Patient or Pretender : The Strange World of Factitious Disorders

Recounts the case histories of factitious disorder patients who make themselves ill as a way of gaining emotional fulfillment and recognition. They take playing sick to pathological extremes, profoundly affecting their lives as well as the lives of those who support them. In these pages, readers will find a group of cases so bizarre that they challenge the imagination and, at times, medical knowledge.

An unsettling account of the pathological behavior of people who carry ``playing sick'' to bizarre extremes. Psychiatrists Feldman and Ford, writing with Reinhold (coauthor, Untamed, 1991), use their own experiences as well as case studies from the medical literature to construct a patchwork portrait of the condition known as ``factitious disorder''--a mental disorder in which physical or psychological symptoms are feigned for emotional satisfaction. Factitious disorder may become the focus of a person's life and can take an extreme, chronic form known as Munchausen syndrome. Especially troubling are cases of Munchausen by proxy, in which parents inflict harm on children to create the appearance of illness in them. The authors reveal how skilled patient-pretenders can become at fooling doctors, nurses, and other caretakers with schemes to produce symptoms and create erroneous test results by putting blood or other substances into their urine, injecting themselves with insulin, or wounding, infecting, starving, or bleeding themselves. Numerous first-person narratives include accounts by either Feldman and Ford, as well as by those suffering from factitious disorder--and their victims. The authors seem both fascinated and exasperated by the syndrome and are clearly dismayed by the harm it causes not just to its sufferers but to those around them. But while Feldman and Ford's stated aim is to increase awareness of factitious disorder in order to make diagnosis and treatment more likely, they seem more concerned with exposing and weeding out than with helping, and their account comes close to being a freak show in which the grotesqueries on display are of central interest. An interesting subject regrettably presented with more sensationalism than science. -- Copyright ©1993, Kirkus Associates, LP. All rights reserved.

According to psychiatrists Feldman and Ford, most of the patients featured in this engrossing collection about feigned illnesses shared a desperate need for attention, sympathy and drama. Recent research suggets they are subject to a brain dysfunction ("factitious disorder") that requires psychiatric care. The authors' medical mystery stories range from simulated breast cancer to near fatal faking of anemia by self-bloodletting. Other patients invent stomach disorders, bulimia, fevers, seizures, blindness, or insantiy, with some purposeful patients deliberately ingesting rat poison or drugs. Most cruel of all deceptions is a form of Munchausen syndrome in which a parent fakes the illness of a child. In a book of more interest to professionals, the authors recommend special training for practitioners who hope to treat these "real, not false patients" despite their calculated deceits. Author tour.
Copyright 1993 Reed Business Information, Inc.

Psychiatrists Feldman and Ford investigate the broad and twisted field of patient-imagined disorders. Problems often arise in dealing with such patients because factitious disorders are usually the last possibilities tested for and because differentiating between malingering and these disorders can be tricky. Feldman and Ford point out methods for identifying such patients and provide suggestions for managing them or referring them to more relevant caregivers. Still, proving a patient has a factitious disorder can be difficult or even impossible, and Munchausen syndrome (and its cruel stepbrother, M.S. by proxy, often resulting in child abuse), diabetes, and pseudologia fantastica frequently enter the picture. Feldman and Ford also look at ethical and legal aspects, false accusations, and what steps to take if you feel you are being victimized by such a factitious disorder sufferer. Their thorough case reports and perceptive discussion should instruct both laypersons and general physicians and encourage pertinent research. William Beatty

Psychiatrists Feldman and Ford describe the bizarre phenomenon of patients who fake symptoms or serious illness (including cancer or AIDS) to get emotional support and attention. A patient's skill at convincing doctors often derives from experience as a healthcare worker or as a caretaker or relative of someone who is chronically ill. In its extreme form, known as Munchausen Syndrome by Proxy, this phenomenon leads patients to make a career of seeking hospitalization for themselves or their children, often disappearing when challenged and reappearing later at another institution. The authors stress the need for early detection and discuss the ethical and legal issues involved. Recommended for medical and large public libraries.
- Lucille Boone, San Jose P.L., Cal.
Copyright 1993 Reed Business Information, Inc.