The Simulated Disorder: When Someone Plays The Role Of Patient

The main characteristic of a simulated disorder is that a person makes up or intentionally causes psychological or physical symptoms. Doctors make this diagnosis through simple direct observation or through a process of elimination. However, in many cases it is still controversial. After all, it is impossible to completely rule out that the patient really does not have what his symptoms indicate.

People make up symptoms so they can play the role of patient.  However, they don’t try to get anything out of that. That’s what distinguishes this disorder from simulating or pretending. Simulants also intentionally cause their symptoms. However, when you know the circumstances, it is easy to see their objective.

For example, a simulant may pretend to be ill to avoid a court appointment. Another example is a man who pretends to be sick so that he can escape conscription. For example, someone in a psychiatric hospital can also pretend that their health is deteriorating. The goal is then to avoid having to move to a less desirable situation. This is also simulation.

In contrast, people with a simulated disorder have a psychological need to take on the role of patient. There are no external motivations here. So it differs sharply when simulating.

By definition, the diagnosis of FGM always involves some degree of psychopathology. So in the mind of the patient something is not right. If a person has a simulated disorder, that rules out the possibility of other physical or psychological symptoms. So it is definitely a difficult problem.

Clinical criteria for diagnosing a simulated disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-4) list lists the following criteria for psychologists and psychiatrists to diagnose a simulated disorder:

A. Pretending or intentionally creating physical or psychological symptoms.

B. The person wants to take on the role of patient.

C. The absence of external drivers of behavior (examples of drivers behind simulating: economic advantage, avoiding legal responsibility, improving physical well-being, etc.).

The DSM-4 also makes the following classification for mimicked disorders:

• Faux disorders with predominantly psychological signs and symptoms. The predominant signs and symptoms in the clinical profile are psychological.
• Faux disorders with predominant physical signs and symptoms. The signs and symptoms that predominate in the clinical profile are physical.
• Simulated disorders with psychological and physical signs and symptoms. Neither of the two types of symptoms is superior to the other.

The simulated disorder

We’ve said it before. The defining characteristic of the simulated disorder is the intentional production of physical or psychological signs and symptoms. The patient can make up the symptoms (for example, the patient complains of stomach pain without actually having stomach pain). They can also fake their symptoms. For example, some patients have created abscesses by injecting saliva under their skin.

The symptoms may also be an exaggeration or exaggeration of a physical disorder that existed before (for example, a patient with a history of mental illness pretends to have delusions). The symptoms can also be a combination or a variation of anything we have described here.

What are the characteristics of people with a simulated disorder?

People with a simulated disorder usually explain their story in a dramatic way. Then if you ask them for more details, their answers are vague and incoherent. They also often get carried away by lies that quickly spiral out of control. Their lies are pathological. The aim is to get the attention of the person asking the questions. The patient lies about his story and about the symptoms.

Often individuals with a simulated disorder know a lot about medical terminology. They also have an extensive knowledge of how hospitals work. Usually they complain of pain and ask for painkillers. When the doctor fails to find a physical problem, they start complaining about other things. They then invent new simulated symptoms.

Individuals suffering from a simulated disorder often undergo numerous examinations and surgeries. In addition, they usually do not have many visitors when they are in the hospital.

The moment they realize that others know they are pretending, they either deny it or leave the hospital. In fact, they may even go against medical advice. Usually they will be admitted to another hospital the same day.

The mimicked disorder with psychological signs and symptoms

This mimicked disorder subtype has a clinical profile with predominantly psychological signs and symptoms. The main symptoms consist in the deliberate fabrication or pretense of psychological symptoms.

The symptoms suggest a mental illness. The apparent goal of the individual is to assume the role of patient. There is nothing in their life to indicate that they are trying to use their “illness” to manipulate.

Professionals usually recognize this disorder. They observe the symptoms that do not fit a typical symptomatic pattern. The symptoms also usually have an unusual clinical course and therapeutic response.

• The symptoms usually get worse when the person realizes that someone is watching them.
• The patients also often complain of depression. They say they have suicidal thoughts because of the death of a loved one (relatives do not confirm this information).
• They also complain of amnesia, hallucinations, delirium, symptoms of post-traumatic stress disorder, and dissociative symptoms.

• They are often extremely negative patients.
• They are not willing to cooperate during the medical examination.

The simulated disorder with physical signs and symptoms

In this subtype, the predominant signs and symptoms are some form of physical illness. Individuals with this type of simulated disorder make up or inflict a number of different medical problems on themselves. Here are some examples:

• abscesses
• wounds that heal slowly
• pain
• hypoglycemia
• anemia
• hemorrhoids
• skin rash
• neurological symptoms
• vomit
• diarrhea
• fever of unknown origin
• autoimmune disorders
• connective tissue disorders

The most severe and chronic type of this disorder is called Munchausen syndrome. People with Munchausen syndrome are regularly hospitalized. They are pathological liars. Every part of their body is a potential target. The only thing that limits their symptoms is their own medical knowledge, their sophisticated way of working and their imagination.

The simulated disorder with a combination of psychological and physical signs and symptoms

Finally, want to discuss this subtype. Individuals in this case have a combination of physical and psychological syndromes. However, neither type of symptoms is predominant. Again, the most severe and chronic form is Munchausen syndrome.

What is the course and evolution of a simulated disorder?

The clinical course of a simulated disorder is characterized by periodic periods. Less common are single episodes or chronic illness without interruption. The disease begins in early adulthood. In addition, it often coincides with hospitalization for a recognizable physical or mental condition. For people with the chronic version of the disorder, consecutive hospitalizations are almost a lifestyle.