Australian health entrepreneur Belle Gibson was the poster girl for healthy living. The 20-something woman from Brisbane claimed she had survived multiple forms of cancer using a healthy diet and alternative therapies. It was all a lie.

Gibson had a hugely successful Apple app, The Whole Pantry, and a cookbook, which taught people how to fight illness using clean living. She had hundreds of thousands of followers on social media, particularly Instagram, who had been seeking her advice since May 2013.

In March this year, her story began to unravel. There were questions surrounding the veracity of her diagnosis, her age (she is 23, not 26), missing donations and her life story and her seemingly miracle-type survival.

On Wednesday, Gibson came clean about the rumours and allegations stacked so high against her, admitting she is behind one of the biggest hoaxes in Australian history. Speaking to the Australian Women’s Weekly about her cancer diagnosis and her life story, she confessed: “No. None of it’s true.”

“I don’t want forgiveness,” she said. “I just think [speaking out] was the responsible thing to do. Above anything, I would like people to say, ‘Okay, she’s human.'” Those duped by Gibson’s lies might not be quick to see the humanity, but it’s a positive step towards uncovering the depths of her fabrications.

Now that we know Gibson made up her story, there is a major question left unanswered: What leads someone to do such a thing?

Clinical Psychologist Dr Katie Treanor, who has researched pathological liars at the University of Wollongong, told Mashable she believes Gibson has strong attributes of someone suffering from factitious disorder, with secondary elements of malingering and a global predisposition to pathological lying. However, without an in-person diagnosis, Treanor said her findings are based on the evidence available and her research in the field.

Factitious disorder is a psychological condition where a person feigns an illness or exaggerates symptoms in order to gain attention from others. People with this condition have often been exposed to illnesses early in life and “learned that being sick is an effective way of meeting your needs.”

This could be the case with Gibson, who claims that as a child growing up in Brisbane she was the primary carer for her mother with multiple sclerosis and her brother with autism. Gibson says she left home at 12, living in multiple Australian states before she was diagnosed with her first cancer in 2009.

“If you are in a home environment, where as a child there are limited emotional resources to meet your emotional needs and you’re seeing all the emotional resources being funneled to those with special needs, then you are learning that is how you get it done,” Treanor told Mashable.

The number one contributing factor corresponding with pathological lying is attachment disruption, Treanor’s research found. This means that in childhood there is a loss of the normal attachment system due to some kind of trauma.

“They have been institutionalised, they have been adopted, a parent has died or abandoned them in some way or a parent has been mentally of physically very unwell,” Treanor said. “If early in childhood you weren’t given that love and admiration and attention, then you have to find other ways to gain that.”

She believes this disruption in Gibson’s case could have been in regards to her mother, “if it is true she was incapacitated with MS, then that would have had an impact.” If a child’s emotional needs have not been met in a healthy way, they then learn to lie in order to garner and secure attention, Treanor said.

“That is the number one background factor, I found, that correlated with someone that grew up to be a pathological liar. The thinking behind that is that they have developed an incredibly insecure sense of self, which is evidenced by the fact she is a bit of a chameleon.

“So someone who has a very firm sense of who they are, they stay the same across time and context while someone with a shaky sense of self will change to suit their environment and that is generally, a survival mechanism for trying to fit in and gain acceptance quickly.”

Often the lies even get too big for the liar, as may be the reason it has taken Gibson so long to come clean. “It gets out of their control, because they have to keep spinning more lies to disguise the first set of lies. It just builds and becomes a huge web of lies and it snowballs out of control for them and that is when it all unravels,” Treanor said.

Malingering is lying for financial gain, yet Treanor believes in Gibson’s case this may not have been her primary reasoning, due to the fact she was embellishing the truth long before financial gain occurred. It also appears Gibson used the fundraising element of her business to assist with making her appear like a good person, rather than having the intention to make profit.

Without evidence her lies extended beyond her medical condition, it is difficult to classify Gibson as a pathological liar. Yet, the inaccuracies in her age and a childhood friend who described Gibson as a chronic liar, who has “always had a problem with fabricating stories,” do open up the possibility.

“For her to be a pathological liar, I would want to see symptoms beyond just feigning illness. If you just stick with feigning illness it is factitious disorder,” Treanor said, yet believes Gibson does display some clear signs of pathological lying.

In 2009, Gibson was a regular user of a skateboarding forum where she slowly began to tell stories of hospital visits, heart surgeries and cancer tests. In this environment, Gibson appeared and acted different to her current clean, wholesome persona. She spoke in a different manner, wore heavy-rimmed glasses and had dyed black hair.

“In my experience of pathological liars, it is common to tell the stories you think will get your needs met by that audience. For instance, how Belle adopted the skater persona, because that was a persona that was going to get her accepted by that group of peers,” Treanor explained. “Tailoring your lies to suit your audience is part and parcel with it.”

“Pathological liars have very good social skills and awareness and quite a bit of intelligence,” Treanor says. “Belle knows how to capture her audience and keep them on the edge of their seat.”

She believes it is possible Gibson was so successful online as it is easier to lie online, and travelling from place to place is a common trait of someone with factitious disorder. “If you are moving around a lot, it is a really good way to make sure no one is getting too close to the truth,” Treanor said.

Unfortunately, if Gibson is suffering from this condition she will have a diminished capacity to understand her behaviour, as sufferers can become self delusional and come to believe their own lies.

In Gibson’s interview she admitted being confused to what is real and what she has created. “I am still jumping between what I think I know and what is reality. I have lived it and I’m not really there yet,” she told the Women’s Weekly, according to News Limited. “If I don’t have an answer, then I will sort of theorise it myself and come up with one. I think that’s an easy thing to often revert to if you don’t know what the answer is.”

From Treanor’s experience, people with this condition are not the type who rush to get help, as they lack the insight to understand it is necessary. “Generally, what happens is they are confronted by their lies and they will either pack up shop and move away, or spin more lies. They are not very good at acknowledging they have lied.”

By the time people with factitious disorder reach adulthood, the research shows the patients behavior is entrenched and it is extremely difficult for them to let go of the habit without receiving intensive, long-term psychotherapy.

“It is a chronic, difficult-to-treat condition. The treatment outcomes are relatively poor and it does require intensive, long-term therapy when you are working on deep down vulnerabilities that are driving them to feel like they have to lie,” Treanor said.

A strikingly similar case is that of author Norma Khouri, real name Norma Toliopoulos, who wrote the novel Forbidden Love, published by Random House in 2002, about a woman on the run from her home of Jordan. The Sydney Morning Herald uncovered her literary fraud, and found she was a mother-of-two living in Chicago who had moved to Australia.

In Toliopoulos’s case, she went to ground and didn’t resurface for years. By then, the story had been all but forgotten. Anna Broinowski then featured her in a film Forbidden Lie$ which began as an attempt to clear Toliopoulos’s name, but ended in revealing more of the lies, despite consistent denials from Toliopoulos. Today, she lives with her children in Chicago, after leaving behind her husband in Australia.

It is common for people suffering similar conditions to lie low until the storm passes, but Gibson has broken the mould by coming clean. She notes she was pushed by her current partner, Clive Rothwell, to acknowledge she had “fucked up.” She told the Weekly he is “supportive, but obviously very devastated”.

It is not uncommon for loved ones to have accepted the lies and holes in stories, rather than confront the person. “It could be that when they do confront them, there is such a strong emotional reaction that they believe it isn’t worth it or they will just fabricate more lies,” Treanor said. “If you are living with them, you see holes and gaps in their lies. It is hard to live with someone and not see it. In saying that, there are examples of people that do get duped and believe in the lie.”

The one thing Treanor stressed is that pathological liars or people with similar conditions generally do not set out to intentionally manipulate in order to hurt others and the unravelling of their lies is deeply distressing for them.

“It is almost always from a very deep sadness, that thinking your true self won’t be accepted or loved by others, so you create other ways to cure that.

“It is easier to hold onto the lie and forget the truth. She has held onto this lie for so long and it is so big and elaborate, I wouldn’t mind betting that there have been times when she believed it.”

Treanor’s research into these conditions tried to understand where the disorder stemmed from, rather than villainise their behaviour. “These are incredibly broken, fragile, depressed people with a poor sense of self. They just desperately want to be loved and accepted and they don’t know how to do that.”

Read more about Belle Gibson’s story.

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