Internet Health Support Groups
Coping With "Problem Posters"

by M.E. Peychers, M.A.

If a member with a serious psychiatric condition tries to keep it hidden, the group may be harmed, even destroyed. If the problem is declared, sometimes it can be defused, allowing the member to remain within the group.

Severe depression
This is a particular risk for people suffering from chronic illnesses, or a lack of self-esteem. (Yapko 1997).

Groups for bodily health problems, such as arthritis or acne, cannot be expected to advise on acute depression, panic attacks, or obsessive disorders, yet this happens. Demands are made for more than any non-psychiatric group can provide. It's good to be sympathetic and supportive, but encouragement should be aimed at securing more appropriate help.

If people say, "I can't live like this," they should be taken at their word, not babied. They should be helped to find treatment to put a stop to that anguish. They should not be urged to go on and on writing about it.

One man announced that he had decided to gas himself. Diagnosed with a disfiguring disease, he couldn't live with a changed appearance. In fact, a doctor had said that his condition should be controllable with one painless annual treatment. Reminded of this, the man apologised for having upset people. He admitted that he was struggling psychologically and promised to do his best not to "do anything stupid."

In or out of groups, we all have our own issues that we bring to the table and want to discuss. Even so, something one person wants to reveal might be deeply distressing for others. If you feel that inappropriate messages are making your group unpleasant and stressful, please report it. The board-owner might be equally unhappy with the situation and be keen to get things back on topic.

Munchausen syndrome by internet
In this condition, someone dishonestly claims to be suffering from serious illnesses, particularly potentially fatal ones such as cancer. As Dr. Marc Feldman has explained in his excellent articles, these people can cause great distress within groups, even destroying them (Feldman 2000, 2004).

One woman's posting history began with an appeal describing herself as helpless and suicidal. Members rushed forward with advice, begging her not to lose hope. In her messages, desperation and agony alternated with a certainty that members could solve her problems. Although they tried very hard, nothing brought any relief.

Then she mentioned that the top specialist at a medical college had said she was making it all up for attention. Two people wrote privately and received bright, excited replies nothing like the "normal" voice of the woman so ill she could hardly type. Pressed to see a counsellor, she suddenly stopped writing. No one criticised her, or ever mentioned her again. Everyone understood that she was seriously ill.

Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD)
People who are obsessive worriers may wrongly convince themselves that they have a particular illness. The next step may be joining a support group, hoping for confirmation of their self-diagnosis. A board can easily be overwhelmed by one person firing off hundreds of messages. At first, other members try to help, but frustration sets in when all of their advice is ignored.

The whole group needs to understand that the poster isn't "being difficult." The nature of OCD is that someone panics over minor issues and has worries that balloon out of proportion (Hyman & Pedrick 1999). If a new member shows signs of OCD, don't be drawn into specifics about the group's shared illness. First find out if there has been a definite diagnosis from a doctor. Posts should not be answered without that diagnosis.

A teenager, who described herself as grotesquely ugly, posted obsessively about scars and said she would kill herself. Severe depression was obvious, but BDD was only confirmed when her photos revealed an attractive girl (Phillips 1986). All advice on medication and counselling was rejected. When she joined a second group, someone posted a link to her messages on the first board. It was agreed that she had already received excellent advice, and should follow it.

A man with severe behavioural problems, including OCD and anger management issues, bombarded group members with emails demanding advice. One person was asked the same question for three years. People who stopped replying were insulted and threatened. It came as a relief when moderators told them he did this with many others and it was "nothing personal." A policy of only answering questions in public might have prevented this situation.

One of the hardest things to cope with is being targeted by an angry and abusive stranger. In the unlikely event that this happens to you, ask the board-owner to help. If there is any suspicion of stalking, contact the police (Jaishankar & Sankary 2005). Don't try to reason with unreasonable people.

Feldman, M.D., (2000): Munchausen by Internet: detecting factitious illness and crisis on the Internet. Southern Journal of Medicine, 93, 669-672
Feldman, M.D., (2004): Playing Sick?: Untangling the web of Munchausen syndrome, Munchausen by proxy, malingering, and factitious disorder. New York, Brunner-Routledge
Hyman, B.M., Pedrick, C., (1999): The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder. Oakland, New Harbinger
Jaishankar, K., Sankary, V.U., (2005) Cyber Stalking: A Global Menace in the Information Super Highway. The Online Quarterly Review of Crime, Ethics and Social Philosophy (ERCES) Vol 2, Issue 3
Phillips, K.A., (1986) The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Oxford, Oxford University Press
Yapko, M.D., (1997): Breaking the Patterns of Depression. New York, Doubleday

Next: Coping with 'Problem Posters' - Conclusion


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