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The puzzling reality of factitious illness is carefully and systematically described in this well-edited compact (229 pages) volume. This book gives a full range of explanations for the seemingly bizarre twist of benefiting from illness. Each chapter, except those concerned with legal issues, includes a formulation for the etiology of the disorder. There are also several discussions of diagnostic criteria and making a differential diagnosis. References follow each chapter and there is a subject index at the end.

For professionals in the healing arts who are trained to take people at face value, it is difficult to understand how the relationship between healer and healed can be so thoroughly tuned on its head as it is in a factitious disorder. It is even more puzzling when the factitious disorder involves a parent, usually a mother, using a false malady of a child for whatever the advantage or benefit is. This is a factitious disorder by proxy. In the fascination with the persons who may be using a child to present a fabricated illness, a form of severe child abuse, the victim of the abuse may be overlooked. The chapter by Rand has a section dealing with assessing the child. This is a problem I have not seen addressed elsewhere and Rand does a good job of outlining a careful assessment of the child who is the victim of a factitious disorder by proxy. It is not enough to assume that disclosure of the abuse will solve it. The effects on the child victim are likely serious and enduring.

Suggestions for case management and treatment are given in several of the chapters with the emphasis on nonconfrontational, behavioral treatment strategies. A necessary warning about developing counter-transference is helpful. When the healing professional feels betrayed and exploited, it is easy to get very angry and begin to take the role of a detective seeking to catch a crook. There are also several discussions of ethical questions that must be faced when a healing professional tries to deal with a factitious disorder.

This is a useful book and can be read and studied with profit by anyone who may have to respond to a situation that may include a factitious disorder. It is a succinct and clear presentation of the current state of knowledge and understanding of this often overlooked disorder.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.