Ginger_beer]

As far as I remember, most of their dogs are backyard bred. There's no pedigree, period. Mazikeen was a craigslist puppy.

About and qualifications for anyone else interested.

LOL, Leerburg. Talk about outdated methodology, but okay. (I'm not complaining about some of the guests at seminars that they host, which are sometimes very good trainers and handlers indeed. Leerburg itself though is "last century", and I say that coming from the conservative end of the spectrum, so it's "eons ago, when giant reptiles walked the Earth".)

Chilli comes from what is essentially a Czech BYB -- the only trace of the kennel I can find on Working Dogs eu is a single mention of a bitch, but she has good dogs behind her on her sire's side. The fact that there's no other mention, and I can't find them on Google or some of the other pedigree GSD registries means they're strictly a single-decent-dog operation.

Carlos has a thoroughly respectable pedigree, though it's lesser dogs from good kennels. He himself is a chuck out of course because long coats are not to standard. Not that working dog people care -- it's important that the dog can work, not the furnishings, but still.

The crossbreds of course have no pedigrees, but the showline bitch has decent enough conformation for an ASL. She wouldn't win anything, but she's type-y and not extreme. The key of course with all of them is "what are their temperaments and working drives like", and that's impossible to tell from the maundering descriptions.

 

[Battery Low]

I can't reply to the @Drain Bamaged post containing the academic article.

This article has been doing the rounds on TERF/detrans twitter, and whilst a lot of it isn't relevant to this thread, the following paragraphs reminded me of some of what was discussed in the other article.

"Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion."

Makes sense, a lot of munchies are also gender-specials. I don't lurk the DID thread but I imagine it's rife with them.

This article doesn't really add much, and the previous article was far more involved as far as going into the "why" of it all. But it tickled my interest non-the-less in terms of typology.

I Thought I Was Saving Trans Kids. Now I’m Blowing the Whistle.

There are more than 100 pediatric gender clinics across the U.S. I worked at one. What’s happening to children is morally and medically appalling.

www.thefp.com

 

[A tree]

Get your Islamic and horrifying ratings ready
please. This is one of the worst things you'll see this year.