Indicators to distinguish symptom accentuators from symptom producers in individuals with a diagnosed adjustment disorder: A pilot study on inconsistency subtypes using SIMS and MMPI-2-RF

Autoři: Cristina Mazza aff001;  Graziella Orrù aff002;  Franco Burla aff001;  Merylin Monaro aff003;  Stefano Ferracuti aff001;  Marco Colasanti aff001;  Paolo Roma aff001
Působiště autorů: Department of Human Neuroscience, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy aff001;  Department of Surgical, Medical, Molecular & Critical Area Pathology, University of Pisa, Pisa, Italy aff002;  Department of General Psychology, University of Padova, Padova, Italy aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


In the context of legal damage evaluations, evaluees may exaggerate or simulate symptoms in an attempt to obtain greater economic compensation. To date, practitioners and researchers have focused on detecting malingering behavior as an exclusively unitary construct. However, we argue that there are two types of inconsistent behavior that speak to possible malingering—accentuating (i.e., exaggerating symptoms that are actually experienced) and simulating (i.e., fabricating symptoms entirely)—each with its own unique attributes; thus, it is necessary to distinguish between them. The aim of the present study was to identify objective indicators to differentiate symptom accentuators from symptom producers and consistent participants. We analyzed the Structured Inventory of Malingered Symptomatology scales and the Minnesota Multiphasic Personality Inventory-2 Restructured Form validity scales of 132 individuals with a diagnosed adjustment disorder with mixed anxiety and depressed mood who had undergone assessment for psychiatric/psychological damage. The results indicated that the SIMS Total Score, Neurologic Impairment and Low Intelligence scales and the MMPI-2-RF Infrequent Responses (F-r) and Response Bias (RBS) scales successfully discriminated among symptom accentuators, symptom producers, and consistent participants. Machine learning analysis was used to identify the most efficient parameter for classifying these three groups, recognizing the SIMS Total Score as the best indicator.

Klíčová slova:

Anxiety – Cognitive impairment – Depression – Emotions – Mental health and psychiatry – Personality – Psychometrics – Psychological adjustment


1. Capri P, Giannini A, Torbidone E, Del Vecchio S, Iecher F, Cesari G, et al. Linee guida per l'accertamento e la valutazione psicologico-giuridica del danno alla persona. Ordine degli Psicologi del Lazio. 2012

2. Cimino L, Vasapollo D. Considerazioni in merito all’uso dei test mentali nella quantificazione del danno biologico di natura psichica. Rivista di Criminologia, Vittimologia e Sicurezza. 2009;3: 49–59.

3. American Psychiatric Association. Diagnostic and statistical manual of mental disorder, 5th edition. 2013.

4. Mittenberg W, Patton C, Canyock EM, Condit DC. Base rates of malingering and symptom exaggeration. J Clin Exp Neuropsychol. 2002;24: 1094–1102. doi: 10.1076/jcen.24.8.1094.8379 12650234

5. Santamaría P, Ramírez PC, Ordi HG. Prevalencia de simulación en incapacidad temporal: Percepción de los profesionales de la salud. Clin Salud. 2013;24: 139–151.

6. Sartori G, Zangrossi A, Orrù G, Monaro M. Detection of malingering in psychic damage ascertainment. In: Ferrara S, editor. P5 medicine and justice. Springer. doi: 10.1007/978-3-319-67092-8_21 (2017)

7. Chafetz M, Underhill J. Estimated costs of malingered disability. Arch Clin Neuropsychol. 2013;28: 633–639. doi: 10.1093/arclin/act038 23800432

8. Knoll J, Resnick PJ. The detection of malingered post-traumatic stress disorder. Psychiatr. Clin. North Am. 2006;29: 629–647. doi: 10.1016/j.psc.2006.04.001 16904503

9. Young G. Resource material for ethical psychological assessment of symptom and performance validity, including malingering. Psychological Injury and Law. 2014;7(3): 206–235.

10. Rogers R, Bender S D. Clinical assessment of malingering and deception. 4th ed. Guilford Publications; 2018

11. Lipman FD. Malingering in personal injury cases. Temple L Rev. 1962;35: 141–162.

12. Resnick PJ. The malingering of posttraumatic disorders. In: Rogers R, editor. Clinical assessment of malingering and deception, second edition. New York, NY: Guildford Press; 1997. pp. 84–103.

13. Halligan PW, Bass C, Oakley DA (Eds.). Malingering and illness deception. New York, NY: Oxford University Press; 2003.

14. Rogers R. (1992). Structured interview of reported symptoms. Odessa, FL: Psychological Assessment Resources.

15. Rogers R., Bagby R. M., & Dickens S. E. (1992). Structured interview of reported symptoms (SIRS) and professional manual. Odessa, FL: Psychological Assessment Resources.

16. Rogers R, Sewell KW, Gillard ND. Structured Interview of Reported Symptoms (2nd ed.). Odessa, FL: Psychological Assessment Resources; 2010.

17. Green D, Rosenfeld B. Evaluating the gold standard: a review and meta- analysis of the structured interview of reported symptoms. Psychological Assessment. 2011; 23: 95–107. doi: 10.1037/a0021149 21381842

18. Rogers R, Gillis J R, & Bagby R M. The SIRS as a measure of malingering: A validation study with a correctional sample. Behavioral Sciences and the Law. 1990; 8: 85–92.

19. Green D, Rosenfeld B, Belfi B. New and improved? A comparison of the original and revised versions of the Structured Interview of Reported Symptoms. Assessment. 2013; 20: 210–218. doi: 10.1177/1073191112464389 23242218

20. Tombaugh TN. Test of Memory Malingering (TOMM). New York, NY: Multi Health Systems; 1996.

21. Rees LM, Tombaugh TN, Gansler DA, Moczynski NP. Five validation experiments of the Test of Memory Malingering (TOMM). Psychol. Assess. 1998,10:10–20

22. Viglione DJ, Giromini L, Landis P. The development of the Inventory of Problems–29: A brief self-administered measure for discriminating bona fide from feigned psychiatric and cognitive complaints. J Pers Assess. 2017;99: 534–544. doi: 10.1080/00223891.2016.1233882 27767344

23. Giromini L, Viglione DJ, Pignolo C, Zennaro A. A Clinical Comparison, Simulation Study Testing the Validity of SIMS and IOP-29 with an Italian Sample. Psychological Injury and Law. 2018, 11: 340–350.

24. Roma P, Giromini L, Burla F, Ferracuti S, Viglione DJ, & Mazza C. Ecological Validity of the Inventory of Problems-29 (IOP-29): an Italian Study of Court-Ordered, Psychological Injury Evaluations Using the Structured Inventory of Malingered Symptomatology (SIMS) as Criterion Variable. Psychol. Inj. and Law. 2019; 1–9.

25. Giromini L, Barbosa F, Coga G, Azeredo A, Viglione DJ, Zennaro A. Using the inventory of problems– 29 (IOP-29) with the Test of Memory Malingering (TOMM) in symptom validity assessment: A study with a Portuguese sample of experimental feigners. Applied Neuropsychology: Adult. 2019, 1–13. doi: 10.1080/23279095.2019.1570929 30773041

26. Smith GP, Burger GK. Detection of malingering: Validation of the Structured Inventory of Malingered Symptoms (SIMS). J Am Acad Psychiatry Law. 1997;25: 183–189. 9213290

27. Edens JF, Otto RK, Dwyer T. Utility of the Structured lnventory of Malingered Symptomatology in identifying persons motivated to malinger psychopathology. J Am Acad Psychiatry Law. 1999;27: 387–396. 10509938

28. Rogers R, Jackson RL, Kaminski PL. Factitious psychological disorders: The overlooked response style in forensic evaluations. J Forensic Psychol Pract. 2005;5: 21–41.

29. Jelicic M, Hessels A, Merckelebach H. Detection of feigned psychosis with the Structured Inventory of Malingered Symptomatology (SIMS): A study of coached and uncoached simulators. J Psychopathol Behav Assess. 2006;8: 19–22.

30. Edens JF, Campbell JS, Weir JM. Youth psychopathy and criminal recidivism: A meta-analysis of the psychopathy checklist measures. Law Hum Behav. 2007;31: 53–75. doi: 10.1007/s10979-006-9019-y 17019617

31. Poythress NG, Edens JF, Watkins MM. The relationship between psychopathic personality features and malingering symptoms of major mental illness. Law Hum Behav. 2001;25: 567–582. doi: 10.1023/a:1012702223004 11771635

32. Heinze MC, Purisch AD. Beneath the mask: Use of psychological tests to detect and subtype malingering in criminal defendants. J Forensic Psychol Pract. 2001;1: 23–52.

33. Clegg C, Fremouw W, Mogge N. Utility of the Structured Inventory of Malingered Symptomatology (SIMS) and the Assessment of Depression Inventory (ADI) in screening for malingering among outpatients seeking to claim disability. J Forens Psychiatry Psychol. 2009;20: 239–254.

34. Ben-Porath YS, Tellegen A. The Minnesota Multiphasic Personality Inventory–2 Restructured Form: Manual for administration, scoring, and interpretation. Minneapolis, MN: University of Minnesota Press; 2008.

35. Sharf AJ, Rogers R, Williams MM, Henry SA. The Effectiveness of the MMPI-2-RF in Detecting Feigned Mental Disorders and Cognitive Deficits: a MetaAnalysis. Journal of Psychopathology and Behavioral Assessment. 2017; 39: 441–455.

36. Monaro M, Gamberini L, Zecchinato F, Sartori G. False identity detection using complex sentences. Front Psychol. 2018;9: 283. doi: 10.3389/fpsyg.2018.00283 29559945

37. Monaro M, Toncini A, Ferracuti S, Tessari G, Vaccaro MG, De Fazio P, et al. The detection of malingering: A new tool to identify made-up depression. Front Psychiatry. 2018;9: 249. doi: 10.3389/fpsyt.2018.00249 29937740

38. Mazza C, Monaro M, Orrù G, Burla F, Colasanti M, Ferracuti S and Roma P. Introducing machine learning to detect personality faking-good in a male sample: A new model based on Minnesota Multiphasic Personality Inventory-2 restructured form scales and reaction times. Front. Psychiatry. 2019;10: 389. doi: 10.3389/fpsyt.2019.00389 31275176

39. Widows MR, Smith GP. Structured Inventory of Malingered Symptomatology. Odessa, FL: Psychological Assessment Resources; 2005.

40. van Impelen A, Merckelbach H, Jelicic M, Merten T. The Structured Inventory of Malingered Symptomatology (SIMS): A systematic review and meta-analysis. Clin Neuropsychol. 2014;28: 1336–1365. doi: 10.1080/13854046.2014.984763 25494444

41. Wisdom NM, Callahan JL, Shaw TG. Diagnostic utility of the Structured Inventory of Malingered Symptomatology to detect malingering in a forensic sample. Arch Clin Neuropsychol. 2010;25: 118–125. doi: 10.1093/arclin/acp110 20110279

42. La Marca S, Rigoni D, Sartori G, Lo Priore C. Structured Inventory of Malingered Symptomatology (SIMS): manuale. Adattamento italiano. Firenze: Giunti O.S.; 2011.

43. Tellegen A, Ben-Porath YS, McNulty JL, Arbisi PA, Graham JR, Kaemmer B. The MMPI–2 Restructured Clinical (RC) scales: Development, validation and interpretation. Minneapolis: University of Minnesota Press. 2003

44. Sirigatti S, Faravelli C. MMPI-2 RF: Adattamento italiano. Taratura, proprietà psicometriche e correlati empirici. Firenze: Giunti O.S.; 2012.

45. Scheffé H. Analysis of variance. London: John Wiley & Sons; 1959.

46. Pierce CA, Block RA, Aguinis H. Cautionary note on reporting eta-squared values from multifactor ANOVA designs. Educ Psychol Meas. 2004;64: 916–924.

47. Hall M, Frank E, Holmes G, Pfahringer B, Reutemann P, Witten I. The WEKA data mining software: An update. SIGKDD Explor Newsl. 2009;11: 10–18.

48. Baker M. Reproducibility: Seek out stronger science. Nature. 2016;537: 703–704.

49. Browne MW. Cross-validation methods. J Math Psychol. 2000;44: 108–132. doi: 10.1006/jmps.1999.1279 10733860

50. Szucs D, Ioannidis JPA. Empirical assessment of published effect sizes and power in the recent cognitive neuroscience and psychology literature. PLoS Biol. 2017;15(3).

51. Cumming G. Replication and p intervals: p values predict the future only vaguely, but confidence intervals do much better. Perspect Psychol Sci. 2008;3: 286–300. doi: 10.1111/j.1745-6924.2008.00079.x 26158948

52. Bokhari E, Hubert L. The lack of cross-validation can lead to inflated results and spurious conclusions: A re-analysis of the MacArthur violence risk assessment study. J Classif. 2018;35: 147–171.

53. Pace G, Orrù G, Monaro M, Gnoato F, Vitaliani R, Boone KB, Gemignani A, Sartori G. Malingering detection of cognitive impairment with the b test is boosted using machine learning. Front. Psychol. 2019;10: 1650. doi: 10.3389/fpsyg.2019.01650 31396127

54. Boone KB, Lu P, Herzberg D. The b-test manual. Los Angeles: Western Psychological Service. 2002.

55. Hall MA. Correlation-based Feature Selection for Machine Learning. The University of Waikato, Hamilton, 1999.

56. Bouckaert RR, Frank E, Hall M, Kirkby R, Reutemann P, Seewald A, et al. WEKA manual for version 3-7-8; 2013.

57. Holte RC. Very simple classification rules perform well on most commonly used datasets. Mach Learn. 1993;11: 63–90.

58. Paulhus DL. Socially desirable responding: The evolution of a construct. In: Braun HI, Jackson DN, Wiley DE, editors. The role of constructs in psychological and educational measurement. Mahwah, NJ: Lawrence Erlbaum; 2002. pp. 49–69.

59. Benge JF, Wisdom NM, Collins RL, Franks R, Lemaire A, Chen DK. Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events. Epilepsy Behav. 2012;24: 439–444. doi: 10.1016/j.yebeh.2012.05.007 22683287

60. Giger P, Merten T, Merckelbach H, Oswald M. Detection of feigned crime-related amnesia: A multi–method approach. J Forensic Psychol Pract. 2010;10: 440–463.

61. Widder B. Beurteilung der beschwerdenvalidität. In: Widder B, Gaidzik PW, editors. Begutachtung in der neurologie (2nd. ed.). Stuttgart: Thieme; 2011. pp. 64–92.

62. Sellbom M, Bagby MR. Detection of overreported psychopathology with the MMPI-2-RF form validity scales. Psychol Assess. 2010;22: 757–767. doi: 10.1037/a0020825 21133544

63. Wygant DB, Ben-Porath YS, Arbisi PA. Development and initial validation of a scale to detect infrequent somatic complaints. Poster session presented at the 39th Annual Symposium on Recent Developments of the MMPI–2/MMPI–A, Minneapolis, MN. 2004 (May).

64. Wygant DB, Anderson JL, Sellbom M, Rapier JL, Allgeier LM, Granacher RP. Association of the MMPI–2 restructured form (MMPI–2–RF) validity scales with structured malingering criteria. Psychol Inj Law. 2011;4: 13–23.

65. Rogers R. Clinical assessment of malingering and deception (3rd ed.). New York, NY: Guilford Press; 2008.

66. Wygant DB, Ben-Porath YS, Arbisi PA, Berry DTR, Freeman DB, Heilbronner RL. Examination of the MMPI–2 Restructured Form (MMPI–2-RF) validity scales in civil forensic settings: Findings from simulation and known-group samples. Arch Clin Neuropsychol. 2009;24: 671–680. doi: 10.1093/arclin/acp073 19797242

67. Ben-Porath YS. Interpreting the MMPI-2-RF. University of Minnesota Press; 2012, 245–250.

68. Ben-Porath YS, Tellegen A. MMPI-2-RF Manuale di istruzioni. Adattamento italiano a cura di Sirigatti, S., & Casale, S. (2012), Giunti OS, Firenze; 2011, 49–56.

69. Wygant DB, Sellbom M, Gervais RO, Ben-Porath YS, Stafford KP, Freeman DB, et al. Further validation of the MMPI-2 and MMPI-2-RF response bias scale: Findings from disability and criminal forensic settings. Psychol Assess. 2010;22: 745–756. doi: 10.1037/a0020042 20919770

70. Gervais RO, Ben-Porath YS, Wygant DB, Sellbom M. Incremental validity of the MMPI-2-RF over-reporting scales and RBS in assessing the veracity of memory complaints. Arch Clin Neuropsychol. 2010;25: 274–284. doi: 10.1093/arclin/acq018 20335183

71. Roma P, Verrocchio MC, Mazza C, Marchetti D, Burla F, Cinti ME, et al. Could time detect a faking-good attitude? A study with the MMPI-2-RF. Front. Psychol. 2018;9: 1064. doi: 10.3389/fpsyg.2018.01064 30090076

72. Roma P, Mazza C, Mammarella S, Mantovani B, Mandarelli G, Ferracuti S. Faking-good behavior in self-favorable scales of the MMPI-2. Eur J Psychol Assess. 2019; 1–9.

73. Roma P, Mazza C, Ferracuti G, Cinti ME, Ferracuti S, Burla F. Drinking and driving relapse: Data from BAC and MMPI-2. PLoS ONE. 2019;14: 1. doi: 10.1371/journal.pone.0209116 30601844

74. Mazza C, Burla F, Verrocchio MC, Marchetti D, Di Domenico A, Ferracuti S, Roma P. MMPI-2-RF Profiles in Child Custody Litigants. Front. Psychiatry. 2019;10.

75. Burla F, Mazza C, Cosmo C, Barchielli B, Marchetti D, Verrocchio MC, & Roma P. Use of the Parents Preference Test in Child Custody Evaluations: Preliminary Development of Conforming Parenting Index. Mediterranean Journal of Clinical Psychology. 2019;7(3).

76. Roma P, Piccinni E, Ferracuti S. Using MMPI-2 in forensic assessment. Rassegna Italiana di Criminologia. 2016;10(2): 116–122.

77. Roma P, Pazzelli F, Pompili M, Girardi P, Ferracuti S. Shibari: double hanging during consensual sexual asphyxia. Archives of Sexual Behavior. 2013;42(5): 895–900. doi: 10.1007/s10508-012-0035-3 23187701

78. Roma P, Ricci F, Kotzalidis GD, et al. MMPI-2 in child custody litigation: A comparison between genders. Eur J Psychol Assess. 2014;30(2): 110–116. doi: 10.1027/1015-5759/a000192

79. Verrocchio MC, Marchetti D, Roma P, Ferracuti S. Relational and psychological features of high-conflict couples who engaged in parental alienation. Ricerche di Psicologia. 2018;41(4): 679–692.

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