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Legal Issues Surrounding the Exposure of "Munchausen by Internet"

TO THE EDITOR: Internet health support groups face immense struggles when targeted by individuals with factitious disorder such as Munchausen syndrome. In the most common manifestation of this "Munchausen by Internet,"¹ an individual seeks attention and succor by playing out a series of highly dramatized near-fatal illnesses alternating with recoveries that increasingly strain credulity. Many support groups have been destroyed by infighting in the wake of the deceptive postings.

Writing of the harm that factitious-disorder patients sometimes wreak, Feldman² has speculated that "lawsuits would be one way to turn the tables on factitious-disorder patients... The odds are good that someday a precedent-setting civil case against a factitious-disorder patient will be waged and won...(p 200)."

Although no such lawsuit has, to our knowledge, been reported, we would like to draw attention to a novel legal case from late-2005 that is relevant to the stance a civil court might well take toward a factitious-disorder patient.

Case Report
A group of online self-help websites that dealt with a particular health problem, and having a worldwide membership of over 7,000, was in turmoil after a prominent member, "Mr. A," claimed to have undergone many potentially fatal operations, multiple massive heart attacks, and other life-threatening crises. The explanations became increasingly contradictory and were often accompanied by abusive and threatening posts in response to questions or doubts. A team of members set up a dedicated website to publicize their objections; even so, it took more than 6 months of fighting across the whole group of sites before Mr. A was removed and issued lifetime bans from each of the boards. At this point, Mr. A took his accusers to a court in the United States and asked the judge to close down their dedicated website as defamatory. The defendants argued that they were acting in the public interest and that the truth of their statements was a complete bar to liability. In court, the plaintiff’s priority was to have his medical records sealed, but, because many of the most damaging claims involved purported health crises that the plaintiff had himself discussed on the Internet, the judge ruled that the medical records lay at the heart of the accusations and that cross-examination relating to their contents would be allowed. The plaintiff immediately withdrew, and the judge dismissed his case with prejudice, eliminating his right to sue the defendants again on the same charges.

Discussion
This legal outcome has effectively ceded to the group the ability to expose the individual’s previous deceptions with minimal fear of being sued. That would seem to offer an escape route for any future critics the plaintiff might threaten with legal action; they would presumably need only to claim to be unnamed administrators from the group that had previously emerged to be able to be sheltered under the same legal immunity. This unpublished case offers the implication that the presentation of inconsistent medical details against a person with factitious disorder—or even the prospect thereof—will someday result in a precedent-setting judgment against such an individual.

REFERENCES

1. Feldman MD: Munchausen by Internet: detecting factitious illness and crisis on the Internet. South Med J 2000; 93:669–672[Medline]
2. Feldman MD: Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder. New York, Brunner-Routledge, 2004

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Feldman, M. D. Articles by Peychers, M.E. Search for Related Content PubMed Citation Articles by Feldman, M. D. Articles by Peychers, M.E. Other Forensic Issues Computers, Telecommunications

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