Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder

The stated goals of Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder are to enlarge the awareness of the powerful effects that deception about illness can have on the lives of others, point out that more sophisticated exploration is required to help professionals understand individuals with these conditions, learn how to meet their needs more effectively, and help family members and others learn to handle their own frustrations and pain as they attempt to break the cycle of participation in these deceptions.

Marc D. Feldman, M.D., is a widely recognized leader on the topics of factitious disorder, Munchausen syndrome, Munchausen by proxy, and malingering. Playing Sick? gives a good historical overview of the disorders of simulation. Feldman reviews epidemiology, presentation, course, motivations, and treatment for each of the disorders. Most chapters include case descriptions of individuals with the various disorders. Some cases are expressed in the patient's own voice. In addition, the book presents many cases from the perspective of friends and family members, who describe their experiences with the disorders. Each case description concludes with a commentary from Feldman. The case descriptions and commentaries are excellent, providing a rare insight into the lives of individuals with these disorders.

The book is divided into chapters based on the individual disorders. The book concludes with a discussion of how to diagnose a disorder of simulation, the issues of malpractice and patients' rights, and treatment interventions. The chapter on malpractice and patients' rights provides useful information for clinicians who work with this patient population. However, it appears out of place in a book that is better suited for nonclinicians.

The book uses DSM-IV definitions of the various disorders of simulation. Although the chapters include some data from the professional literature, a rigorous review of the literature is not incorporated. Readers who are looking for evidence-based data will be disappointed. Alternatively, this book would be well received by a nonclinician audience. I would recommend this book to clinicians who are unfamiliar with the presentation of disorders of simulation, nonpsychiatric clinicians who encounter disorders of simulation, and family and friends of individuals with a diagnosis of a disorder of simulation.

Dr. Sorrentino is director of forensic psychiatry at the Erich Lindemann Mental Health Center in Boston.