Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
People who demonstrate factitious disorders often claim to have physical ailments or be recovering from the consequences of stalking, victimization, harassment, and sexual abuse. Several behaviors present themselves to suggest factors beyond genuine problems. After studying 21 cases of deception, Feldman listed the following common behavior patterns in people who exhibited Munchausen by Internet:
- Medical literature from websites or textbooks is often duplicated or discussed in great detail.
- The length and severity of purported physical ailments conflicts with user behavior. Feldman uses the example of someone posting in considerable detail about being in septic shock, when such a possibility is extremely unlikely.
- Symptoms of ailments may be exaggerated as they correspond to a user's misunderstanding of the nature of an illness.
- Grave situations and increasingly critical prognoses are interspersed with "miraculous" recoveries.
- A user's posts eventually reveal contradictory information or claims that are implausible: for example, other users of a forum may find that a user has been divulging contradictory information about occurrence or length of hospital visits.
- When attention and sympathy decreases to focus on other members of the group, a user may announce that other dire events have transpired, including the illness or death of a close family member.
- When faced with insufficient expressions of attention or sympathy, a forum member claims this as a cause that symptoms worsen or do not improve.
- A user resists contact beyond the Internet, such as by telephone or personal visit, often claiming bizarre reasons for not being able to accept such contact.
- Further emergencies are described with inappropriate happiness, designed to garner immediate reactions.
- The posts of other forum members exhibit identical writing styles, spelling errors, and language idiosyncrasies, suggesting that the user has created fictitious identities to move the conversation in their direction.
Munchausen by Internet is a pattern of behavior akin to Munchausen syndrome (renamed factitious disorder imposed on self), a psychiatric disorder, wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. In Munchausen by internet, users seek attention by feigning illnesses in online venues such as chat rooms, message boards, and Internet Relay Chat (IRC). It has been described in medical literature as a manifestation of factitious disorder imposed on self, or if claiming illness of a child or other family member, factitious disorder imposed on another. Reports of users who deceive Internet forum participants by portraying themselves as gravely ill or as victims of violence first appeared in the 1990s due to the relative newness of Internet communications. The pattern was identified in 1998 by psychiatrist Marc Feldman, who created the term "Münchausen by Internet" in 2000. It is not included in the fifth revision of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5).
The development of factitious disorders in online venues is made easier by the availability of medical literature on the Internet, the anonymous and malleable nature of online identities, and the existence of communication forums established for the sole purpose of giving support to members facing significant health or psychological problems. Several high-profile cases have demonstrated behavior patterns which are common among those who pose as gravely ill or as victims of violence, or whose deaths are announced to online forums. The virtual communities that were created to give support, as well as general non-medical communities, often express genuine sympathy and grief for the purported victims. When fabrications are suspected or confirmed, the ensuing discussion can create schisms in online communities, destroying some and altering the trusting nature of individual members in others.
In factitious disorder imposed on another, a caregiver makes a dependent person appear mentally or physically ill in order to gain attention. To perpetuate the medical relationship, the caregiver systematically misrepresents symptoms, fabricates signs, manipulates laboratory tests, or even purposely harms the dependent (e.g. by poisoning, suffocation, infection, physical injury). Studies have shown a mortality rate of between 6% and 10%, making it perhaps the most lethal form of abuse.
At the time of diagnosis, the average age of the persons affected was 4 years. Slightly over 50% were aged 24 months or younger, and 75% were under 6 years old. The average duration from onset of symptoms to diagnosis was 22 months. By the time of diagnosis, 6% of the affected persons were dead, mostly from apnea (a common result of smothering) or starvation, and 7% suffered long-term or permanent injury. About half of the affected had siblings; 25% of the known siblings were dead, and 61% of siblings had symptoms similar to the affected or that was otherwise suspicious. The mother was the perpetrator in 76.5% of the cases, the father in 6.7%.
Most present about 3 medical problems in some combination of the 103 different reported symptoms. The most frequently reported problems are apnea (26.8% of cases), anorexia / feeding problems (24.6% of cases), diarrhea (20%), seizures (17.5%), cyanosis (blue skin) (11.7%), behavior (10.4%), asthma (9.5%), allergy (9.3%), and fevers (8.6%). Other symptoms include failure to thrive, vomiting, bleeding, rash and infections. Many of these symptoms are easy to fake because they are subjective. A parent reporting that their child had a fever in the past 24 hours is making a claim that is impossible to prove or disprove. The number and variety of presented symptoms contribute to the difficulty in reaching a proper MSbP diagnosis.
Aside from the motive (which is to gain attention or sympathy), another feature that differentiates MSbP from "typical" physical child abuse is the degree of premeditation involved. Whereas most physical abuse entails lashing out at a child in response to some behavior (e.g., crying, bedwetting, spilling food), assaults on the MSbP victim tend to be unprovoked and planned.
Also unique to this form of abuse is the role that health care providers play by actively, albeit unintentionally, enabling the abuse. By reacting to the concerns and demands of perpetrators, medical professionals are manipulated into a partnership of child maltreatment. Challenging cases that defy simple medical explanations may prompt health care providers to pursue unusual or rare diagnoses, thus allocating, even more, time to the child and the abuser. Even without prompting, medical professionals may be easily seduced into prescribing diagnostic tests and therapies that are at best uncomfortable and costly, and at worst potentially injurious to the child. If the health practitioner instead resists ordering further tests, drugs, procedures, surgeries, or specialists, the MSbP abuser makes the medical system appear negligent for refusing to help a poor sick child and their selfless parent. Like those with Munchausen syndrome, MSbP perpetrators are known to switch medical providers frequently until they find one that is willing to meet their level of need; this practice is known as "doctor shopping" or "hospital hopping".
The perpetrator continues the abuse because maintaining the child in the role of patient satisfies the abuser's needs. The cure for the victim is to separate the child completely from the abuser. When parental visits are allowed, sometimes there is a disastrous outcome for the child. Even when the child is removed, the perpetrator may then abuse another child: a sibling or other child in the family.
Factitious disorder imposed on another can have many long-term emotional effects on a child. Depending on their experience of medical interventions, a percentage of children may learn that they are most likely to receive the positive maternal attention they crave when they are playing the sick role in front of health care providers. Several case reports describe Munchausen syndrome patients suspected of themselves having been MSbP victims. Seeking personal gratification through illness can thus become a lifelong and multi-generational disorder in some cases. In stark contrast, other reports suggest survivors of MSbP develop an avoidance of medical treatment with post-traumatic responses to it. This variation possibly reflects broad statistics on survivors of child abuse in general, where around 30% go on to also become abusers even though a significant percentage do not.
The adult care provider who has abused the child often seems comfortable and not upset over the child's hospitalization. While the child is hospitalized, medical professionals must monitor the caregiver's visits to prevent an attempt to worsen the child's condition. In addition, in many jurisdictions, medical professionals have a duty to report such abuse to legal authorities.
Factitious disorder imposed on another, also known as Munchausen syndrome by proxy (MSbP), is a condition where a caregiver or spouse fabricates, exaggerates, or induces mental or physical health problems in those who are in their care, with the primary motive of gaining attention or sympathy from others. The name is derived from the term Munchausen syndrome, a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. However, unlike Munchausen syndrome, in MSbP, the deception involves not themselves, but rather someone under the person's care. MSbP is primarily distinguished from other forms of abuse or neglect by the motives of the perpetrator. Some experts consider it to be an elusive, potentially lethal, and frequently misunderstood form of child abuse or medical neglect. However, others consider the concept to be problematic, since it is based largely on supposition regarding a person's motives, which can be open to radically different interpretations.
Factitious disorder imposed on another has also spawned much heated controversy within the legal and social services communities. In a handful of high-profile cases, mothers who have had several children die from sudden infant death syndrome have been declared to have MSbP. Based on MSbP testimony of an expert witness, they were tried for murder, convicted, and imprisoned for several years. In some cases, that testimony was later impeached, resulting in exoneration of those defendants.
Otherkin largely identify as mythical creatures, with others identifying as creatures from fantasy or popular culture. Examples include: angels, demons, dragons, goats, elves, fairies, sprites, aliens, and cartoon characters. Many otherkin believe in the existence of a multitude of parallel universes, and their belief in the existence of supernatural or sapient non-human beings is grounded in that idea.
With regards to their online communities, otherkin largely function without formal authority structures, and mostly focus on support and information gathering, often dividing into more specific groups based on kintype. There are occasional offline gatherings, but the otherkin network is mostly an online phenomenon.
Some otherkin (such as elvenkin) state they are allergic to iron (and products of modern technology), while others (such as dragonkin) state that having no allergies is a sign of otherkin condition. Some otherkin also claim to be especially empathic and attuned to nature. Some state to be able to shapeshift mentally or astrally, meaning that they experience the sense of being in their particular form while not actually changing physically.
The therian and vampire subcultures are related to the otherkin community, and are considered part of it by most otherkin, but are culturally and historically distinct movements of their own, despite some overlap in membership.
Otherkin are a subculture who socially and spiritually identify as partially or entirely non-human. Some of them surmise that they are, either spiritually or genetically, not human; however, this claim is unsubstantiated. This is explained by some members of the otherkin community as possible through reincarnation, having a non-human soul, ancestry, or symbolic metaphor. Some scholars categorize this identity claim as "religious", because it is largely based on supernatural beliefs. Adherents more typically deny the religiosity of otherkinism, referring to it instead as simply a congenital condition, or a metaphysical state of being.
Cyberchondria, otherwise known as 'compucondria', is the unfounded escalation of concerns about common symptomology based on review of search results and literature online. Articles in popular media position cyberchondria anywhere from temporary neurotic excess to adjunct hypochondria. Cyberchondria is a growing concern among many healthcare practitioners as patients can now research any and all symptoms of a rare disease, illness or condition, and manifest a state of medical anxiety.
Video game addiction (VGA) is a hypothetical behavioral addiction characterized by excessive or compulsive use of computer games or video games, which interferes with a person's everyday life. Video game addiction may present itself as compulsive gaming, social isolation, mood swings, diminished imagination, and hyper-focus on in-game achievements, to the exclusion of other events in life.
In May 2013, the American Psychiatric Association (APA) proposed criteria for video game addiction in the 5th edition of the "Diagnostic and Statistical Manual of Mental Disorders", concluding that there was insufficient evidence to include it as an official mental disorder. However, proposed criteria for "Internet Gaming Disorder" were included in a section called "Conditions for Further Study".
While Internet gaming disorder is proposed as a disorder, it is still discussed how much this disorder is caused by the gaming activity itself, or whether it is to some extent an effect of other disorders. Contradictions in research examining video game addictiveness may reflect more general inconsistencies in video game research. For example, while some research has linked violent video games with increased aggressive behavior other research has failed to find evidence for such links.
Attraction to disability or devotism is a sexualised interest in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept "paraphilia" continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. The most common interests are towards amputations, prosthesis, and crutches.
Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences. The condition derives its name from Baron Munchausen.
Factitious disorder imposed on self is related to factitious disorder imposed on another, which refers to the abuse of another person, typically a child, in order to seek attention or sympathy for the abuser. This drive to create symptoms for the victim can result in unnecessary and costly diagnostic or corrective procedures.
Exhibitionism is the act of exposing in a public or semi-public context those parts of one's body that are not normally exposed – for example, the breasts, genitals or buttocks. The practice may arise from a desire or compulsion to expose themselves in such a manner to groups of friends or acquaintances, or to strangers for their amusement or sexual satisfaction or to shock the bystander. Exposing oneself only to an intimate partner is normally not regarded as exhibitionism. In law, the act of exhibitionism may be called indecent exposure, "exposing one's person", or other expressions.
A disability pretender is subculture term meaning a person who behaves as if he or she were disabled. It may be classified as a type of factitious disorder or as a medical fetishism.
One theory is that pretenders may be the "missing link" between devotees and wannabes, demonstrating an assumed continuum between those merely attracted to people with disabilities and those who actively wish to become disabled. Many wannabes use pretending as a way to appease the intense emotional pain related to having body integrity identity disorder.
Pretending takes a variety of forms. Some chatroom users on internet sites catering to devotees have complained that chat counterparts they assumed were female were revealed as male devotees. This form of pretending (where a devotee derives pleasure by pretending to be a disabled woman) may indicate a very broad predisposition to pretending among devotees.
Pretending includes dressing and acting in ways typical of disabled people, including making use of aids (Walking sticks, crutches, wheelchairs, mobility scooters, white canes, etc. Pretending may also take the form of a devotee persuading his or her sexual partner to play the role of a disabled person. Pretending may be practiced in private, in intimacy, or in public, and may occupy surprisingly long periods. In the latter case, some pretenders hope that the disability may become permanent, such as through tissue necrosis caused by constricted blood supply.
In factitious disorder imposed on self, the affected person exaggerates or creates symptoms of illnesses in themselves to gain examination, treatment, attention, sympathy, and/or comfort from medical personnel. In some extreme cases, people suffering from Munchausen syndrome are highly knowledgeable about the practice of medicine and are able to produce symptoms that result in lengthy and costly medical analysis, prolonged hospital stays, and unnecessary operations. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with this syndrome. This disorder is distinct from hypochondriasis and other somatoform disorders in that those with the latter do not intentionally produce their somatic symptoms. Munchausen syndrome is distinct from other psychiatric disorders such as malingering in that Munchausen does not fabricate symptoms for material gain such as financial compensation, absence from work, or access to drugs.
Risk factors for developing factitious disorder include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and low self-esteem. Factitious disorder is more common in men and is seen in young or middle-aged adults. Those with a history of working in healthcare are also at greater risk of developing it.
Arrhythmogenic Munchausen syndrome describes individuals who simulate or stimulate cardiac arrhythmias to gain medical attention.
A similar behavior called factitious disorder imposed on another has been documented in the parent or guardian of a child. The adult ensures that his or her child will experience some medical affliction, therefore compelling the child to suffer through treatments and spend a significant portion of their youth in hospitals. Furthermore, a disease may actually be initiated in the child by the parent or guardian. This condition is considered distinct from Munchausen syndrome. There is growing consensus in the pediatric community that this disorder should be renamed "medical abuse" to highlight the harm caused by the deception and to make it less likely that a perpetrator can use a psychiatric defense when harm is done.
Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference "Diagnostic and Statistical Manual of Mental Disorders", text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.
The term "klismaphilia" was coined in 1973 by Dr. Joanne Denko, an early investigator in this field, to describe the activities of some of her patients. A person with klismaphilia is a "klismaphile" or "klismaphiliac".
Computer addiction can be described as the excessive or compulsive use of the computer which persists despite serious negative consequences for personal, social, or occupational function. Another clear conceptualization is made by Block, who stated that "Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging". While it was expected that this new type of addiction would find a place under the compulsive disorders in the DSM-5, the current edition of the "Diagnostic and Statistical Manual of Mental Disorders", it is still counted as an unofficial disorder. The concept of computer addiction is broadly divided into two types, namely offline computer addiction and online computer addiction. The term offline computer addiction is normally used when speaking about excessive gaming behavior, which can be practiced both offline and online. Online computer addiction, also known as Internet addiction, gets more attention in general from scientific research than offline computer addiction, mainly because most cases of computer addiction are related to the excessive use of the Internet.
Although addiction is usually used to describe dependence on substances, addiction can also be used to describe pathological Internet use. Experts on Internet addiction have described this syndrome as an individual being intensely working on the Internet, prolonged use of the Internet, uncontrollable use of the Internet, unable to use the Internet with efficient time, not being interested in the outside world, not spending time with people from the outside world, and an increase in their loneliness and dejection. However, simply working long hours on the computer does not necessarily mean someone is addicted.
Klismaphilia (or "klysmaphilia"), from the Greek words ("enema", from , "deluge, flood") and ("(fraternal) love"), is a paraphilia involving enjoyment of, and sexual arousal from, enemas.
Previously, the DSM-IV differentiated among three types:
- Factitious disorders with predominantly psychological signs and symptoms: if psychological signs and symptoms predominate in the clinical presentation
- Factitious disorders with predominantly physical signs and symptoms: if physical signs and symptoms predominate in the clinical presentation
- Factitious disorders with combined psychological and physical signs and symptoms: if both psychological and physical signs and symptoms are present and neither predominates in the clinical presentation
Digital hoarding (also known as e-hoarding) is excessive acquisition and reluctance to delete electronic material no longer valuable to the user. The behavior includes the mass storage of digital artifacts and the retainment of unnecessary or irrelevant electronic data. The term is increasingly common in pop culture, used to describe the habitual characteristics of compulsive hoarding, but in cyberspace. As with physical space in which excess items are described as "clutter" or "junk," excess digital media is often referred to as "digital clutter."
Excessive computer use may result in, or occur with:
- Lack of face to face social interaction
- Computer vision syndrome
Bondage pornography is the depiction of sexual bondage or other BDSM activities using photographs, stories, movies or drawings. Though often described as pornography, the genre involves the presentation of bondage fetishism or BDSM scenarios and does not necessarily involve the commonly understood pornographic styles. In fact, the genre is primarily interested with the presentation of a bondage scene and less with depictions of sexuality, such as nudity or sex scenes, which may be viewed as a distraction from the aesthetics and eroticism of the bondage scenario itself.
Historically, most subjects of bondage imagery have been women, and the genre has been criticized for promoting misogynistic attitudes and violence against women.
Ganser syndrome was once considered a separate factitious disorder. It is a disorder of extreme stress or an organic condition. The patient suffers from approximation or giving absurd answers to simple questions. The syndrome is sometimes diagnosed as merely malingering—however, it is more often defined as a factitious disorder. This has been seen in prisoners following solitary confinement, and the symptoms are consistent in different prisons, though the patients do not know one another.
Symptoms include a clouding of consciousness, somatic conversion symptoms, confusion, stress, loss of personal identity, echolalia, and echopraxia. Individuals also give approximate answers to simple questions such as, "How many legs on a cat?" "Three"; "What's the day after Wednesday?" "Friday"; and so on. The disorder is extraordinarily rare with fewer than 100 recorded cases. While individuals of all backgrounds have been reported with the disorder, there is a higher inclination towards males (75% or more). The average age of those with Ganser syndrome is 32, though it stretches from ages 15–62 years old.
Candaulism is a sexual practice or fantasy in which a man exposes his female partner, or images of her, to other people for their voyeuristic pleasure.
The term may also be applied to the practice of undressing or otherwise exposing a female partner to others, or urging or forcing her to engage in sexual relations with a third person, such as during a swinging activity. Similarly, the term may also be applied to the posting of personal images of a female partner on the internet or urging or forcing her to wear clothing which reveals her physical attractiveness to others, such as by wearing very brief clothing, such as a microskirt, tight-fitting or see-through clothing or a low-cut top.
Vorarephilia (often shortened to vore) is a paraphilia characterized by the erotic desire to be consumed by, or sometimes to personally consume, another person or creature, or an erotic attraction to the process of eating in general. Since vorarephilic fantasies cannot usually be acted out in reality, they are often expressed in stories or drawings shared on the Internet. The word "vorarephilia" is derived from the Latin "vorare" (to "swallow" or "devour"), and Ancient Greek φιλία ("philía", "love").
The fantasy usually involves the victim being swallowed whole, though occasionally the victims are chewed up, and digestion may or may not be included. Vore fantasies are separated from sexual cannibalism because the living victim is normally swallowed whole. Sometimes the consumers are human, but anthropormorphized animals, dragons, and enormous snakes also appear frequently in these fantasies. After consumption, the enlarged belly of the consumer is often described with great care. Vorarephiles sometimes prefer to differentiate between "soft vore" and "hard vore"; soft vore means the victim is swallowed whole and alive, and may possibly come back out in the case of a "non-fatal" scenario, while in hard vore the victim goes through a more gruesome, realistic digestion process, often getting chewed up beforehand.
Vore is most often enjoyed through pictures, stories, videos, and video games, and it can appear in mainstream media. In some cases, vorarephilia may be described as a variation of macrophilia and may combine with other paraphilias. Apart from macrophilia, vore fantasies often have themes of BDSM, microphilia, pregnancy fetishism, furry fetishism, "unbirthing" (a desire to be swallowed whole into the vagina and returned to the uterus), and sexual cannibalism.
One case study analysis connected the fantasy with sexual masochism, and suggested that it could be motivated by a desire to merge with a powerful other or permanently escape loneliness. With "no known treatment" for vorarephiles who feel ill at ease with their sexuality, psychologists at Toronto's Centre for Addiction and Mental Health have recommended trying to "adjust to, rather than change or suppress" the sexual interest. Medication for sex drive reduction could be used if deemed necessary.
Apotemnophia / Body Integrity Disorder (BIID) is a is a rare, infrequently studied and highly secretive condition in which there is a mismatch between the mental body image and the physical body. Apotemnomphilia is characterized by an intense desire for amputation of a limb. Currently BIID is not included in the International Statistical Classification of Diseases 11 or the Diagnostic and Statistical Manual of Mental Disorders IV. It is often not known to surgeons, neurologists and psychiatrists. BIID individuals typically avoid healthcare and often act out their desires by pretending they are disabled or perform actual self-amputation.
A 2012 study concluded, based on interviews with 54 individuals, that the main rationale for their desire for body modification (amputation) was to feel complete or to feel satisfied inside. Based on the results of the survey, researchers concluded that psychotherapy was often supportive, but did not help diminishing BIID symptoms. Individuals reported that antidepressants were helpful in reducing depressive symptoms related to BIID, but that antipsychotics were not. Actual amputation of the limb was effective in all 7 cases who had surgical treatment.