Will-controlled Disorder: Playing The Role Of A Patient

The primary characteristic of a will-controlled disorder is to falsify mental or physical symptoms or cause them intentionally. Doctors diagnose it easily through direct observation or through the elimination process. In many cases, however, it is still controversial because it is impossible to rule out that the patient does not really have what their symptoms indicate.

People falsify symptoms so that they can play the role of a patient. However, they are not trying to get anything out of it. That is what separates this from simulation. People who simulate also cause their own symptoms on purpose, but the goal is easy to see when you are familiar with the circumstances.

For example, someone who simulates can  falsify a disease to avoid a court date. Another example is a man who pretends to be ill to escape conscription. In the same way, someone in a mental hospital can falsify a decline in their health to avoid moving to a less desirable institution. This is also considered a simulation.

People with a will-controlled disorder , on the other hand, have a mental need to take on the role of a patient. The absence of external intensives here contrasts strongly with simulation.

By definition, the diagnosis of a will-controlled disorder always involves a certain degree of psychopathology. In other words, something is not right in the patient’s mind. That said, if a person has a will-controlled disorder, it does not rule out the possibility of other physical or mental symptoms. In short, it is a complicated problem.

Clinical criteria for diagnosing a will-controlled disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-4) sets out the following criteria for psychologists and psychiatrists in diagnosing a will-controlled disorder:

A. Simulation or intentional production  of physical or mental symptoms.

B. The subject wants to take on the role of a patient.

C. Absence of external behavioral intensives (ie intensifications behind simulation such as financial gain, avoidance of legal liability, improvement of physical well-being, etc.).

DSM-4 also sets the following classification for will-controlled disorders:

• Will control disorders with emphasis on mental signs and symptoms. The prevailing signs and symptoms in the clinical profile are mental.
• Will control disorders with emphasis on physical signs and symptoms. Signs and symptoms that are prevalent in the clinical profile are physical.
• Will control disorders with mental and physical signs and symptoms. No one is superior to the other.

Will-controlled disorder

As we have said before, the defining characteristic of this disorder is the intentional production of physical or mental signs and symptoms. The patient may invent symptoms (ie the patient complains of abdominal pain without actually having them). They can also falsify their symptoms. For example, some patients have created abscesses by injecting saliva under their skin.

The symptoms can also be an exaggeration or aggravation of an existing physical disorder (ie a patient with a history of mental illness who pretends to have delusions). Similarly, the symptoms may be a combination or variation of all of the above.

What are the characteristics of people with will-controlled disorder?

People with this disorder usually explain their history in a dramatic way. Then, if you ask them for more details, their answers are vague and inconsistent. They tend to get carried away with lies that quickly get out of control. Their lies are pathological and are meant to get the attention of the person asking the questions. The patient lies about his history and symptoms.

People with will-control disorders often know a lot about medical terminology. Their knowledge of how hospitals work is extensive. They usually complain of pain and require painkillers. When the doctor is unable to find any physical problems, they start complaining about other things. Then they come up with new symptoms.

People who suffer from will-control disorders often undergo a number of examinations and surgeries. In addition, when they are in the hospital, they usually do not have many visitors.

When they realize that others know they are counterfeiting, they either deny it or leave the hospital. In fact, they can leave the hospital themselves against the doctor’s medical advice. They will usually be admitted to another hospital on the same day.

Will-controlled disorder with mental signs and symptoms

This subtype of will-controlled disorder has a clinical profile with prevailing signs and symptoms that are mental. The primary symptoms consist of intentional production or simulation of mental symptoms.

The symptoms indicate mental illness. The apparent goal of the individual is to take on the role of patient, and there is nothing in life that they do not try to use to manipulate their “disease”.

Professionals usually recognize this disorder by observing symptoms that do not fit a typical symptom pattern. The symptoms have an unusual clinical course and therapeutic response.

• The symptoms usually get worse when the person is aware that someone is looking at them.
• Patients also have a tendency to complain of depression, saying that they have suicidal thoughts due to the death of someone they loved (information that family members do not confirm).

• They also complain of memory loss, hallucinations, delirium, PTSD symptoms and dissociative symptoms.
• Often they are extremely negative patients.
• They will not cooperate during medical examination.

Will-controlled disorder with physical signs and symptoms

In this subtype are the prevailing signs and symptoms of a kind of physical illness. People with this type of disorder falsify or inflict a variety of medical problems themselves. Some examples are:

• abscesses
• wounds that slowly heal
• pain
• hypoglycemia
• anemia
• bleeding
• rash
• neurological symptoms
• vomiting
• diarrhea
• fever of unknown origin
• autoimmune disorders
• connective tissue diseases

The most serious and chronic subtype of this disorder is called Munchausen’s syndrome. People with Münchausen syndrome are often in the hospital. They are pathological liars and all parts of their bodies are potential targets. The only things that limit their symptoms are their own medical knowledge, sophistication and imagination.

Will-controlled disorder with a combination of mental and physical signs and symptoms

Finally, this subtype consists of people who have a combination of physical and mental signs and symptoms. But no one is more prevalent than the other. Here again, the most serious and chronic form of this disorder is actually Münchausen’s syndrome.

What is the course and development of a will-controlled disorder?

The clinical course of a will-controlled disorder has periodic episodes. Some episodes are not so common, as well as chronic disease without remission. The disease starts early in adulthood. In addition, it often coincides with hospitalization for an identifiable physical or mental illness. For people with a chronic version of this disorder, their subsequent hospitalization becomes almost like a lifestyle.