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Patient or Pretender.

When "playing sick" becomes a game of life and death. A look into the strange world of factitious disorders.

There is a psychological condition in which a person knowingly fakes an illness by simulating symptoms of a serious disease. The purpose? To attract attention, say psychiatrists who specialize in the problem.

These patients, some of whom actually make themselves ill, seem to become sick in order to achieve such gains as emotional fulfillment, sympathy, and power over their doctors and their family and friends.

Drs. Feldman and Ford are experts in the field of factitious disorders. Their book offers compelling accounts of patients they have treated. The patients have resorted to dangerous and bizarre practices -- from taking needless medications; to injecting themselves with dirt and bacteria to generate fevers; or to bleeding themselves to produce anemia or introduce blood into urine samples to simulate kidney disease. Many of these patients undergo serious and unnecessary surgical procedures -- and consequently die of these self-induced diseases.

Munchausen syndrome is probably the "highest order" of pretender syndromes. Patients not only feign illness but also make these disease portrayals the center of their lives. They have also been known to induce illness in their children so that they can become heroic, self-sacrificing parents.

Many cases of factitious disorders are not recognized by doctors. According to the authors, most are improperly diagnosed.

The case histories, stranger than fiction. An example:

"Jenny" walks into her office one day and announces to her co-workers that she has terminal breast cancer. Family, friends, and fellow employees support her courage. Her hair begins to fall out; she grows pale and thin; she joins a breastcancer support group. Almost two years later, when it becomes suspicious that her cancer is getting neither better nor worse, phone calls are made to Jenny's doctors; questions are asked, and it is discovered that Jenny never had cancer at all. It is discovered, in fact, that Jenny lied to everyone from her mother to her fellow employees to her caretakers; that she shaved her head and starved herself to elicit the appearance of a cancer patient; that two years ago her fiance broke off their engagement unexpectedly, and that this bizarre two-year charade was Jenny's desperate attempt to fill an emotional void in her life.

The authors recount these stories with compassion, offering profound insights into the bruised psyches of these "disease forgers." It becomes apparent that what compels these people to take extraordinary risks to obtain sympathy and emotional fulfillment is a mystery that is yet to be solved. Does the answer lie in being more generous with love and recognition? Or must we resign ourselves to the uncomfortable truth that as the human psyche is further explored, we should expect tantalyzing revelations without explanations?
COPYRIGHT 1994 Vegetus Publications
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1994 Gale, Cengage Learning. All rights reserved.

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Publication:Nutrition Health Review
Article Type:Book Review
Date:Mar 22, 1994
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