SIMS: Symptom Simulation Test

Some people try to deceive the psychologist based on simulating symptoms so that the professional can issue a diagnosis that interests them. We are talking about a serious problem, in front of which psychologists are often helpless: the performance of this professional depends on the patient’s honesty. So what can psychologists do to avoid being deceived?

Lying can become an art. Therefore, its identification is a real challenge for specialists. Thus, specific measurement instruments are needed to unmask these “fictitious” patients. 

In this sense, and with the objective of detecting patterns of faking and exaggeration of symptoms, the Structured Symptom Simulation Inventory (SIMS) was developed. Thanks to it, it is possible to contrast the simulation hypothesis and increase the reliability, validity and accuracy of the psychological assessment.

Credibility of symptoms

It is the psychologist’s responsibility to judge the accuracy and reliability of any source that might influence the outcome of the assessment and, where possible, corroborate the information. Thus, it is necessary to consider the possibility that the patient is in the field of deception. Sometimes family and friends can be more reliable than the patient, especially in cases involving anosognosia.

The problem: the symptoms or the testimonies given by these people cannot be the object of much research, even if only because of the amount of resources it would require. Therefore, one should choose to explore what can be analyzed: the patient’s symptoms, observations and clinical picture. Thus, it would be possible to determine, according to scientific and diagnostic criteria, the possible feigning of the disease.

What is SIMS?

The purpose of SIMS is to detect the simulation of psychopathological and neuropsychological symptoms. It is an analysis instrument consisting of 75 dichotomous response items (true or false). In addition, it consists of 5 scales of 15 items each:

• Psychosis.  Unusual or extravagant psychotic symptoms, atypical of real pathology. His area of ​​search for symptom simulation is psychopathological. “I think the government installed cameras at traffic lights to spy on me.” “There’s nothing I can do that has any effect on the voices I hear other than taking the medications.”
• Neurological deterioration.  Illogical or very atypical neurological type symptoms. Your area of ​​search for symptom simulation is physics. “For me, walking is very difficult due to the balance problems I have.”

• Amnestic disorders.  Symptoms related to memory disorders. For example, “My biggest problem is my memory” or “I have trouble remembering the days of the week”. His area of ​​search for symptom simulation is cognitive.
• Low intelligence.  Exaggeration of intellectual deficit through errors on general knowledge questions. Like the previous one, its symptom simulation search area is cognitive. “Italy’s capital is Hungary” or “A week has six days”.
• Affective disorders.  Unusual symptoms of depression and anxiety. His area of ​​search for symptom simulation is psychopathological. For example, “I rarely laugh” or “I cry very rarely ”.

To establish or not the simulation, there are critical points on each scale. Thus, the score in each of them allows detecting the symptomatology that presents itself in an atypical way; or how the analyzed person tries to distort a specific disorder. This allows knowing both the degree of suspicion of simulation and the areas in which it appears.

Application time

Its application time is very fast, varying between 10 and 15 minutes. Thanks to this, it can be used as a test to identify clinical signs quickly and effectively; or as part of a more extensive, complete and exhaustive test battery. Furthermore, it can be applied in different contexts and adapts to different conditions and needs of a clinical, labor, medico-legal and/or forensic nature.

Who uses symptom simulation?

Symptom simulation is most common in individuals involved in a criminal investigation or civil litigation, as well as in the process of claims of disability insurance or worker compensation. However, this test is also useful for detecting shoplifters who pretend to be kleptomaniacs to avoid prosecution or use as a mitigating factor in judgment.

Symptom simulation is technically not a psychiatric illness. In any case, the ideal is to record in the report when the person has consciously and voluntarily tried to deceive the examiner in the application of measures such as the Structured Symptom Simulation Inventory.