Deceptive Clinical Diagnosing of Malingering via Structured Inventory of Malingered Symptomatology

Abstract

This article provides illustrative case histories of patients with legitimate neuropsychological symptoms after their motor vehicle accidents (MVAs) who had been rejected as malingerers by the psychologist contracted by the car insurance company. The psychologist ignored the physical facts of the MVA (such as repeated major impacts) to instead blindly rely on the patient’s scores on the Structured Inventory of Malingered Symptomatology (SIMS). The SIMS was never properly validated on patients with neuropsychological symptoms such as the post-concussion syndrome or on patients with well documented causes of chronic pain: the test has scientifically very inept rates of false positives, i.e., of patients with legitimate symptoms falsely classified as malingerers. The SIMS contains many items inquiring about impaired sleep, depressive feelings, impaired memory or concentration, and other typical post-MVA neuropsychological symptoms such as tinnitus or impaired balance. That is, these items describe what is clinically known to be legitimate typical post-MVA symptoms: in an absurd manner, the endorsement of these SIMS items counts as “malingering” and alone causes the post-MVA patients to accumulate a score above the SIMS cut-off point of > 14, thus misclassifying them as malingerers. The more of these symptoms are experienced by the patient, the more likely is he or she to be classified as a malingerer.