SIMS: Symptom Simulation Test

Some people try to fool the psychologist by simulating symptoms. This is so that they work out the diagnosis they want. We are talking about a serious problem, in the face of which psychologists are often helpless. They rely on the patient’s honesty, but sometimes that’s not enough. What can they do then?

The deception can present itself as a true work of art, so identifying it is a real challenge for specialists. Therefore, specific evaluation tools are needed to be able to unmask these “fake” patients. 

In order to identify patterns of falsification and exaggeration of symptoms, the SIMS, acronym for Structured Inventory of Malingered Symptomatology, was developed. Thanks to it, it is possible to refute the simulation hypothesis and strengthen the reliability, validity and accuracy of the psychological assessment. 

Credibility of the symptoms

It is the responsibility of the psychologist to judge the accuracy and reliability of any source that may affect the result of the evaluation and, when possible, to confirm the information.

He must therefore evaluate the hypothesis that the patient who requested his opinion is moving into the terrain of deception. Sometimes family and friends can be more reliable than the patient himself, especially in the case of anosognosia.

Symptoms or patient statements in these cases cannot be thoroughly researched, as it would require a huge amount of resources.

Therefore, we opt to explore what can be analyzed: the symptoms, the results and the clinical picture of the patient. In this way, it will be possible to determine the possible simulation of the disease according to scientific and diagnostic criteria.

What is the SIMS questionnaire

The purpose of the SIMS is to identify the simulation of psychopathological and neuropsychological symptoms. It is an evaluation tool made up of 75 dichotomous (true or false) statements. It consists of 5 areas, each consisting of 15 statements:

• Psychosis. Unusual or extravagant psychotic symptoms, atypical in real pathology. His sphere of control of symptom simulation is the psychopathological realm. “I believe the government has installed cameras on traffic lights to spy on me.” “There is nothing that affects the voices I hear, except the drugs.”

• Neurological deterioration. Illogical or particularly atypical neurological symptoms. His symptom control area is the physical one. “ Walking is difficult for me due to my balance problems”.

Other areas of symptom simulation

• Disorders of amnesia. Symptoms associated with memory problems. For example, “the biggest problem I have is my memory” or “I have difficulty remembering the day of the week”. His area of ​​control of symptom simulation is the cognitive sphere.

• Poor intelligence. Exaggeration of the intellectual deficit through incorrect answers to general questions. As for the previous point, the control scope of symptom simulation is the cognitive one. “ The capital of Italy is Hungary” or “a week consists of 6 days”.

• Affective disorders. Atypical symptoms of anxiety and depression. The control area of ​​symptom simulation is the psychopathological one. For example, “I rarely laugh” or “I cry very little”.

To determine if it is a simulation case, each stair has breaking points. Thus, the score obtained in each one allows to identify the symptomatology that presents itself in an atypical way; or how the assessed patient is trying to simulate a particular disorder. This allows us to know both to what extent the simulation is suspected and the areas in which it occurs. 

Duration of the symptom simulation test

It is short-lived, lasting about fifteen minutes. Thanks to this, it can be applied as a screening or detection of critical signals quickly and effectively; or as part of a wider, more complete and comprehensive diagnostic system.

It is possible to use it in different contexts and it adapts to different conditions and needs of a clinical, working, medico-legal and / or forensic nature. 

Who simulates the symptoms?

Simulation of symptoms is more common in individuals involved in a criminal investigation or civil dispute. It also happens when you apply for a disability or unemployment pension.

The SIMS test, however, is also useful for identifying shoplifters who pretend to be kleptomaniacs to avoid prosecution or use the disorder as an extenuating circumstance in court.

Symptom simulation is not technically a psychiatric illness. However, an up-to-date log should be kept of the situation when a patient has consciously and voluntarily tried to deceive the psychotherapist after the application of measurement tools such as the structured symptom simulation inventory.