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Multicenter Study
. 2021 Nov 19;12(1):1984048.
doi: 10.1080/20008198.2021.1984048. eCollection 2021.

The utility of the Structured Inventory of Malingered Symptomatology for distinguishing individuals with Dissociative Identity Disorder (DID) from DID simulators and healthy controls

Bethany L Brand  1 , Michelle Barth  1 , Yolanda R Schlumpf  2 , Hugo Schielke  3 , Sima Chalavi  4 , Eline M Vissia  5 , Ellert R S Nijenhuis  6 , Lutz Jäncke  7 , Antje A T S Reinders  8
Affiliations
Multicenter Study

The utility of the Structured Inventory of Malingered Symptomatology for distinguishing individuals with Dissociative Identity Disorder (DID) from DID simulators and healthy controls

Bethany L Brand et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Individuals with dissociative identity disorder (DID) have complex symptoms consistent with severe traumatic reactions. Clinicians and forensic assessors are challenged by distinguishing symptom exaggeration and feigning from genuine symptoms among these individuals. This task may be aided by administering validity measures.

Objective: This study aimed to document how individuals with DID score on the Structured Inventory of Malingered Symptomatology (SIMS). The second objective was to compare coached DID simulators and healthy controls to DID patients on the SIMS's total score and subscales. The third objective was to examine the utility rates of the SIMS in distinguishing simulated DID from clinically diagnosed DID.

Method: We compared SIMS data gathered from participants from two Dutch sites, one Swiss site and one U.S. site. Sixty-three DID patients were compared to 77 coached DID simulators and 64 healthy controls on the SIMS. A multivariate analysis compared the groups on the SIMS total scores and subscales, and post-hoc Games Howell tests and univariate ANOVAs examined differences between the groups. Utility statistics assessed the accuracy of the SIMS in distinguishing clinical from simulated DID.

Results: DID simulators scored significantly higher than DID individuals and healthy controls on every SIMS subscale as well as the total score. The majority (85.7%) of the individuals with DID scored above the cut-off, which is typically interpreted as indicative of possible symptom exaggeration. DID individuals scored higher than the healthy controls on every subscale except Low Intelligence, even after controlling for dissociation. The subscales and items most frequently endorsed by the DID group are consistent with symptoms associated with complex trauma exposure and dissociative reactions. The SIMS total score had a sensitivity of 96% but an unacceptably low specificity of 14%.

Conclusions: The findings indicate that the instrument is not accurate in assessing potential symptom exaggeration or feigning in DID.

Antecedentes: Los individuos con trastorno de identidad disociativo (TID) tienen síntomas complejos consistentes con reacciones traumáticas severas. Los clínicos y evaluadores forenses se enfrentan al reto de distinguir la exageración de los síntomas y la simulación de los síntomas genuinos entre estos individuos. Esta tarea puede verse facilitada por la administración de medidas de validez.Objetivo: Este estudio tuvo como objetivo documentar la puntuación de los individuos con TID en el Inventario Estructurado de Sintomatología Simulada (SIMS). El segundo objetivo era comparar los simuladores de TID entrenados y los controles sanos con los pacientes de TID en la puntuación total y las subescalas del SIMS. El tercer objetivo fue examinar los índices de utilidad del SIMS para distinguir el TID simulado del TID diagnosticado clínicamente.Método: Se compararon los datos de la SIMS obtenidos de participantes de dos centros holandeses, un centro suizo y un centro estadounidense. Se compararon 63 pacientes de TID con 77 simuladores de TID entrenados y 64 controles sanos en el SIMS. Un análisis multivariante comparó los grupos en las puntuaciones totales y subescalas de la SIMS, y las pruebas post-hoc de Games Howell y los ANOVAs univariantes examinaron las diferencias entre los grupos. Las estadísticas de utilidad evaluaron la precisión de la SIMS para distinguir el TID clínico del simulado.Resultados: Los simuladores de TID obtuvieron puntuaciones significativamente más altas que los individuos con TID y los controles sanos en cada subescala del SIMS, así como en la puntuación total. La mayoría (85,7%) de los individuos con TID puntuaron por encima del punto de corte, que suele interpretarse como indicativo de una posible exageración de los síntomas. Los individuos con TID puntuaron más alto que los controles sanos en todas las subescalas excepto en Inteligencia baja, incluso después de controlar la disociación. Las subescalas y los ítems más frecuentemente respaldados por el grupo de TID son consistentes con los síntomas asociados con la exposición al trauma complejo y las reacciones disociativas. La puntuación total del SIMS tuvo una sensibilidad del 96% pero una especificidad inaceptablemente baja del 14%.Conclusiones: Los resultados indican que el instrumento no es preciso para evaluar la potencial exageración o simulación de los síntomas en el TID.

背景: 患有分离性身份障碍 (DID) 的个体具有与严重创伤反应一致的复杂症状。临床医生和法医评估员面临着区分这些人症状夸大和装病与真实症状的挑战。这项任务可以通过实施有效测量来帮助。目的: 本研究旨在记录 DID 患者如何在诈病症状学结构化问卷 (SIMS) 上评分。第二个目的是在 SIMS 的总分和分量表上比较训练过的 DID 模拟器和健康对照与 DID 患者。第三个目的是考查 SIMS 在区分模拟 DID 和临床诊断 DID 方面的有效性。方法: 我们比较了从两个荷兰站点, 一个瑞士站点和一个美国站点参与者中收集的 SIMS 数据。对 63 名 DID 患者与 77 名训练过的 DID 模拟器和 64 名 SIMS 方面的健康对照进行了比较。多变量分析比较了各组的 SIMS 总分和分量表, 事后Games Howell 检验和单变量方差分析考查了各组间差异。有效性统计评估了 SIMS 在区分临床和模拟 DID 方面的准确性。结果: 在每个 SIMS 分量表以及总分上, DID 模拟器的得分显著高于 DID 个体和健康对照。大多数 (85.7%) DID 个体得分高于临界值, 这通常被解释为可能的症状夸大的迹象。 DID 个体在除低智力外的每个子量表的得分都高于健康对照, 即使在控制了分离之后也如此。 DID 组最常患的分量表和条目x与复杂创伤暴露和分离反应相关症状一致。 SIMS 总分具有 96% 的敏感性, 但令人无法接受的 14% 低特异性。结论: 结果表明, 此工具在评估 DID 潜在症状夸大或装病方面并不准确。.

Keywords: SIMS; Structured Inventory of Malingered Symptomatology; dissociation; exaggeration; feigning; malingering; simulation; trauma.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
DID = dissociative identity disorder; SIM = simulators; HC = healthy controls; SIMS = Structured Inventory of Malingered Symptoms; NI = neurological impairment; AF = affective disorders; P = psychosis; LI = low intelligence; AM = Amnesia
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