Playing for Sympathy

When Anna’s fiance broke off their engagement, it was too much for her to bear. Devastated and feeling abandoned, the 35-year-old corporate secretary went to work one day shortly after the breakup and did something inexplicable. She told everyone she had terminal breast cancer. But she didn’t just stop at that. Soon, Anna began to imitate the look of someone very ill. Mirroring the appearance of an acquaintance who did have cancer, she shaved her head to mimic the side effects of chemotherapy; she began wearing a wig. A woman of average weight, she forced herself to lose 20 pounds to appear gaunt. She turned down any social engagement or activity that required physical energy; she didn’t want others to think she looked “too well” . . .

. . . After all, Anna was physically well. Mentally, however, she suffered from a poorly understood malady called factitious disorder: the need to make up symptoms in order to be treated like a sick person, says Dr. Marc Feldman, a psychiatrist who eventually treated Anna (not her real name) at Duke University Medical Center in Durham, N.C.

The woman’s bizarre odyssey began about three years ago when her fiance of more than a year became involved in another relationship and suddenly ended their engagement.

Anna, an insecure and shy woman, hadn’t seen the breakup coming. Not long after that emotional jolt, she blurted out to co-workers that she was suffering from breast cancer and that the cancer had spread to other parts of her body. Immediately, colleagues and the few friends she told embraced her with warmth and sympathy. Family members, who did not live in Raleigh-Durham area, knew nothing of her “illness.”

Anna was intelligent and resourceful. She didn’t risk blowing her cover by submitting medical insurance forms or by seeking care from a doctor.

Still, something compelled her to carry the ruse even further.

In the sprawling medical compound of nearby Duke University, Anna found another pocket of comfort and security. Claiming to be dying of breast cancer, she enrolled in a support group. As with all the women in the group, Anna was welcomed and given unconditional comfort.

She felt at home with women who also had been touched by tragedy.

Meeting week after week, in the group’s warm, candid environment, Anna developed a close circle of friends even though, Feldman says, making friends had always been difficult for her.

She was a vocal participant in the meetings, eagerly sharing her thoughts and advice and often urging members to face up to their illness. She enjoyed being the center of attention. And yet, aside from talking about a recent vacation, she shied away from telling too much about her life.

Sometimes, like others in the group dealing with the emotional burden of cancer, Anna cried.

She was convincing, says Rachel Schanberg, director of Duke’s cancer support group program:

“She certainly knew a lot about cancer. And she did look ill. She did so many things to make herself look ill.”

Anna continually reminded others of her illness. But at one point, when she sensed her co-workers had become complacent, she elicited a new outpouring of sympathy with the news that her grandfather had been seriously injured in a fire.

Eventually, however, both co-workers and support-group leaders sensed something odd about Anna’s story.

Support group leaders say that, after she joined them, they made a routine check with the physician Anna claimed was treating her. The doctor denied knowing her. Anna said the doctor had forgotten her name and mentioned another doctor who had treated her.

Again, the information proved false.

“We were getting in touch with one physician after another,” Schanberg says. “We were increasingly aware something was wrong.”

After about six months of chasing false leads, the support-group leaders concluded she was lying. Stunned, they asked Feldman for advice.

“I suggested they go ahead and confront her but that they also give her my name if she wanted to talk to someone about this,” says Feldman, then on staff at Duke University Medical Center and now in private practice in Birmingham, Ala.

When support-group leaders confronted Anna, she briefly denied it, but then confessed.

“I think she was probably relieved,” Schanberg says. “I think it was getting difficult to carry off this pretense. I think she came to the group in the first place with the thought that she might get caught.”

Anna promised she would tell others that she had made up the entire tale. When she told her boss the next day, she was fired.

Tearfully, she called Feldman and asked for help.

“I’ve been acting like a compulsive liar,” she cried.

Anna entered a hospital psychiatric treatment program ready to get help. Exceedingly thin and wearing a short haircut in place of a wig, she was eventually diagnosed with depression and a personality disorder. She seemed exhausted by the “role” that had overtaken her life.

During her hospitalization, she initially ate very little because, as she told Feldman: “Every time I pick up a fork, I still keep thinking: ‘A person with cancer shouldn’t be able to eat this.’ ” But after four weeks of intensive treatment, Anna improved and promised “not to lie any more. It creates more problems than it solves.”

“She was relieved that, after two years of maintaining this, it was over,” Feldman says.

“I think it was becoming more and more difficult for her to maintain this. She was a productive employee. I think co-workers might have begun wondering how she could be so sick and perform her work duties so well.”

No one noticed that Anna never submitted insurance claims. However, Feldman says, some of her co-workers told him they were perplexed about why she didn’t seem to get any sicker.

“I got a few calls after this was revealed from people who were angry and wanting to ventilate,” he says. “But no one wanted to confront her about their doubts.”

Despite the weave of intricate lies, Feldman says, she exhibited no outward symptoms of psychological problems.

After being discharged from the hospital, Anna told Feldman she was moving out of North Carolina to live with a friend who knew of her problems. She planned to find a new job and continue therapy.

Her family, who hadn’t known about her condition until her hospitalization, supported her throughout her treatment.

But she never did get her fiance back. And, he says, many of her acquaintances and friends abandoned her.