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By Marc D. Feldman Playing Sick?: Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Fact (1st First Edition) [Hardcover]

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Hardcover

First published January 1, 2004

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About the author

Marc D. Feldman

13 books15 followers
Dr. Feldman is Clinical Professor of Psychiatry and Adjunct Professor of Psychology at the University of Alabama, Tuscaloosa. A Distinguished Life Fellow of the American Psychiatric Association, Dr. Feldman is an international expert in factitious disorders, including Munchausen Syndrome and Munchausen by Proxy, as well as another form of medical deception known as Malingering. He is the author of five books, more than one hundred peer-reviewed articles, and has appeared as an expert in dozens of television programs, print media, and documentaries throughout the world. He has served as an expert consultant and/or expert witness in cases nationally and internationally.

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Displaying 1 - 22 of 22 reviews
Profile Image for Petra X.
2,456 reviews35.7k followers
June 22, 2022
Review I was reading today of a woman whose child was in a wheelchair, a scarf over her bald head, a victim of cancer. Not so. Her mother was the recipient of benefits. But... how come so many doctors were taken in and performed so many invasive procedures? How come no one thought to send a child psychiatrist to the child to find out what was really going on? This is among the worst kind of child abuse there is.

How does one ever recover from a mother who pretends to love and care for you when you are so seriously ill and who really only cares for themselves and will do anything, including sacrificing their child, for attention (and benefits, they were enough that she didn't have to work). Reminds me of my sister-in-law, who definitely had Munchausen's by proxy when her children were young, but she wasn't quite so extreme (SIL story at the end).

Reading this, reminded me I had never reviewed this book!
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Reading notes Fascinating book! I'm reading now about Factitious disorder which is where the person invents illnesses because they want the attention but they are not after any material rewards, such as drugs or money. That is a mental disorder. However they know exactly what they are doing including taking substances to give them the symptoms they want and telling lies about what the doctors, if they have seen any, have diagnosed plus the treatment they are undergoing (which they aren't).

Resolution to their problems rarely exists because once caught out they disappear and go somewhere else to do their thing. In one case in the book, a woman invented a dead boyfriend, leukemia, chemotherapy, rape and a couple more and had much attention from her friends and fellow workers as you can imagine. When someone got suspicious and phoned her mother... the game was up. She left. A short while later, telling a new employee about her, the newbie said she had just come to work at the place she left and was telling the same stories! That is Factitous disorder. She was looking for sympathy and attention not any material rewards.

Munchausens is the extreme end of this. Factitious disorder can also be part of Borderline Personality Disorder. But it is very difficult to diagnose Factitous disorder because doctors are inclined to believe that all patients are truthful and have a physical problem they didn't cause. Borderline Personality Disorder is also very difficult to distinguish from people who are arrogant, selfish, moody and want their own way come hell or high water. Still the treatment for both is behavioural modificiation so maybe it doesn't matter?
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It is best to see the difference between malingering 'playing sick' and having an actual mental disorder right at the start, I'm going to quote in full as it is quite complex:
Researchers classify patients with unexplained medical complaints (UMCs) into two general categories. One category includes patients who consciously create symptoms in themselves, either for secondary (material) gain as in malingering, or for more subtle benefits such as emotional support as in factitious disorder.

The second category includes patients whose symptoms are purely unconscious expressions of stress, as illustrated by somatoform disorders. Somatoform disorders include somatization disorder, which is distinguished by a history of an inordinate number of unexplained physical problems; pain disorder, in which emotional distress is communicated through complaints of persistent pain; hypochondriasis, which is a faulty conviction, despite supporting aches and pains, that one is diseased; and conversion disorder, which involves a loss of or alteration in physical functioning, such as sudden paralysis, blindness, or mutism. Unlike the somatoform disorders, malingering and factitious disorder involve deliberate, willful disease forgeries.

Thus, UMCs range from malingering—in which the person knowingly lies and acts sick for obvious, tangible gains such as narcotics, malpractice payments, Social Security Disability dollars, or insurance compensation—to the aforementioned conversion disorder (further discussed below). Unlike conversion disorder, malingering may be viewed more as a crime than a psychological disorder, though it could suggest the presence of some underlying personality problem.

Factitious disorder, which falls between malingering and conversion in the range of UMCs, is a conscious act as malingering is; however, the goal is intangible and psychologically complex, involving some form of emotional satisfaction. That duality places it in the middle.
My sister-in-law appears to have Munchausen's and M. by Proxy, her greatest pride is in impressing doctors with her knowledge of medicine and use of technical terms. She has ruined the life of her eldest son and enabled her daughter to live the live of an entitled sloth. But her second son, born only 11 months after the eldest, has escaped and is a tall, handsome, successful man, the sort of person they might all have been if my SIL had had a better character.

She is a definite malingerer as she herself gets disability payments since she can't work owing to long-standing back issues which don't stop her spending all day in Brent Cross mall, going store to store trying on shoes and clothes. Her first husband was a taxi driver, so I think the multiple disability payments were quite welcome, and it bumped them up the social housing list too.

Finished 28 Dec 2021, reviewed 21 June 2022
24 reviews
June 11, 2021
My introduction to the existence of Munchausen Syndrome came from the emergence of bizarre cases of Munchausen by Proxy. The most high profile of these was the case of Gypsy Rose Blanchard a victim of Munchausen by Proxy at the hands of her mother, who was eventually murdered at the hand of Gypsy's boyfriend. Gypsy herself was convicted of 2nd degree murder. The peculiarity of such a case made me want to learn more about what kind of person would do such a thing. Literary resources were few and far between as far as I could see. Luckily then for Feldman's comprehensive dive into the subject of Factitious disorders, amongst them Munchausen by proxy. The book is a mix of true accounts by both victims and sufferers, as well as medical practitioners. These are coupled with dissections of the disorder and its roots, advice for recovery, and a look at the legal implications for Munchausen sufferers, and the victims and medical practioners drawn into their web. Because of the lack of knowledge both on the part of the public and the medical community, this book was intended as an educational resource.

Munchausen by Proxy is just one grape in a bunch of similar disorders. There is Factitious Disorder, where a patient feigns illnesses and tragic life events, but at a fairly functional level. It is just a facet of their lives, a coping mechanism for when things get tough and the nurturing environment of a hospital is their go-to form of comfort. Of course only sick people can go to hospital, so white lies need to be told, temperatures faked and blood needs to be let on the sly. In addition, they might look to gain sympathy from their friends, family, coworkers and community due to escalating tragic life events. Stories of terminal cancer are bolstered here and there by a horrific rape, a broken engagement, or the deaths of family members (even though those family members are perfectly alive).

A step up from Factitious Disorder is Munchausen Syndrome, where the sufferer devotes their life to feigning illness. People with Munchausen disorder can be see as hospital "frequent flyers", often traveling from city to city to seek out new hospitals as their lies are discovered. Because of the frequent movement, medical records are often hard to trace and doctors have to take the patient at their word. A Munchausen patient can realistically bamboozle their way into everything from unnecessary medications to multiple unnecessary surgical procedures. In the worst cases their efforts are fatal.

There comes a point where this class of disorders crosses the line from mere self-harm and a waste of medical resources to more heinous activity. Munchausen by Proxy is when, instead of pretending they themselves are sick, a dependent is victimized instead. This could be an elderly relative, a child or even a pet. The hapless dependent is on the recieving end of unnecessary medications, medical procedures and devices such as wheelchairs and feeding tubes while the Munchausen patient rakes in the sympathy and praise for tirelessly taking care of their charge.

Finally, we have the Malingerer, who does all of the above for fun and profit. Through their deceptions, the Malinger may recieve monetarial gifts and donations, free items and medical care. In the case of Dee Dee and Gypsy Rose Blanchard the booty included free trips to Disneyland.

Again, what type of person would do this? What Feldman describes is a psychological condition that can often be comorbid with more common conditions such as depression and anxiety. At its inception a patient might get their start from a very real hospital or doctors visit. A fledgling Munchausen patient might discover that feigning illness is a way to escape abuse, gain sympathy or even get the attention they don't usually get at home. Regardless of the cause, this type of behaviour is a way of fulfilling an emotional need that sufferers don't know how to get any other way.

As a medical professional, calling out such a person is not as easy as it sounds. A doctor might be accused of malpractice, libel or bias. They might be shamed for not catching on sooner. They might be realistically hit with legal charges. Feldman outlines ways to approach these situations, pointing out that they are not dead ends for either doctors or patients. In fact recovery is possible with solid emotional support and psychiatric treatement.

As you can probably tell by this review, the book definitely increased my knowledge on the subject. It wasn't too dry of a text to be unenjoyable, and the interspersing of anecdotes made the book that much more readable. Worth a read whether you just have an interest in the subject or are dealing with it in real life.
Profile Image for tara bomp.
520 reviews162 followers
March 15, 2013
Interesting and about as sympathetic as I can imagine a book on Munchausen Syndrome could be. The book is structured generally as story/case study and then a section talking about things shown by the experience and possible advice to sufferers/victims/healthcare professionals. He makes it constantly clear that Munchausen's and factitious disorder are problems people suffer from and they need support to get through them and that they're not just hurting themselves or constantly lying for no reason. He talks about how they're generally related to needing to establish some sort of control over sufferers's lives or find some sort of emotional support that sufferers have trouble finding in healthy ways. The last chapter is the most interesting, giving relatively long accounts from former sufferers who with therapy and support have mostly moved on. The book would have been enhanced through more words from sufferers, but it's understandable that very few admit to it and even fewer would want to be in a book, even anonymously. He does try to put in what he has throughout the book and there are a few other stories scattered throughout. Inevitably, the stories mostly focus on the victims of the lying but they're still interesting and most are relatively non-judgemental.

Some of the stories are about sufferers who could never possibly give permission and it does feel a bit voyeuristic reading about them, although the stories are completely anonymised and I understand it would be impossible to talk about the syndrome without them. I feel he gives too much credit to the American healthcare system in general - although this is understandable given he's a doctor - meaning some possible explanations for things are missed and there's a couple of times where he weirdly focuses on the horrors of somewhat higher expenses rather than patients. He also doesn't talk about wider problems like the stigma of mental illnesses and lack of financial and emotional support in general. I understand that it would make the book longer and greatly expand the scope but it basically just gets a paragraph at the end, which undermines the analysis a bit. His chapter on ethics is constrained by working within American systems, but again understandable.

Ultimately, although it's a bit limited by the scope he chose and the perspective he has, I can't really imagine how it could be improved without changing the book significantly. Worth reading if you're at all interested in these disorders.
Profile Image for Claire.
46 reviews1 follower
June 7, 2017
Easily readable, with really good explanations of factitious disorder and Münchausen syndrome. Lots of real stories and examples, which really helps to humanize this spectrum of problems. I also really appreciate that Dr Feldman communicates his compassion for people who resort to faking illness, and I think this is key to their treatment. Dr Feldman's perspective is that people who fake illness are trying to get their emotional needs met, just going about it in an unhealthy way. If you can get them to admit they are doing this, you can help them get their needs met in healthier ways. This book was both informative and instructional in how to approach medical fakers with true compassion. A fascinating read.
Profile Image for Max.
Author 5 books103 followers
February 13, 2018
Author seemed like a dick but the parts quoting people who had experienced this stuff directly or through a close friend/member of the family were really interesting
Profile Image for PinkAmy loves books, cats and naps .
2,717 reviews252 followers
September 25, 2025
A lot of people are familiar with the condition Factitious Disorder Imposed on Another (FDA) known colloquially as Munchausen’s Syndrome by Proxy. Fewer people may know Factitious Disorder Imposed on Self(FDS). In PLAYING SICK? Dr Mark D Feldman primary discusses FDS, though also touches on FDA.

Dr Feldman’s bland storytelling works better when describing types of Factitious Disorders than in the vignettes telling people’s accounts.

The case studies Dr Feldman relays also tell a story about the history of patients’ rights. In a mid twentieth century case doctors injected their patient with a substance that would identify if the patient was infecting herself with something to make her sick (I can’t remember the names). While scanning the patient nurses inspected the room including her handbag and found hypodermic needles and the products the patient used to make herself sick. Today this would be considered assault and theft and possibly mean prison time for those involved.

My biggest criticism of PLAYING SICK? is that Dr Feldman sees theses disorders everywhere, whether or not they are symptoms of others disorders or simply typical behaviors. Kids feigning illness to stay home from school is a tradition as old as schools. A child with Separation Disorder Anxiety who plays sick isn’t a FDS patient, but a child who is using illness as a way to stay home with his mom. The behavior is a symptom of the anxiety, not the disorder. In my opinion, over attributing behaviors as FDS waters down this uncommon disorder by lowering the threshold of diagnostic criteria. Similarly a teenager making herself sick to escape her stepfather’s sexual abuse to me is resourceful, a strength albeit one that needs to be channeled into communication using her voice. I’d never diagnose her with FDS because making herself sick was a tool toward achieving safety. Schizophrenics who make themselves sick in response to hallucinatory demands aren’t FDS, they’re exhibiting a symptom of the schizophrenia.

Another criticism is that Dr Feldman repeatedly talks about patients who’ve become friends which is unethical except under strict criteria and certainly not with many former patients.

I appreciate Dr Feldman’s attempt to inform the public in a user friendly way, although I wish he made clear that not every situation is FDS and the subtlety needed to understand the difference.
Profile Image for Alice Wardle.
Author 1 book4 followers
October 6, 2021
When people walk through the doors of a hospital, declaring that they feel faint and think they might be anaemic, it would never have crossed my mind before reading this book that they might be feigning illness. Never would I have imagined that people would draw out their own blood to make themselves sick just so that they could claim the attention of caregivers. Dr Marc Feldman presents the patients with a mostly soft aura – people with Munchausen's syndrome are sensitive, vulnerable, and insecure, so much so they constantly need to feel obsessively cared for by other people. Dr Feldman's own attitudes towards such people were impressed on me by the end of the book. After all, people with Munchausen's Syndrome ARE ill and need help, but not for the reason they entered the hospital. The lengths some of these people go to demand the care they so desire presents them as clearly have a mental illness, not as maliciously attempting to drain resources (this would be malingering).

The only slight downside of this book is that I do not recall a clear and concise definition of Munchausen's syndrome, Maunchausen's syndrome by Proxy, and malingering being made. I wish more of the book could have been dedicated to investigating what causes the condition, as there is so much information given on the current case studies of the time. It is an intriguing read, nonetheless.
Profile Image for Alexa.
692 reviews
July 11, 2025
I read Sickened by Dr Feldman and Julie Gregory years ago after seeing Mrs. Gregory on Oprah (?) and a couple of other talk shows (back when I was plugged into the book talk show circuits.

I have been obsessed ever since, Human Monsters (podcast) has several episodes on MbP as does Suffer the Children (Podcast) and Andrea Dunlops podcast Nobody Should Believe Me. and there are many many mentions of Dr. Feldman, who also has amazing papers and I collect all the ones that are not behind pay walls.

excellent book, very happy to have picked up the audiobook on Audible.

recommend to all its phenomenal
Profile Image for Chaitalee Ghosalkar.
Author 2 books23 followers
April 9, 2022
Two and a half stars

To my mind, Munchausen's syndrome is the second most fascinating mental disorder after schizophrenia. The fascination could partly arise from having dealt with a significant number of liars in my life :P

Playing Sick charts the author's experience with people suffering from Munchausen's and some related disorders (the classification I was unaware about). While the cases mentioned are certainly interesting, they don't quite enthral you. Also, the format of the writing is such that it suits a curriculum book more than a standalone commercial one.
Profile Image for Heather Barrett.
82 reviews
May 9, 2021
An informative review of Feldman's many experiences with Munchausen Syndrome & Factitious Disorder patients. However, many of the vignettes lack depth and meaningful analysis, making this more of a directory of oddities. Feldman could definitely show some more compassion for his patients, even if they are driving him batty. A good introduction to some of these cases, but not a definitive study by any means.
Profile Image for Ashton Eleazer.
501 reviews15 followers
April 1, 2024
This book felt like a great reference for understanding factitious disorder and what goes on in the minds and motivation behind deciding doing and how to support recovery for those with this disorder. Though it labels factitious disorder by proxy as explicit abuse and I’m glad it does. It is extensive in how effective in analyzing different treatments.
35 reviews1 follower
October 31, 2021
Props on how easy-to-read this was. 5 stars on achieving the goal of the book, which was to education laypeople and medical professionals on factitious disorder and Munchausen Syndrome. Fascinating topic, especially when you know someone with Munchausen by Internet 👀👀👀
Profile Image for Madeline Mayberry .
23 reviews
February 14, 2023
Feldman summarises what factitious disorder is, provides plenty of case studies, and offers suggestions as to what family members and heath professionals can do if they encounter a person with factitious illness.

Playing Sick is comprehensive, fascinating and empathetic.
Profile Image for Townmayorjules.
31 reviews
February 10, 2025
A very informative book from a leading expert on Munchausen.
This book goes over personal tales from people who were caught in the orbit of malingerers and munchies, and Feldman offers insight as to why these people create the lies they do.
Profile Image for Tarquilla.
164 reviews1 follower
February 24, 2019
Enlightening and fascinating. A useful and interesting book.
Profile Image for Jennifer.
254 reviews3 followers
March 9, 2025
Full of wonderful case studies, a compassionate and helpful overview of the types of cases that can be super frustrating for providers and loved ones alike.
Profile Image for Rachel Stolz.
91 reviews
November 22, 2025
Excellent, a must read for those in health care and anyone who has been seen this in action.
8 reviews
December 30, 2010
After feeling ineffective with some of my clients I found this book that helped me identify what was behind the situation with those clients that seemed to not progress. There are stories by other professionals that helped me realize that I was not alone, some of them having been in the field longer than I have.
Profile Image for Laura.
648 reviews5 followers
March 4, 2011
Good and informative, if a little repetitive. Interesting case studies though most were only a paragraph or two. Reads less like a textbook than I wad expecting. Recommended for those with a definite interest but also good for the medical field in general. Julie Gregory's memoir Sickened makes for more gripping and emotional reading.
Profile Image for Carrie Kyllonen.
2 reviews
April 21, 2013
Great book! It was a really easy read. I bought it to use as a reference for my research paper and really enjoyed reading it.
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