Sick for Attention

Marc Feldman has spent more than 25 years studying fakes, but the bespectacled Alabama-based psychiatrist still vividly recalls the woman who introduced him to what became his life’s work. It was in the early 1990s, when he was a newly minted psychiatrist, shortly after completing his residency at Duke University. His department chair asked him to see a patient he calls “Anna,” who was suffering from an unusual psychological disorder.

The woman sitting in the brightly lit exam room was emaciated, and her gaunt body was virtually devoid of flesh with an ill-fitting brown wig sitting on her shaved head. She was in her 30s and had been employed in a position of some responsibility. Anna’s alarming appearance was presumably the result of several grueling rounds of chemotherapy for her metastatic breast cancer, which had sucked about 60 pounds off her frail frame and caused her hair to fall out.

Except that it was all a lie. For nearly two years, Anna had pretended to be sick: She copied the cancer symptoms of an acquaintance, starved herself to shed weight, and shaved her head to mimic the appearance of undergoing treatment. In a case report, Feldman and his co-author Rodrigo Escalona noted that Anna refused social invitations, fearing her vigilance would falter and she’d give the ruse away by acting “too well.”

The words that came tearfully tumbling out to explain what motivated her to fabricate such an elaborate ruse had a certain twisted logic. A few years before, her fiancé had abruptly ended their engagement, which left her feeling abandoned and betrayed. Soon after, she told coworkers about her “breast cancer diagnosis” and that her prognosis was grim. Their outpouring of sympathy filled the profound emptiness in her life, which had become more pronounced after her broken engagement. Their warmth and concern prompted her to join a cancer support group, where she quickly established a network of close friends, even though it had been difficult for her to form deep relationships.

But her deception was discovered when the leader of the support group, in a routine review of her medical chart, found out Anna had never seen the oncologist she claimed had treated her. Confronted with the truth, she confessed—and was promptly fired when she told her irate employer. Distraught, Anna realized she needed help, which is how she ended up in a psychiatric ward diagnosed with Munchausen syndrome, a condition in which people feign illness or make themselves sick.

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