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When Stephany Angelacos was diagnosed with Stage 2 breast cancer in 2016, she immediately turned to the internet for support. Online, there are numerous groups and forums where people dealing with cancer can share their experiences. Angelacos researched her disease and its treatments, and then, inspired by how knowledgeable everyone was, decided to found her own invite-only breast-cancer Facebook group that same year.

Today, this group has grown to 1,700 members. About a third have a metastatic or terminal diagnosis. Others are family members or medical professionals who share advice. The members comfort one another, organize fundraisers, and coordinate visits to those who are alone at the end of their lives. Angelacos, who has now completed active treatment, oversees many of these efforts.

Over the past year, one of the group’s more active and popular members was Marissa Marchand. When she joined in 2017, according to group members, Marchand said she was a terminally ill, grieving single mom. She posted pictures of herself bald from chemotherapy and wearing an IV drip. She quickly became close to many women in the group, and received an outpouring of sympathy, money, and gifts—including expensive wigs—to help defray the costs of medical care and raising her family.

“She came across as genuine, loving, and funny,” says Angelacos. “No one questioned her authenticity, including me—and I usually have a pretty active BS radar.”

Marchand’s posts gradually became more extreme, the group’s members say. She wrote that her son was being bullied over her diagnosis, and that her dog had been shot. Then, in December, according to Angelacos, Marchand announced that she was out of treatment options. Her cancer had spread to all of her major organs. She didn’t have much time left to live. Soon, she stopped posting.

Angelacos assumed Marchand had become another tragic cancer statistic. But when Angelacos reached out to Marchand’s family to check in, she was shocked to learn that Marchand was alive—and apparently healthy.

Around the time Marchand stopped posting in the Facebook group, she was arrested in Colorado for faking terminal cancer on the crowdfunding platform GoFundMe and accepting donations through multiple accounts. It seemed she had faked her illness to the Facebook group, too. At trial, she pleaded guilty and was sentenced to community service. “The entire group was devastated, angry, and in a state of disbelief,” Angelacos says. “Everyone felt they had come to know her so well. There was a huge sense of betrayal.” (Marchand and her lawyer did not respond to requests for comment.)

This was not the first time many of the group’s members had felt this way. As harrowing as the experience can be for those involved, people in online cancer support groups are routinely outed as healthy. It’s difficult to speculate exactly how common this phenomenon is: There have been no large-scale scientific investigations into the internet’s cancer fakers, and the evidence is limited to only those who have actually been suspected or caught. But among the internet’s cancer communities, it’s an often acknowledged problem, albeit still a shocking one. Among 10 people from three groups I spoke with recently, every person recalled someone being outed for faking in their communities at least once, if not more.

Several recent high-profile cases have highlighted the issue. In 2015, the wellness blogger Belle Gibson confessed that she lied for years about a brain-cancer diagnosis. Last year, the then nanny Candace Ann Streng was sentenced to up to 15 years in prison after pretending to have terminal cancer and scamming $30,000 via a GoFundMe campaign. In February, a New Yorker profile accused the best-selling author Dan Mallory of faking brain tumors to colleagues several years ago. (Mallory claimed after the story was published that he’d feigned brain cancer to disguise struggles with bipolar disorder.)

This condition of faking illness online has a name: “Munchausen by internet,” or MBI. It’s a form of factitious disorder, the mental disorder formerly known as Munchausen syndrome, in which people feign illness or actually make themselves sick for sympathy and attention. According to Marc Feldman, the psychiatrist at the University of Alabama at Tuscaloosa who coined the term MBI back in 2000, people with the condition are often motivated to lie by a need to control the reactions of others, particularly if they feel out of control in their own lives. He believes that the veil of the internet makes MBI much more common among Americans than the 1 percent in hospitals who are estimated to have factitious disorder.

Dawn Branley-Bell, a psychologist at Northumbria University who studies extreme online behaviors, agrees that digital life can encourage deceptive behavior. “The internet makes it easier to portray ourselves as something we are not,” she says. “Trolls often justify their actions by saying the online world is not ‘real life,’ so it doesn’t matter what they do or say online. It is possible some users refuse to believe their [actions] online have real, psychological effects upon others.” Once the lie is told, she notes, it can be difficult to backtrack.

Those with factitious disorder can use a variety of techniques to induce actual sicknesses, including poisoning and planting fecal matter in IV drips. Online, though, people especially appear to feign cancer. I had my first run-in with MBI 15 years ago. On a Harry Potter forum, a girl who called herself Amanda claimed to be a 15-year-old American undergoing grueling treatment for leukemia. She posted about getting sick after visiting the hospital and feeling too tired to pick roses when gardening with her mother. As a nerdy, friendless preteen, I became attached to Amanda—until one of the forum’s administrators alerted the group that Amanda was in fact a healthy 35-year-old Australian mother.

Branley-Bell and Feldman both believe there are several reasons people with MBI might gravitate toward lying about cancer in particular. “[Cancer] is mentioned on an almost daily basis due to how commonly it occurs in our world, so people are familiar with the illness,” Branley-Bell says. The absence of early signs of the illness, the huge variation in life span, the possibility for reappearing bouts and remissions, and the fact that it can inflict anyone all make it a prime candidate for a faker.

“So few people would question an individual’s self-report of having it,” Feldman adds. Cancer is the bogeyman of the medical world; its victims are often seen as struggling more than anyone else. “Cancer is associated with heroism for the vigorous ‘battle’ waged against it by those afflicted,” Feldman says.

The decontextualized, often anonymous nature of the internet makes it extra difficult to know how many elaborate deceptions might still be playing out today. Even in cases such as Marchand’s, where an alleged faker uses his or her actual name—which presumably would lend itself to detection—the ethos of online cancer groups generally remains to take people’s word in good faith. The groups want to welcome those suffering and in search of a community with open arms, not with suspicion. Administrators usually act only when evidence has been presented by other members.

When a group believes it has identified a faker, its members often cross-post the findings of their sleuthing to other support groups that the accused faker has joined. Among real cancer survivors, sympathy for those with MBI tends to be in short supply. Angelacos, the founder of the Facebook group, considers people who lie about the disease “soulless manipulators”: “They’re missing the empathy chip that makes the rest of us truly human,” she says.

Becca Jean Munoz, a breast-cancer survivor from Texas who runs her own Facebook support group, agrees. “[Cancer survivors] suffer, emotionally, physically, financially,” she says. “It blows my mind that someone would fake this disease for attention. It’s sick.” Munoz says that she recently removed a healthy woman who had been claiming across three online communities that she was in the ICU with sepsis and dying of cancer. “It really affects [a support group’s] members when a fraudster is uncovered,” she says. “We’re sharing really personal details of our lives here, and fakers make a mockery of things.”

The motivations of those who are caught faking cancers are rarely investigated on any deep level. In the case of Streng, the nanny, her attorney told the court that she suffered from depression and struggled to make friends. Jasmin Mistry, who was recently sentenced to four years in prison for collecting money for a fabricated brain-cancer treatment, told police when she was caught that she simply didn’t know why she’d done it, according to the BBC. In addition to Marchand, I reached out to Streng and other people who have been accused by their online communities of faking cancer. Streng didn’t respond; others also didn’t reply or declined to comment.

It’s possible MBI is simply incomprehensible to those who don’t have it. But it’s also painfully clear that cancer-support groups supply levels of attention and sympathy that are rarely found elsewhere. I know this from experience: In February last year, I was diagnosed with breast cancer. I was 26 at the time, and the odds of getting the disease at that age are about one in 1,700. I found solace in a 500-person Facebook community of mostly young women in the same situation. Support there was unconditional; there was always a place to vent, always somewhere to get sympathy, affection, and attention.

Cancer treatment was the hardest thing I have ever done, but it was also the time in my life when I had the most support. Friends and family offered to drop everything to be with me. If I missed a deadline at work, it was okay. If I forgot someone’s birthday, it was okay. If I lost my temper, it was okay.

Today, I’m almost completely back to normal. I completed chemotherapy in August, and finished the rest of active treatment at the end of the year. I still have to take drugs and my surgeon tells me I won’t be able to say I’m officially “cancer free” for five years, but the relief that comes from being better is the best thing I have ever felt. It’s bliss to do boring everyday tasks and go to work and be unexceptional and under the radar. But I’ll never forget how good it felt to be cared for.

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