How to Tell if Someone Is Pretending to Have an Illness

Keeping a Fair Attitude

Recognize that undiagnosed illnesses are still illnesses. Sometimes, people may have an issue that they don't have a name for, and that doctors can't label yet. This can be a confusing and frustrating process for the patient, but they are likely to eventually find an accurate diagnosis and stop needing to search for a diagnosis.

Recognize that a string of diagnoses doesn't always mean that someone is faking it. Sometimes, people get misdiagnosed, or only diagnosed for one condition when they actually have several of them. It may take a while for a person to settle on the right one(s).

Remember that other people's experiences may be different from yours. People can experience things that you've never heard of, and they can experience things that you've had much more severely than you did. Don't assume that someone is faking just because you don't understand what they are going through. For example, if you have never had severe menstrual cramps, that doesn't mean that cramps can't ever be severe. One person may only experience mild cramps, while another person might experience pain and exhaustion so serious that they cannot function at work or school.

Get rid of any judgments or stereotypes you might hold. People with various illnesses can be diverse. Someone doesn't have to fit the stereotype of an illness in order to have it. Mental illnesses and disabilities are just as real and serious as physical ones. Just because you haven't personally witnessed someone's symptoms (especially invisible symptoms) doesn't mean that the symptoms aren't there. Someone can look fine on the outside and be suffering on the inside. This can happen especially with mental illnesses. People with chronic conditions can have "good days" and "bad days." During a flare-up, their symptoms can be worse. Just because their symptoms are less severe on some days doesn't mean it's fake. Not all people with an illness or disability meet the stereotype. For example, people with depression may feel happy from time to time, and people who use wheelchairs might be capable of standing or walking very short distances.

Evaluate whether you have any ulterior motives. Why do you want to accuse this person of faking an illness? Is it possible that you are trying to harm their reputation? Be honest with yourself. Make sure that you're looking into this for the right reasons and not the wrong ones. Are you looking for something to accuse this person of, because you don't like them? Are you jealous of the attention they are getting? Do you just not want to deal with helping them or investing emotional energy in their well-being?

Recognize that it can be serious to accuse someone of faking an illness. This accusation may break relationships, sometimes irreparably. Be certain before you make any serious accusations. If you accuse someone of faking, when they are actually suffering, this may change people's opinions of you.

Noticing Signs

Consider whether the person displays symptoms when they are alone (or think they are alone). If someone is faking an illness, then they no longer need to keep up the pretense when they think no one is watching. You may notice that they miraculously become "okay" when they are alone. Keep in mind that people may experience fewer symptoms while resting. For example, someone who is in pain might experience less pain if they hold the affected area still and keep their mind occupied on something else (like a TV show).

Consider whether they seem to be enjoying their symptoms and the care they receive. While a sick person may appreciate others' kindness, their goal is to get better and stop relying on other people (there are exceptions, but this is generally the case). Their illness can cause frustration, sadness, or general distress to them.

Consider how they react to the idea of medicine and treatment. Someone who is feeling bad is likely to accept over-the-counter medicine, because they want to feel better. Someone who is faking it is likely to refuse it, because they don't actually need it. There are a few reasons why an injured or sick person may refuse treatment. Some people (especially men) may be too proud to admit that they need treatment, and conspiracy theorists or anti-vaxxers may fear that modern medicine will harm them. Take the person's personality into account.

Notice how they react to the idea of seeing a doctor. A sick person may agree out of the desire to get better, or prefer to wait it out a little longer to see if it goes away, but will rarely have an extreme reaction like eagerness or emphatic denial. Someone who has a very strong reaction may be faking their sickness. Someone faking illness to avoid or gain something may want to avoid seeing a doctor, who might figure out that they are lying. They may adamantly not want to see a doctor, and start "getting better" quickly after you mention it. People who enjoy playing sick may be eager to see a doctor, because they enjoy playing the role of a patient.

Notice how comfortable the person is in a medical setting. Most people feel a little nervous in a doctor's office or hospital. A faker may fear being found out. A person with factitious disorder, however, may be especially relaxed and happy to be there because receiving medical care was their goal. Keep in mind that everyone reacts differently to medical treatment. Some people are less nervous, and may just be tired or relieved to finally be getting help. Someone who enjoys being a patient may have a lot of medical knowledge, potentially surprising doctors and nurses with how much they know.

Examine why a person seems relieved about getting treatment. A sick person may feel relieved about getting a diagnosis and getting treatment, because they want to feel better. A person who is faking it may be relieved because their lie is being believed, or because they are falling into the "patient" role that they enjoy.

Considering Causes

Consider non-serious causes of faking an illness. Sometimes people, especially children, fake an illness to get out of school or work, or to receive attention. This may be a one-time or occasional issue. Avoiding a demand Avoiding a stressful situation (such as a school bully) Wanting attention

Look out for malingering. A person who malingers is hoping to gain something, such as money, from faking illness.

Recognize factitious disorder (formerly known as Munchausen syndrome). People with factitious disorder are looking for attention and care, and believe that faking sick is the only way to get it. They enjoy playing the role of a patient and getting medical treatments. Many people with factitious disorders have a history of childhood trauma or hardship and may have real underlying mental illnesses such as anxiety, depression, or bipolar disorder. They may say that their symptoms have gotten worse after they receive treatment. They may come up with a new illness after the last one has been treated. They may try to tamper with test results or make themselves sick. They may have a lot of medical knowledge that they use to fake various disorders. They may also feign illness or injury for social reasons, such as trying to stop family members from fighting.

Consider disorders that don't involve faking sick. Some people genuinely feel ill for unusual or mysterious reasons. They are often frustrated and distressed by their symptoms, and they can't control them. Disorders that could be mistaken for "faking sick" include: Illness anxiety disorder (IAD), formerly known as hypochondria, is when a person obsessively worries over their health. They may fear that normal aches and pains are serious health problems. This is not done on purpose, and treatment for anxiety can help reduce symptoms. Conversion disorder is when excessive stress manifests itself as health problems (tremors, weakness, numbness, trouble walking, etc.) and is not controlled by the person. This can be caused by tackling the root cause: chronic or severe stress. Autism and developmental disabilities can sometimes result in a person being confused about why they feel a certain way. For example, they might not know how to tell the difference between a cold and a combination of allergies and feeling worn out. This confusion isn't intentional, and it may help to have attentive family members keep an eye on how they're doing. Ordinary mental illnesses such as depression, anxiety, and OCD can cause physical symptoms like stomachaches or fatigue. A mental health screening may be able to identify the problem so that the person can receive appropriate treatment. Rare or undiagnosed illnesses can cause mystery symptoms until a person gets appropriate help.

Moving Forward

Be gentle but firm with an attention-seeking child. If you suspect that a child is doing this because they feel ignored, address the problem. Tell them that it's not okay to lie, and then invite them to seek attention in a more constructive manner. For example, "Joey, lying about how you're doing is not okay. If you want my attention, then you can tell me that you're lonely or invite me to hang out with you. Is that what you want? If so, you can ask me to hang out." Be sure to listen and provide a more effective way to get attention, or the child may learn that faking sick is the only reliable way to get your attention.

Talk to a child who is trying to skip school. Children who are doing well rarely lie in order to skip school. Ask them why they are faking sick, and what it is at school that they are afraid of. They may be trying to avoid something that scares them. Your child may be suffering from... Bullying Too much or too difficult schoolwork A mean teacher An anxiety disorder An undiagnosed disability that makes school very hard (e.g. a child with dyscalculia fearing math or a child with asthma hating gym class)

When in doubt, be kind without investing much emotional energy. Show respect to the person and meet their basic needs. You don't have to shower them with attention or love. Be dutiful, without going above and beyond for them. If they were attention seeking, then this will let them know that faking illness isn't an effective way to get much attention.

Set boundaries with an adult who makes a habit of faking sick. It can be exhausting to deal with someone who constantly seeks attention in a negative manner. You don't have to engage, and it's okay to politely change the subject or leave the conversation. Here are some examples of things you can say: "I can't help you today. I have a prior commitment." (If they ask what, say it's personal.) "Aunt Cass, Uncle Henry is trying to open up about something difficult. You can wait your turn, and we'll talk about your thing next." "I'm sorry to hear that. Anyway, I was saying that I'll be out of town this weekend." "I'm afraid I can't attend. I already have plans."