'Munchausen by Internet' Crises a Warning for All HCPs

Alicia Ault

August 05, 2021

A new study documents a handful of cases of women with Munchausen syndrome by internet who targeted doulas in the United Kingdom during the COVID-19 lockdown. The women pretended to have a variety of dramatic perinatal crises that garnered them significant attention from birth support professionals.

The five cases were investigated by Kathryn Newns, DClinPsy, a clinical psychologist in Cambridge, England, who said the cases were brought to her attention by a doula she herself had used for the birth of her own child a decade earlier.

Newns said she believes these are not isolated cases ― either geographically or in terms of the specialty involved.

"I don't think it is likely that this is only happening in the UK. And I'm sure it's not just happening in the doula world," Newns told Medscape Medical News.

Co-investigator Marc Feldman, MD, a clinical professor of psychiatry at the University of Alabama, Tuscaloosa, Alabama, coined the term "Munchausen by internet" in a 2000 article. The expression refers to use of electronic media to perpetrate hoaxes that reward posers with sympathy, control, or emotional gratification. The hoaxers do not seek financial gain.

"The ease of carrying out Munchausen behaviors makes me think that it must be much more common than it ever was," Feldman told Medscape Medical News.

He noted that the new DSM-5 will eliminate the terms "Munchausen" and "Munchausen by internet" and will clarify that "factitious disorder" can be partly or wholly carried out online.

The study was published in the May issue of the Annals of Clinical Psychiatry.

A Warning for Others

In the past, those with factitious disorder had to go to medical libraries to study up on the ailment they wanted to feign. They would then present to an emergency department or a doctor's office and act convincingly, Feldman said.

"Now all you have to do is go to Wikipedia and you can become an expert on a medical ailment within a few minutes," he added.

In the five cases described in the study, the hoaxers created rich stories, especially in cases 1 and 2. In those cases, the perpetrator turned out to be the same person. Subterfuge "obviously made it much harder to know she wasn't who she purported to be," said Newns.

Feldman noted that in Munchausen by internet, there may be some element of truth within the stories.

For healthcare professionals, "it takes a considerable leap to assume that somebody who's talking about some dreaded ailment is in fact exaggerating or outright lying," he said.

In the five cases described in the study, persons contacted doulas, then related traumatic stories and described dramatic, immediate needs. All of the doulas were working remotely because of the COVID-19 pandemic. This likely made it easier for the perpetrators to pull off the hoaxes. The healthcare professionals agreed to share their experiences in the hopes of warning others.

Elaborate Scenarios

The first two cases were ultimately determined to involve one person who had created elaborate scenarios.

In case 1, the hoaxer, who called herself "Jessica," texted the doula "Charlotte" when she was allegedly 39 weeks' pregnant. She said she was unable to go to the hospital because of the COVID-19 risks to her husband, who had cystic fibrosis and had recently undergone a heart and lung transplant.

The husband "Jordan" took over communications, using the same WhatsApp number as Jessica, as Jessica went into labor.

Ostensibly, a midwife team had come to Jessica's and Jordan's house. When the doula was on the phone with Jordan, she heard Jessica crying, grunting, and screaming, and then, at 2:00 AM, she heard the sound of a baby crying. A photo of the baby was texted to Charlotte.

Soon, there were many problems. Jessica allegedly had a postpartum hemorrhage, and mother and baby were taken to separate hospitals. The baby was then diagnosed with congenital heart disease.

Over the next week, "midwives" started texting back and forth with Charlotte. The doula began to have doubts and asked a midwife to share a visual communication.

After receiving no response, Charlotte used a video call, got Jessica on screen, and told her she thought there was no baby. Jessica said the baby was real and showed a "growth chart" as proof of the 5-day-old baby's existence. The birth and baby noises were later determined to be recordings.

Child Deaths

After sharing information among themselves on a private Facebook group, the doulas determined that the person in case 2, "Dakota," was the same woman who was involved in case 1.

In case 2, a doula had spent 2 years supporting Dakota through the deaths of a parent and her baby, who had a congenital defect. A baby-loss charity had also worked with Dakota but could not confirm the baby's existence.

Dakota had gone so far as to make a video for the doula that showed a hospital room. In a voice-over, Dakota thanks everyone for the support she received as the baby died.

In case 3, "Hannah" texted a doula seeking emotional but not birth support. The doula, Nikki Barrow, has recounted the case on her own blog.

Hannah became desperate when she went into labor. Barrow remained close via texts, phone, and video calls, even as the baby supposedly died after 3 days. The doula lit a candle for the baby and cried with Hannah.

Barrow was eventually able to break away from Hannah, saying she was not a bereavement specialist. However, days later, Hannah tracked her down and claimed she had an infection in her heart and did not have much time to live. At that point, Barrow stopped all contact.

She determined from other doulas that Hannah had been hoaxing doulas for 4 or 5 years. Some had offered to get her help, but she refused and ended all contact.

Multiple COVID Crises?

In case 4, a woman sought support on a doula-centered Facebook page and said her partner "Jack" would be in touch. Jack sent the doula hundreds of emails, texts, and WhatsApp messages and then said he was hospitalized with COVID. The woman, "Hayley," was also soon diagnosed with COVID.

Hayley refused video contact and did not share photos. Drama continued to unfold. She reported that her baby was breach, that she had a second uterus with a second pregnancy simultaneously, and that the baby had COVID.

Hayley also claimed that her partner had come to the hospital, had raped her, and had brandished a gun. When the doula called the police, they did not find Hayley at the hospital or elsewhere.

In case 5, a "grandmother" contacted "Lisa" to find a doula for her daughter-in-law, "Anna." Hours later, Anna was giving birth, and the baby had to be taken to the hospital because of cardiac and breathing problems. The doula heard nothing more after a few weeks.

However, at least three other doulas said they had supported the same "family."

Online Training Program

In all cases, the doulas were not paid for their time. Reports to the police prompted no action because no money had changed hands. Some doulas said they felt bereaved, angry, or "silly" that they had been hoodwinked. All noted how difficult it was to disengage from clients who seemed to be in peril.

Barrow decided to create an online training program in which doulas are advised on how to stay safe while working online.

DoulaMatch, which matches birth support specialists with women in the United States and Canada, offers tips to help protect doulas from hoaxes.

Kim James, BDT (DONA), ICCE, LCCE, CLE, the owner and operator of DoulaMatch, said the organization is aware of "scammers that waste everyone's time and have found doulas to be the latest easy targets."

However, she noted, "I've only very occasionally and anecdotally heard about people fabricating a pregnancy for emotional gratification."

In his 2000 article, Feldman offers clues to help detect hoaxers. He advises clinicians to be wary of the following:

  • Cases in which the length, frequency, and duration of posts are incongruous with the severity of the illness the person is claiming to have; for example, someone who claims to be in septic shock submitting detailed posts

  • Near-fatal exacerbations of illness alternating with miraculous recoveries

  • Personal claims that are fantastic, are contradicted by later posts, or are disproved

  • Continual dramatic events occurring in the person's life, especially when others in a group become the focus of attention

  • Others ostensibly posting on behalf of the individual who have identical patterns of writing, such as making grammatical errors, misspellings, and using stylistic idiosyncrasies

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault.

Ann Clin Psychiatry. 2021 May;33:e8-e12. Abstract

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