Some people try to trick the psychologist into giving a diagnosis that interests them based on the simulation of symptoms. We are talking about a serious problem and one that psychologists are often helpless against: in their actions they rely on the honesty of the patient. Now, what can they do to avoid being fooled?
Deception can be an art, and its detection is a real challenge for specialists. Specific measuring instruments are therefore needed to unmask this type of “fictitious” patient.
In this regard, and to detect patterns of symptom falsification and exaggeration, the Structured Inventory of Symptom Simulation (SIMS) has been developed. Thanks to it, the hypothesis of simulation can be contrasted and the reliability, validity, and precision of the psychological assessment can be increased.
Credibility of symptoms
It is the psychologist’s responsibility to judge the accuracy and reliability of any source that may influence the outcome of the assessment and, where possible, to corroborate the information. Thus, the psychologist must consider the possibility that the person who has come to the consultation is moving in the area of deception. Sometimes, family and friends can be more reliable than the patient himself, especially in cases with anosognosia.
The problem: the symptoms or testimonies given by these people cannot be the subject of a major investigation, if only because of the amount of resources that such an investigation would require. Therefore, one must opt to explore what can be analyzed: the symptoms and findings and the clinical picture of the patient. In this way, it will be possible to determine, according to scientific and diagnostic criteria, the possible feigning of illness.
What is SIMS?
The purpose of SIMS is to detect the simulation of psychopathological and neuropsychological symptoms. It is an assessment instrument made up of 75 dichotomous response items (true or false). In addition, it is made up of 5 scales, each with 15 items:
- Psychosis. Unusual or bizarre psychotic symptoms, atypical of real pathology. The area of focus for symptom simulation is psychopathology. “I believe the government has installed video cameras at traffic signals to spy on me.” “ There is nothing I can do, other than taking medication, that will have any effect on the voices I hear.”
- Neurological impairment. Illogical or very atypical neurological symptoms. The area of focus for simulating symptoms is the physical. “Walking is very difficult for me because of my balance problems.”
- Amnestic disorders. Symptoms related to memory disorders. For example, “The biggest problem I have is my memory” or “I have difficulty remembering the day of the week .” Their symptom simulation scanning area is cognitive.
- Low intelligence. Exaggeration of intellectual deficit, by purposely failing general knowledge questions. Same as above. The area of simulation of symptoms is cognitive. “The capital of Italy is Hungary” or “a week is made up of 6 days”.
- Affective disorders. Atypical symptoms of depression and anxiety. Their symptom simulation scanning area is the psychopathological one. For example, “I rarely laugh” or “I cry very rarely.”
To establish or not the simulation, cut-off points are provided in each scale. Thus, the score in each of them allows us to detect the symptomatology that is presented in an atypical way; or how the person evaluated tries to falsify a specific disorder. This allows us to know both the degree of suspicion of simulation and the areas in which it is presented.
Application time
Its application time is very short, about 10 or 15 minutes. Thanks to this, it can be used as a screening test to identify clinical signs quickly and effectively; or as part of a more extensive, complete, and exhaustive battery of tests. In addition, it can be applied in different contexts and is adapted to different conditions and needs of a clinical, occupational, medical-legal, and/or forensic nature.
Who is faking symptoms?
Malingering is most common in individuals involved in criminal investigations or civil litigation, as well as in the course of insurance disability or workers’ compensation claims. However, this test is also useful in detecting shoplifters who pretend to be kleptomaniacs, to avoid prosecution or use it as a mitigating factor in court.
Malingering is not technically a psychiatric illness. However, it is best to record in the report the circumstance when the person has tried to consciously and voluntarily deceive the examiner after applying measuring instruments such as the Structured Inventory of Malingering.