Structured Inventory of Malingered Symptomatology: a Psychometric Review

The Structured Inventory of Malingered Symptomatology (SIMS) is a stand-alone symptom validity test. The 75-item, true/false measure samples feigned symptoms across five subscales: Psychosis, Neurologic Impairment, Amnestic Disorders, Low Intelligence, and Affective Disorders. Initial psychometrics reported in the manual were adequate, and since publication, dozens of studies have been published on the SIMS, with practice surveys indicating the measure as one of the most commonly used SVTs. Several SIMS short forms, alternate scales, and translations have been published. The SIMS purports to measure feigned self-reported symptoms. Several studies demonstrate convergent validity for the SIMS, as well as incremental validity when compared to clinical judgment based on interview and record review alone. Cutoff scores were quite variable across studies, but when using common cutoff scores, the SIMS does not reliably distinguish feigned psychopathology from severe manifestations of genuine psychiatric illness. This lack of robust discriminant validity means that evaluators need to consider higher SIMS cutoff scores in certain circumstances, which we describe herein. Van Impelen et al. published a meta-analysis on the SIMS in 2014; an updated diagnostic accuracy table is provided here, including new research since the prior review. We conclude by highlighting strengths, weaknesses, and areas of future exploration with the SIMS.

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The Self-Report Symptom Inventory

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

The Self-Report Symptom Inventory (SRSI): a New Instrument for the Assessment of Distorted Symptom Endorsement

Notes

By “commonly defined” we mean “malingering” as a quasi-diagnostic label (e.g., World Health Organization, 2021), and the standard dictionary definition, e.g., “to feign or produce physical or psychological symptoms to obtain financial compensation or other reward” (Oxford University Press, 2018).

2. Feigning is defined as “deliberate fabrication or gross exaggeration of psychological or physical symptoms, without any assumptions about its goals” (Rogers, 2018, p. 6). Of note, in some cases, we use terminology by original authors given the increased precision, such as participants specifically instructed to simulate malingering.

In some instances, an assessment method might be able to differentiate exaggerated from fabricated symptoms, but the SIMS has not exhibited this capability to date.

Provided the evaluator selects an appropriate cutoff score, e.g., ≤ 16 for populations where exaggeration/feigning prevalence is high (Lewis et al. 2002) or ≤ 23 if the exaggeration/feigning base rate is relatively low.

It should be noted that the SIMS manual refers to the Slick et al. (1999) criteria and best practices of using multiple sources of data when evaluating malingering.

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Funding

This work was supported by the Salisbury VA Health Care System, Mid-Atlantic (VISN 6) Mental Illness Research, Education, and Clinical Center (MIRECC) and the Department of Veterans Affairs Office of Academic Affiliations Advanced Program in Mental Illness, Research, and Treatment.

Author information

Authors and Affiliations

1. VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MA-MIRECC), Salisbury, NC, USA Robert D. Shura & Anna S. Ord
2. Research & Academic Affairs Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, NC, USA Robert D. Shura & Anna S. Ord
3. Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA Robert D. Shura & Anna S. Ord
4. Health West, Inc. (Federally Qualified Health Center), Pocatello, ID, USA Mark D. Worthen
5. Regent University, VA Beach, USA Anna S. Ord

1. Robert D. Shura