As a therapist, I occasionally come across a person who has made up a medical condition or illness. I am not talking about laziness or benefit fraud. Or the intent to deceive for its own sake or for some gain. Indeed, the people I am referring to typically have a strong work ethic. Or high – or too high – standards or expectations of themselves. So, why would they make up an illness? There has always been a psychological need.
Reasons for making up an illness
Sometimes, the reasons for making up an illness are quite straightforward. The person was finding parts of life just too difficult. Or the stress was just too much. For example, a major social event would feel unmanageable but they felt unable to put their needs first and decline the invitation. Or they were being treated badly at work but didn’t have the assertiveness to press for change. Unable to find a way of coping, they made up an illness as a way out of the difficult situation.
Another common reason is needing help or support of some sort, but being unable to obtain it. Usually that means they found it difficult to ask for or accept help, rather than not being able to find a suitable source of help.
A third reason is that someone has emotions that were too difficult to express or even understand, so they begin to talk about them as physical feelings. In the end though, the reasons for making up an illness are usually unique to the person in some way.
Related conditions
This might sound a bit like Munchausen syndrome, sometimes called ‘factitious disorder’, which gets much more attention in the media. The person with Munchausen syndrome may reject treatment and move on to a new doctor so the fiction can be maintained.. Other people may allow themselves to undergo unnecessary tests and procedures. This is a more severe psychological condition, usually requiring psychiatric help.
Made-up illnesses are also different to psychosomatic illness. These are usually where psychological distress manifests as physical symptoms. The person really does feel these symptoms, but they seem to have no identifiable cause. Made-up illnesses are different, too, from medically unexplained symptoms. These affect your ability to function properly, but doctors can’t find a problem with the body that may be the cause. Here the person is really experiencing the symptoms. The same is true of conversion disorder where someone genuinely experiences neurological symptoms, even though doctors can find no reason for them. In all of these cases, there is no intention to deceive.
In contrast to all of the above, the people I am referring to here have got into a tangle by making something up and then become reliant on that story. It has becomes difficult to extricate themself. And all the while they are probably not addressing the problem they needed help with in the first place.
How can therapy help when you have been making up an illness
Understanding the original need
Sometimes when a person feels heard, understood and supported, they can let go of the made-up illness. The need to have a pretend illness fades away. They no longer need it as a means to get the help or care they really needed in the first place. They often experience some relief at gaining the help they need. And more relief at not having to continue the fiction of an illness.
Sometimes they will just tell me that the illness has gone, even though there is some unspoken awareness between us that it was not real. This is enough, if they are now getting the help they couldn’t ask for before. However, acknowledging that the illness was not real can be more helpful for several reasons. Why is this?
Firstly, it is often useful to understand how the difficulty in seeking care turned into the need for a made-up illness. There are many reasons why this can happen and they are usually unique to the individual. Most common is some version of devaluing oneself and putting other people first. Then we can understand why it was difficult. And how the person can seek help more easily in future.
Secondly, it is sometimes more straightforward to deal with consequences of having made up an illness when we acknowledge it. Support to untangle the situation is often just as important.
Dealing with the consequences of making up an illness
Even when the original problem that led to the made-up illness has been sorted out, there are often consequences of having misled people. There is a wish to undo all of that. But that’s not always possible. It’s usually more realistic to recognise the impact and start from there. Quite possibly, you will need to repair relationships if you have upset someone.
There may be embarrassment or shame attached to having pretended to have the illness. Therapy can help with this at the same time.
Sometimes, there is hesitation about going back to the doctor involved and having to admit that an illness was made up. Or just to face those same doctors again. But we need doctors in our life, sooner or later. It’s important not to repeat the mistake of not seeking care when we need it.
In fact, we can usually find a way to do this that doesn’t feel too awkward. Doctors tend to be very understanding as to how this came about. After all, they are here to help with our mental health as well as physical ailments.
Occasionally making up an illness leads to legal proceedings where you have misrepresented the facts or committed fraud. It is helpful to recognise these circumstances are now part of your life. But also that you can deal with these and move on. Therapy can support you in doing so.
Therapists will not judge you
Maybe you have made up an illness yourself? I hope you can see by now that, as a therapist, I have will understanding for the difficulties you have faced. For example, that you found it difficult to ask for the help you needed. Or maybe that you found it difficult to admit to yourself that you needed help at all. I will not be judging you for making something up when that felt like the only thing possible. I suspect most therapists will take the same view. If you find yourself in this situation, please don’t hesitate to ask for help.