"That statistic may be overstated, on the other hand, this is a disorder that is bathed in deceit and I think doctors miss most cases," said Feldman, who endorsed Hall and Avigal's book. "The patient presents symptoms that appear credible and the doctor doesn't have the time to review old records or collateral sources. It's easier to write a prescription or do a procedure than tell if the patient is telling the truth."
Feldman, the author of the 2004 book, "Playing Sick," said Munchausen's is "viewed largely as untreatable. ... The wording of the prognosis is guarded or grim."
There have been breakthrough cases, he said. One woman who was hospitalized 650 times and had 42 abdominal operations stopped her behavior after 12 years after adopting a cat and learning to get outside herself.
Feldman also said he successfully treated another patient who had injected herself with feces and water, going into septic shock, and even drank boiled lead to give herself lead poisoning.
But those are anomalies, said Feldman. He said that Hall was successful, in part, with Avigal because he had created for her, "sort of an ideal family." He does, however, acknowledge the methodology is impractical for most therapists.
Avigal said she grew up in a dysfunctional home in New York City, the daughter of a Holocaust survivor who suffered from bipolar disorder.
"He viscously beat me and stabbed my mother," she said. "In one of the worst situations, he held the whole family hostage at gunpoint for 24 to 36 hours. He started to sexually abuse me at the age of 5. … I lived my life in constant fear that me or others would be killed."
When she was 14, Avigal's parents had her institutionalized for psychiatric problems and she would stay for four years, never attending high school.
"They blamed all their problems on me," she said. "I was identified as the patient.
"In the 1970s, there were no patients' rights," she said. "They were very abusive toward young people like me -- it was like being imprisoned, horrible and awful."
When Avigal was 16, her father committed suicide after she confronted him about the sexual abuse.
"I was guilt-ridden for years," she said.
After getting her GED in the psychiatric hospital, Avigal got a nursing degree at a community college. She met her husband, a lab analyst, and had three children.
She said she felt "happy and safe" for the first time and focused on being a mother, keeping the Munchausen's, for a time, at bay. But in 1999, her 13-year-old son, who had been diagnosed with brain cancer as a toddler, died.
"My illness spiraled out of control," Avigal said. "It returned with a vengeance.
"My husband knew I was sick all the time and in the hospital, but he didn't know why," she said. "There was no end in sight and he had to constantly take time off from work."
She said for her, the illnesses became "an escape from the responsibility of having to function and the emotional pain. ... I wondered how far can I go without dying."
By 2002, Avigal was in treatment with Hall over the crushing death of her son, but even he was in the dark. Until two and a half years later, when she ended up on death's door, in the ICU.
"I knew it was no longer an option or I was going to die," she said.
Now, eight years later, Avigal credits her recovery to Hall.
"It was based on the trust he built in therapy," she said. "He went above and beyond conventional methods not typically used."
In between scheduled therapy sessions, Hall made himself completely available to Avigal.