535. Deceptive behaviors around illness are often signs of deep, unmet emotional needs. In this episode, Dr. Monica Johnson looks at the severe medical and psychological costs of factitious disorder and malingering. She looks at how to recognize these patterns and discusses how specific therapies like CBT and DBT can help an individual build a life based on authenticity.
535. Deceptive behaviors around illness are often signs of deep, unmet emotional needs. In this episode, Dr. Monica Johnson looks at the severe medical and psychological costs of factitious disorder and malingering. She looks at how to recognize these patterns and discusses how specific therapies like CBT and DBT can help an individual build a life based on authenticity.
Find a transcript here.
Savvy Psychologist is hosted by Dr. Monica Johnson.
Have a mental health question? Email us at psychologist@quickanddirtytips.com or leave a voicemail at 929-256-2191.
Find Savvy Psychologist on Facebook and Twitter, or subscribe to the newsletter for more psychology tips.
Savvy Psychologist is a part of Quick and Dirty Tips.
Links:
https://quickanddirtytips.com/savvy-psychologist
https://www.facebook.com/savvypsychologist
https://twitter.com/qdtsavvypsych
https://www.kindmindpsych.com/
If you spend any time on social media, you’ve probably scrolled past a teary hospital gown selfie, a viral story about a rare illness, or a heartfelt thread about mysterious symptoms doctors “just can’t figure out.” Some of those stories are absolutely real. Some reflect misunderstood or underdiagnosed conditions. And others…let’s just say they’re as authentic as a reality TV star’s “I woke up like this” moment.
Today I want to break down two often-misunderstood phenomena: factitious disorder (what many still call “Munchausen syndrome”) and malingering. Both involve people pretending to be ill, but they differ in motivation, meaning, and what kind of help is needed. And in today’s world where likes, shares, and sympathy can translate into real rewards these conditions are more visible and complicated than ever.
Welcome back to Savvy Psychologist, I'm your host, Dr. Monica Johnson. Every week on this show, I'll help you face life's challenges with evidence-based approaches, a sympathetic ear, and zero judgment.
What Exactly Is Factitious Disorder?
Factitious disorder is a psychiatric condition where someone intentionally fakes, exaggerates, or even induces illness. The goal isn’t money, drugs, or skipping work. Instead, the “reward” is internal: attention, care, and the identity of being a patient.
This can look like:
Hospital visits with dramatic but inconsistent stories.
Fluency in medical jargon that rivals an episode of the Pitt.
Self-harm or tampering with test results to create convincing symptoms.
The more dangerous form, factitious disorder imposed on another (FDIA) once called “Munchausen by proxy” involves a caregiver making someone else sick, often a child. This isn’t just deception. It’s abuse, with potentially devastating consequences. We all know examples of this, with one of the more recent being Gypsy Rose.
What Is Malingering?
Malingering, on the other hand, is not a psychiatric disorder. It’s a behavior: someone fakes or exaggerates illness to get tangible external rewards.
Examples include:
A student exaggerating ADHD symptoms to get stimulants or testing accommodations.
An employee faking an injury to extend paid leave.
A defendant “losing their memory” right before trial.
If factitious disorder is about wanting to be sick, malingering is about wanting what comes with being sick.
Now add the influence of social media, a space where being visibly sick can earn sympathy, followers, or even sponsorship deals. Illness has become both content and, sometimes, currency.
Munchausen by Internet
Psychiatrist Marc Feldman coined this term in 2000 to describe people who feign illness online. The patterns are dramatic: repeated hospitalizations, miraculous recoveries, or crises that seem designed to keep attention focused.
Symptom Contagion
Doctors have reported waves of teens suddenly developing tic-like behaviors after binge-watching TikTok videos from creators with Tourette’s. While most of these cases aren’t deliberate fakery, they show how symptoms can spread socially and unconsciously.
Malingering 2.0
External rewards aren’t just disability checks anymore. On platforms like TikTok or Instagram, the payoff can be likes, GoFundMe donations, sponsorships, or the halo of being inspirational. That turns attention itself into a form of external gain.
Why Does This Happen?
This isn’t about “bad people lying.” It’s about unmet needs showing up in unhealthy ways.
For factitious disorder: Many individuals report childhood trauma, neglect, or medical mistreatment. Illness can become a way to feel seen and cared for.
For malingering: Sometimes it’s survival. If society leaves you without resources, pretending illness may feel like the only way to access help.
In the social media era, attention is its own currency. Followers and sympathy can function like external gain.
The ripple effects of factitious disorder and malingering are far-reaching and often underestimated. On the medical side, the consequences can be severe and, in some cases, life-threatening. People with factitious disorder sometimes go to extraordinary lengths to appear ill, injecting themselves with foreign substances or reopening wounds which can lead to dangerous infections, disfigurement, or permanent organ damage. Others undergo invasive procedures and surgeries they do not actually need, exposing them to anesthesia risks, surgical complications, and long-term side effects.Which are things I’ve seen during my years as a psychologist.
The social costs are equally significant. Trust is a fragile thing in healthcare, and these conditions can erode it quickly. When a person’s deception is revealed, relationships with family, friends, and even entire support networks often suffer lasting damage. Loved ones may feel manipulated, betrayed, or even complicit in the deception. In cases of factitious disorder imposed on another (FDIA), children may be subjected to years of unnecessary treatments, hospitalizations, and emotional trauma. Some have died as a result of their caregiver’s actions. Even when the physical harm is not fatal, the psychological consequences for children and family members chronic anxiety, medical phobias, and attachment difficulties for example can last well into adulthood.
There are broader social and cultural consequences too. Highly publicized cases of deception can increase skepticism toward patients with legitimate but poorly understood illnesses, such as chronic pain, autoimmune disorders, or functional neurological conditions. This is particularly damaging for marginalized groups who already face systemic bias and are more likely to have their symptoms dismissed or minimized. The legacy of deception, real or perceived, can fuel dangerous stereotypes about patients “faking it,” creating barriers to care and deepening mistrust between communities and healthcare providers. Online, the problem magnifies. Support groups may fracture when members feel betrayed by fabricated stories, and entire online movements dedicated to chronic illness can lose credibility if a few high-profile accounts are exposed as deceptive. The result is a chilling effect that discourages people with real conditions from seeking support or sharing their stories.
And then there’s the deeply personal cost, which is often the most heartbreaking. For the individual engaging in deceptive behaviors, the cycle of fabrication rarely delivers the relief they’re seeking. When they are exposed, they may withdraw from relationships, avoid healthcare altogether, or spiral into depression and suicidal ideation. Those who malinger for external gain may face legal repercussions, financial penalties, or the collapse of relationships once their deception is discovered. And even when legal consequences aren’t on the table, the damage to one’s sense of self, reputation, and integrity can be profound. Understanding these consequences is essential if we want to respond not just with suspicion or anger, but with strategies that prioritize safety, healing, and human dignity.
If you’re listening to this and some of it sounds uncomfortably familiar, please know this: there is help available to you. Engaging in deceptive behaviors around illness doesn’t erase your humanity or invalidate your suffering. It’s often a sign that deep, unmet needs are trying to find expression in the only way they know how. Acknowledging the problem, however shameful it might feel, is the first and most powerful step toward change. The next is reaching out for help. Find a psychologist or psychiatrist you trust and be as honest as you can. You don’t have to confess everything all at once; even saying something as simple as, “I sometimes make my symptoms seem worse than they are, and I don’t know why,” is enough to start the conversation. A good clinician will understand that this behavior is often rooted in trauma, attachment wounds, or overwhelming emotional needs—not malice.
Treatment for factitious disorder focuses less on “stopping the lying” and more on healing the psychological pain underneath it. In the hands of a trauma informed provider, treatments such as cognitive behavioral therapy (CBT), schema therapy, or psychodynamic approaches, can help you explore the origins of your behavior and develop healthier ways to meet your emotional needs. Dialectical Behavior Therapy (DBT) is particularly effective because it teaches concrete skills for emotion regulation, distress tolerance, and reducing self-harm skills that many people with factitious disorder struggle with. If co-occurring conditions like depression, anxiety, or PTSD are present, medication may also be part of your treatment plan. Over time, therapy can help you build new patterns of relating to yourself and others grounded in authenticity rather than performance.
Practical steps matter too. If certain online spaces trigger the urge to exaggerate or fabricate, consider limiting your exposure to them, at least temporarily. Surround yourself with relationships and communities that value you for your whole self, not just for the role of “the sick person.” And most importantly, practice self-compassion. It’s easy to spiral into shame, but shame keeps you stuck. Recognize that your suffering is real even if your symptoms aren’t, and that seeking help is an act of courage, not confession. Recovery isn’t about erasing the past, it's about writing a different story for your future, one built on truth, healing, and connection.
Did you know about factitious disorders before today? Let me know! You can contact me via Instagram @kindmindpsych or via my email at psychologist@quickanddirtytips.com.
The Savvy Psychologist is a Quick and Dirty Tips podcast. It's audio engineered by Steve Riekeberg. The director of podcasts is Holly Hutchings. Our advertising operations specialist is Morgan Christiansen. Rebekah Sebastian is our marketing manager, and Nathaniel Hoopes is our marketing contractor. Follow Savvy Psychologist on Apple Podcasts, Spotify, or wherever you listen to podcasts. That's all for this episode of Savvy Psychologist. Thanks for listening! I'll see you next week.