When Illness Isn’t Just Illness: Navigating Manipulation, Denial, and Exaggeration

Elizabeth has been estranged from her father for five years. And in those five years, he has “almost died” more times than she can count.

They don’t talk unless there’s an emergency. But somehow, her father is always in crisis: a new diagnosis, another accident, another late-night phone call.

Before the estrangement, their relationship was already fractured. He was absent for much of her childhood, and when he was around, he was unreliable. After years of disappointment and trying to fix things, Elizabeth finally stepped back.

Still, every time the phone rings, she wonders: What if this is the time it’s real? If she doesn’t answer, and something happens, will she regret it forever? She feels guilty for questioning him, resentful of the endless chaos, and angry that she can’t seem to get free.

And maybe you’ve asked yourself the same questions:

• Who doubts their parent’s health?
• Who doesn’t want to help when someone is sick?

The truth is, many adults in dysfunctional or estranged family relationships end up here. Because when illness becomes the only way someone knows how to connect, you’re not just responding to sickness, you’re responding to a pattern.

When Illness Becomes a Strategy

Illness is supposed to bring care, compassion, and support. However, in some families, it also becomes a means to pull people back in, create guilt, or exert control.

Sometimes it looks like constant medical “emergencies” that never add up. Other times, it’s vague diagnoses, repeated accidents, or exaggerated symptoms that flare up whenever contact is lost. This doesn’t always happen consciously. For some, illness is the only way they’ve ever gotten attention or kept people close. They may even hold onto a fantasy: If I get sick, they will have to come back.

And yes, sometimes illness is real. That’s what makes it so confusing. You’re left questioning yourself, wondering if you’re being cold or if you’re being manipulated.

Why People Might Use Illness in This Way

Research shows there are patterns behind this behavior:

• Attention and sympathy (secondary gain): Illness can bring comfort, care, and freedom from responsibility.
• Learned patterns (reinforcement): Studies show children complain of more symptoms when they’re met with attention. That same reinforcement can carry into adulthood.
• Identity in caregiving and being cared for: For some, being sick or being the one who steps in to help becomes tied to their sense of worth and belonging.
• Deeper struggles: These patterns often overlap with trauma, personality disorders, or emotional immaturity, which can make relationships messy and unpredictable.

How to Protect Yourself Without Feeling Cruel

When illness keeps showing up as a hook to pull you back in, it can feel impossible to set boundaries. But you do have options:

• Notice the patterns. Does the crisis always come when you’ve pulled back? Does the story change every time? Noticing this doesn’t make you heartless.
• Choose your response. You can acknowledge a message without jumping into rescue mode. Sometimes a simple, calm, consistent response is enough.
• Stay rooted in your boundaries. Decide in advance what kind of support you’re comfortable with, whether that’s checking in, offering information, or none at all. Boundaries aren’t cruel. They’re what make relationships safe.
• Allow things to change. You may offer more support in one season and less in another. That doesn’t make you unreliable; it makes you human.

Illness should be met with care. But when it’s used as a way to guilt, control, or keep you stuck, it’s okay to pause and ask: What’s really happening here?

It’s not cruel to question patterns. It’s not selfish to step back. And it’s not wrong to want both things: to care about someone’s health and to protect your own peace.

The hard truth is that no illness, real or exaggerated, can repair a relationship on its own. Repair takes honesty, safety, and change. Until then, it’s okay to take care of yourself in the ways you need most.