Structured Inventory Of Malingered Symptomatology Research Articles

Criterion validity of low intelligence scale of the Sims

Objective: The Structured Inventory of Malingered Symptomatology (SIMS) is a widely used test. We evaluated the criterion validity of SIMS Low Intelligence scale (LI). Our previous study showed that the LI scale consists only of arithmetic tasks, logical tasks and tasks evaluating general knowledge and no tasks assessing non-verbal intelligence. None of these tasks appeared suited to differentiate malingerers from patients with cognitive impairment such as impairments documented in survivors of high impact car accidents. Method: We used ANOVA to compare SIMS LI scores from four samples: 23 survivors of high impact motor vehicle accidents (MVA), Capilla Ramírez‘s data of 30 persons instructed to malinger whiplash symptoms, Parks’s data of 26 undergraduates instructed to feign post-concussive symptoms and data of 34 normal controls published in SIMS manual. Results: In the ANOVA, LI scores of the 23 injured survivors of high impact MVAs were significantly higher than scores of 30 malingerers of whiplash and of normal controls, but they were not significantly different from Parks’s malingerers of post-concussive symptoms, i.e., from malingerers of cognitive impairment. Conclusions: Patients with intense post-concussive symptoms are likely to obtain LI score levels similar to persons instructed to malinger post-concussive symptoms. Both the legitimately injured patients and the malingerers of post-concussive symptoms are likely to score higher on the LI scale than normal controls. This is further evidence that the SIMS and its scales constitute a pseudo psychological test without capacity to differentiate malingerers from legitimate patients.

Deceptive Clinical Diagnosing of Malingering via Structured Inventory of Malingered Symptomatology

Deceptive Clinical Diagnosing of Malingering via Structured Inventory of Malingered Symptomatology

Pseudodiagnoses of Malingering of Neuropsychological Symptoms in Survivors of Car Accidents by the Structured Inventory of Malingered Symptomatology

Pseudodiagnoses of Malingering of Neuropsychological Symptoms in Survivors of Car Accidents by the Structured Inventory of Malingered Symptomatology

Classification accuracy of the symptom validity tests Word Memory Test and the German version of the Structured Inventory of Malingered Symptomatology

The symptom validity tests Word Memory Test (WMT) and "Strukturierter Fragebogen Simulierter Symptome" (SFSS, German version of the Structured Inventory of Malingered Symptomatology, SIMS) are used in psychiatric expert reviews in the context of social benefit proceedings to elucidate the validity of apatient's symptom presentation and to unveil possible malingering. Many of the studies on the WMT and the SFSS estimated the sensitivity and specificity of the tests by using student populations or healthy volunteers. The objective of the present study was to investigate the accuracy of the WMT and the SFSS in aclinical sample and if their combined use leads to better classification results. The study was conducted as arandomized controlled trial (RCT) with 60 inpatients and outpatients with depressive and anxiety disorders. The patients randomly received one of two different instructions. The control group was instructed to answer honestly. The intervention group received the instruction to imagine themselves in the situation of asocial benefit claimant who wants to emphasize a medical condition. For the WMT and its recommended cut-off of ≤82.5% the sensitivity was determined to be 80% and the specificity 93.3%. The SFSS achieved asensitivity of 93.3% and aspecificity of 70% with the recommended cut-off of >16. The combined deployment of the tests attained asensitivity of 92.3% and aspecificity of 95.2%. Only the combined deployment of the WMT and the SFSS yielded satisfactory results. Given the high probability of false positive classifications of malingering, the use of one of the tests alone cannot be recommended.

A Clinical Comparison, Simulation Study Testing the Validity of SIMS and IOP-29 with an Italian Sample

The Inventory of Problems–29 (IOP-29) was recently introduced as a brief, easy-to-use measure of non-credible mental and cognitive symptoms that may be applied to a wide variety of contexts or clinical conditions. The current study compared its validity in discriminating bona fide versus feigned (via experimental malingering paradigm) psychopathology against that of the Structured Inventory of Malingered Symptomatology (SIMS). Specifically, 452 Italian adult volunteers participated in this study: 216 were individuals with mental illness who were asked to take the SIMS and IOP-29 honestly, and 236 were nonclinical participants (experimental simulators) who took the same two tests with the instruction to feign a psychopathological condition. Two main, broad categories of symptom presentations were investigated: (a) psychotic spectrum disorders and (b) anxiety, depression, and/or trauma-related disorders. Data analysis compared the effect sizes of the differences between the patients and experimental simulators, as well as the AUC and classification accuracy statistics for both the SIMS and IOP-29. The results indicate that the IOP-29 outperformed the SIMS, with the differences between the two tools being more notable within the psychotic (IOP-29 vs. SIMS: d = − 1.80 vs. d = − 1.06; AUC = .89 vs. AUC = .79) than within the anxiety, depression, and/or trauma related subgroup (IOP-29 vs. SIMS: d = − 2.02 vs. d = − 1.62; AUC = .90 vs. AUC = .86). This study also demonstrates that the IOP-29, with its single cutoff score, is generalizable culturally and linguistically from the USA (English) to Italy (Italian).

Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.

Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24–30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.

SIMULACIÓN DE SÍNTOMAS EN PACIENTES CON FIBROMIALGIA

Abstract.SIMULATION OF SYMPTOMS IN PATIENTS WITH FIBROMYALGIAIn this paper we find a study about the variable of simulation of symptoms in fibromyalgia syndrome regarding to other psychological variables such as quality of life, depression, anxiety as well as gradation of pain. The study was performed with 40 patients, all diagnosed with fibromyalgia by the criteria of the American Rheumatology Association. The instruments used were the Structured Inventory of Malingered Symptomatology (SIMS), the Graded Chronic Pain Scale and SF-36 Health Survey (SF-36v2). The results show that there is a relationship between the simulation of symptoms and chronic pain but not with quality of life. The simulation of symptoms in patients with fibromyalgia is a very complex phenomenon that depends on several methods of control among which it is possible to emphasize the use of screening like the SIMS supported with important physical and psychological examinations by experts.Key words: Fibromyalgia, chronic pain, symptom simulation.Resumen.En el presente trabajo encontramos un estudio sobre la variable simulación de síntomas en pacientes con fibromialgia en relación con otras variables psicológicas como calidad de vida, depresión y ansiedad al igual que la gradación del dolor. El estudio se realizó con un total de 40 pacientes todos diagnosticados con fibromialgia por los criterios de la Asociación Americana de Reumatología. Los instrumentos utilizados fueron, el Inventario Estructurado de Simulación de síntomas (SIMS), el Graded Chronic Pain Scale y el SF-36 Health Survey (SF-36v2) o Cuestionario autogestionado de Salud SF-36. Los resultados expuestos muestran que existen relación entre la simulación de síntomas dolor crónico pero no con la calidad de vida. La simulación de síntomas en pacientes con fibromialgia es un fenómeno muy complejo que depende de varios métodos de control entre los que cabe destacar la utilización de screening como el SIMS apoyados con importantes exámenes físicos y psicológicos por expertos.Palabras clave: Fibromialgia, dolor crónico, simulación de síntomas.

Plausibility Judgments of Atypical Symptoms Across Cultures: an Explorative Study Among Western and Non-Western Experts

Symptom validity tests (SVTs) are predicated on the assumption that overendorsement of atypical symptoms flags symptom exaggeration (i.e., questionable symptom validity). However, few studies have explored how practitioners from different cultural backgrounds evaluate such symptoms. We asked professionals working in Western (n = 56) and non-Western countries (n = 37) to rate the plausibility of uncommon symptoms taken from the Structured Inventory of Malingered Symptomatology (SIMS), dissociative symptoms from the Dissociative Experience Scale (DES-T), and standard symptoms (e.g., anxiety, depression) from the Brief Symptom Inventory-18 (BSI-18). Western and non-Western experts gave similar plausibility ratings to atypical, dissociative, and standard symptoms: both groups judged BSI-18 symptoms as significantly more plausible than either dissociative or atypical symptoms, while the latter two categories did not differ. Our results suggest that the strategy to detect symptom exaggeration by exploring overendorsement of atypical items might work in a non-western context as well.

Validation of neuropsychological consequences in victims of intimate partner violence in a Spanish population using specific effort tests

Neuropsychological consequences in female survivors of intimate partner violence are being used in courts as evidence of acquired injury and for criminal exculpation. To support the validity of neuropsychological test performance and the veracity of victim testimony, effort tests can be used by expert witnesses. Nevertheless, no study has evaluated whether the two principle types of effort tests, Symptom validity tests or Performance validity tests, are most adequate for this population. The study’s objective was to compare the false positive rates of a Performance validity test (Test of Memory Malingering: TOMM) and a Symptom validity test (Structured Inventory of Malingered Symptomatology: SIMS). The sample included 68 female intimate partner violence victims and 40 control females. SIMS showed a significantly higher rate of false positives in victims on four of five subtests, reaching a 59.3% in the total score. There were 0% false positives in both groups on the TOMM. Findings indicate that the SIMS may incorrectly score female IPV victims, undermining the victim’s testimony in judicial cases.

Detecting feigned postconcussional and posttraumatic stress symptoms with the structured inventory of malingered symptomatology (SIMS)

ABSTRACTThe Structured Inventory of Malingered Symptomatology (SIMS) is a standalone symptom validity test (SVT) designed as a screening measure to detect a variety of exaggerated psychological symptoms. A number of studies have explored the accuracy of the SIMS in litigious and clinical populations, yet few have examined the validity of the SIMS in detecting feigned symptoms of postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD). The present study examined the sensitivity of the SIMS in detecting undergraduate simulators (N = 78) feigning symptoms of PCD, PTSD, and the comorbid presentation of both PCD and PTSD symptomatologies. Overall, the SIMS Total score produced the highest sensitivities for the PCD symptoms and PCD+PTSD symptoms groups (.89 and .85, respectively), and to a lesser extent, the PTSD symptoms group (.69). The Affective Disorders (AF) subscale was most sensitive to the PTSD symptoms group compared to the PCD and PCD+PTSD symptoms groups. Additional sensitivity values are presented and examined at multiple scale cutoff scores. These findings support the use of the SIMS as a SVT screening measure for PCD and PTSD symptom exaggeration in neuropsychological assessment.

Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study

Our study involved three samples (N=85; N=38, and N=27) of asylum seekers in a Dutch psychiatric hospital. We looked at how often they reported severe dissociative episodes (i.e., not recognizing oneself in a mirror; seeing traumatic images in a mirror) and whether these symptoms were related to deviant performance on Symptom Validity Tests (SVTs), notably items from the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) and a forced-choice task modeled after the Morel Emotional Numbing Test (MENT; Morel, 1998). We also examined whether poor language proficiency and the presence of incentives to exaggerate symptoms might affect scores on SVTs. Dissociative target symptoms were reported by considerable percentages of patients (27–63%). Patients who reported these symptoms had significantly more often deviant scores on SVT items compared with those who did not report such symptoms. With a few exceptions, deviant scores on SVT items were associated with incentives rather than poor language skills. We conclude that the validity of self-reported symptoms in this target group should not be taken for granted and that SVTs may yield important information.

Poor symptom and performance validity in regularly referred Hospital outpatients: Link with standard clinical measures, and role of incentives

We investigated the frequency of symptom validity test (SVT) failure and its clinical correlates in a large, heterogeneous sample of hospital outpatients referred for psychological assessment for clinical purposes. We studied patients (N=469), who were regularly referred for assessment to the psychology departments of five hospitals. Background characteristics, including information about incentives, were obtained with a checklist completed by the clinician. As a measure of over-reporting, the Structured Inventory of Malingered Symptomatology (SIMS) was administered to all patients. The Amsterdam Short-Term Memory test (ASTM), a cognitive underperformance measure, was only administered to patients who were referred for a neuropsychological assessment. Symptom over-reporting occurred in a minority of patients, ranging from 12% to 19% in the main diagnostic patient groups. Patients with morbid obesity had a low rate of over-reporting (1%). The SIMS was positively associated with levels of self-reported psychological symptoms. Cognitive underperformance occurred in 29.3% of the neuropsychological assessments. The ASTM was negatively associated with memory test performance. We found no association between SVT failure and financial incentives. Our results support the recommendation to routinely evaluate symptom validity in clinical assessments of hospital patients. The dynamics behind invalid symptom reporting need to be further elucidated.

The Development of a Reduced-Item Structured Inventory of Malingered Symptomatology (SIMS)

Effort assessment is a relevant area in neuropsychological assessment. There are well-established self-report measures, such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) FBS Symptom Validity Scale (FBS; Lees-Haley, English & Glenn, Psychological Reports 68: 203-210, 1991) and MMPI-2 Response Bias Scale (RBS; Gervais, Ben-Porath, Wygant & Green, Assessment 14: 196, 2007). However, there is also a need for brief measures of symptom exaggeration. The Structured Inventory of Malingered Symptomatology (SIMS) appears to be a promising self-report measure of symptom validity (e.g., Smith & Burger, Academy of Psychiatry and the Law 25: 183-189, 1997). In order to understand the psychometric properties of the SIMS, a comprehensive item analysis was performed with the questionnaire. Items were removed due to invariable response or lack of relationship with the total SIMS. Receiver operating characteristics (ROC) curve analyses were completed using RBS and FBS Symptom Validity Scale (FBS) of the MMPI-2 with items grouping from the SIMS indices. The results found that limiting the number of items did not affect overall utility. The abbreviated indices on the SIMS had excellent discrimination with the neurologic impairment (NI) and affective disorder (AF) scales and good discrimination with psychosis (P) and amnesic disorder (AM) scales of the SIMS. The briefer measure allows for less time required to administer the measure, while still maintaining the integrity of the SIMS.

The SIMS Screen for feigned mental disorders: the development of detection-based scales.

Time-efficient screens for feigned mental disorders (FMDs) constitute important tools in forensic assessments. The Structured Inventory of Malingered Symptomatology (SIMS) is a 75-item true-false questionnaire that has been extensively studied as an FMD screen. However, the SIMS scales are not based on established detection strategies, and only its total score is utilized as a feigning screen. This investigation develops two new feigning scales based on well-established detection-strategies: rare symptoms (RS) and symptom combinations (SC). They are studied in a between-subjects simulation design using inpatients with partial-malingering (i.e., patients with genuine disorders asked to feign greater disabilities) conditions. Subject to future cross-validation, the SC scale evidenced the highest effect size (d=2.01) and appeared the most effective at ruling out examinees, who have a high likelihood of genuine responding.

Exaggerating Psychopathology Produces Residual Effects That Are Resistant to Corrective Feedback: An Experimental Demonstration

We explored the effects of feedback on symptom reporting. Two experimental groups (n = 15 each) were given a scenario with the option to exaggerate symptoms. Compared with a control condition (n = 15), both groups scored significantly higher on the Structured Inventory of Malingered Symptomatology. Next, one group was confronted in a sympathetic way about their symptom validity test failure, whereas the other group was confronted in a neutral manner. Both groups subsequently completed the Brief Symptom Inventory (BSI). BSI scores of both feedback groups remained significantly higher than those of control participants. Participants who had been provided with sympathetic feedback or neutral feedback did not differ in their BSI scores. Even participants who indicated during the exit interview that they had given up symptom exaggeration attained significantly higher BSI scores than those of controls, indicating that exaggeration has residual effects that are resistant to corrective feedback. We discuss cognitive dissonance as a model for understanding the residual effects of symptom exaggeration.

Swiss population-based reference data for six symptom validity tests

Symptom validity test (SVT) results should be resistant against sociodemographic variables. Healthy, cooperative respondents should be able to pass these tests. The purpose of the study was to collect reference data for a selection of SVTs (Medical Symptom Validity Test, Structured Inventory of Malingered Symptomatology, Amsterdam Short-Term Memory Test, Emotional Numbing Test, Reliable Digit Span, Maximum Span Forward). A representative population-based sample of 100 German speaking Swiss citizens from 18 to 60 years of age was investigated. Multiple regression analyses revealed that age and verbal intelligence had an effect on various SVTs, whereas sex and education did not. The rate of positive test scores ranged from 1% (Emotional Numbing Test, Structured Inventory of Malingered Symptomatology) to 4% (Maximum Span Forward). One of the pertinent questions is if such positive results in reference or normative samples represent false positives or true positives and how to deal with the problem.

Detección de exageración de síntomas mediante el SIMS y el MMPI-2-RF en pacientes diagnosticados de trastorno mixto ansioso-depresivo y adaptativo en el contexto medicolegal: un estudio preliminar

The aim of this preliminary study is to find a symptom exaggeration pattern in patients diagnosed of mixed anxiety-depressive disorder and adjustment disorder in the medico-legal context. Overall sample (n=26) was divided in two groups: bona fide patients (n=12) and suspected of malingering patients (n=14). The Spanish adaptations of the Structured Inventory of Malingered Symptomatology (SIMS) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) were administered to all participants. Regarding the SIMS scores, the best discriminant scales found between groups were Total scale, Neurological Impairment (NI), Amnesic Disorders (AM), and Affective Disorders (AF) scales. Regarding the MMPI-2-RF scores, the best discriminant validity scales were, in order, Fs, Fp-r, F-r and FBS-r, and the best discriminant substantive scales were those regarding somatic complaints (RC1, HPC, NUC, and COG), thought disorders (THD, RC8, and PSYC-r), and mood disorders (Rcd and ACT). Results support the use of both SIMS and MMPI-2-RF as a convergent source of information for the detection of symptom exaggeration in mixed anxiety-depressive disorder and adjustment disorder in the medico-legal context.

Utility of the Mild Brain Injury Atypical Symptoms Scale to detect symptom exaggeration: An analogue simulation study

Brief self-report symptom checklists are often used to screen for postconcussional disorder (PCD) and posttraumatic stress disorder (PTSD) and are highly susceptible to symptom exaggeration. This study examined the utility of the five-item Mild Brain Injury Atypical Symptoms Scale (mBIAS) designed for use with the Neurobehavioral Symptom Inventory (NSI) and the PTSD Checklist–Civilian (PCL–C). Participants were 85 Australian undergraduate students who completed a battery of self-report measures under one of three experimental conditions: control (i.e., honest responding, n = 24), feign PCD (n = 29), and feign PTSD (n = 32). Measures were the mBIAS, NSI, PCL–C, Minnesota Multiphasic Personality Inventory–2, Restructured Form (MMPI–2–RF), and the Structured Inventory of Malingered Symptomatology (SIMS). Participants instructed to feign PTSD and PCD had significantly higher scores on the mBIAS, NSI, PCL–C, and MMPI–2–RF than did controls. Few differences were found between the feign PCD and feign PTSD groups, with the exception of scores on the NSI (feign PCD > feign PTSD) and PCL–C (feign PTSD > feign PCD). Optimal cutoff scores on the mBIAS of ≥8 and ≥6 were found to reflect “probable exaggeration” (sensitivity = .34; specificity = 1.0; positive predictive power, PPP = 1.0; negative predictive power, NPP = .74) and “possible exaggeration” (sensitivity = .72; specificity = .88; PPP = .76; NPP = .85), respectively. Findings provide preliminary support for the use of the mBIAS as a tool to detect symptom exaggeration when administering the NSI and PCL–C.

Swiss population-based reference data for six symptom validity tests

Symptom validity test (SVT) results should be resistant against sociodemographic variables. Healthy, cooperative respondents should be able to pass these tests. The purpose of the study was to collect reference data for a selection of SVTs (Medical Symptom Validity Test, Structured Inventory of Malingered Symptomatology, Amsterdam Short-Term Memory Test, Emotional Numbing Test, Reliable Digit Span, Maximum Span Forward). A representative population-based sample of 100 German speaking Swiss citizens from 18 to 60 years of age was investigated. Multiple regression analyses revealed that age and verbal intelligence had an effect on various SVTs, whereas sex and education did not. The rate of positive test scores ranged from 1% (Emotional Numbing Test, Structured Inventory of Malingered Symptomatology) to 4% (Maximum Span Forward). One of the pertinent questions is if such positive results in reference or normative samples represent false positives or true positives and how to deal with the problem.