Faking an illness
CBC News
Monday, August 9, 2010

It can be a lie, or a real disorder

When it comes to faking illnesses, no one is immune.

"In the normal range of behaviour, we all do it. Everybody gets a headache every once in a while to avoid something they don't want to do or to get a benefit like a day off," says Toronto psychiatrist Irvin Wolkoff.

But pretending to be sick can take a far more sinister turn for some. In early August, allegations first surfaced that a 23-year-old Burlington, Ont., woman was fundraising under the guise she had terminal cancer.

Ashley Kirilow was charged with three counts of fraud under $5,000 after she turned herself in to police.

"She showed me how she didn't have any hair and she showed me how she had cancer and stuff, and I really believed her," said Sarah Slingsby, a nine-year-old cancer patient who became friends with Kirilow after the young woman approached her in a mall.

The alleged hoax began online with postings on Facebook and MySpace that quickly garnered thousands of supporters to Kirilow's cause — and brought in thousands of dollars.

Technology experts say it can be easy in the age of the internet for a little white lie on a status update or 140-character tweet to spin out of control.

"It's hard to get out of a lie like that. In a social circle, it's easy to admit what's gone wrong, but when thousands of people are involved it's a lot harder to fess up," says CBC's technology columnist, Jesse Hirsh.

Generating 'hot air'
But Wolkoff says a normal person would understand when things were getting out of control and right the wrong. Largely, he says, that's because most people have a good internal understanding of self — and recognize the need to behave according to certain standards or values in order to be part of a family or community.

As with many of the images posted online of Ashley Kirilow, this one from her MySpace page suggests she had lost her hair from cancer treatment.As with many of the images posted online of Ashley Kirilow, this one from her MySpace page suggests she had lost her hair from cancer treatment. (MySpace)

"If you don't have an accurate, consistent picture of 'you' in your mind, you can do anything at any given minute," said Wolkoff. "So you end up capable, not of functioning like a normal human being, but of doing anything to keep the balloon afloat. You generate hot air forever.

"And some people do it by claiming to be relatives of European royalty, others imitate rock stars. Some people do it by being sicker than anybody else and getting a tremendous amount of attention."

Such behaviour can go deeper than lack of personal understanding and into the realm of mental disorders.

Factitious disorder is an umbrella category for mental disturbances where the person acts physically or mentally ill, without any visible benefits to the person.

When the act involves clear gain for the alleged patient, it falls under an entirely new term — malingering — which though official sounding does not constitute a legitimate malady.

'Hospital hobos'
Chronic factitious disorders where the signs or symptoms are primarily physical are often referred to as Munchausen syndrome. Many with such an illness have been known to move from hospital to hospital in search of treatment, earning them the nicknames of "hospital hobos."

Experts have been unable to pinpoint the cause of factitious disorder. Magnetic resonance imaging (MRI) has found abnormalities in the brain structure of those with chronic factitious disorder, suggesting biological or genetic factors.

Among the psychological explanations explored are whether the patient has underlying problems with masochism, needing to be the centre of attention and wanting to receive care and nurturing.

Whatever the reason, Wolkoff warns, lying about an illness can have wider repercussions.

"Whatever actually happened, the allegation that someone faked an illness and raised money weakens the social fabric, so all the rest of us decide that maybe it's not worth supporting worthy causes or it's not worth it to be kind and obliging to sick people."

That said, Wolkoff still has this message: "Don't give up on society."