Psychology Department, Towson University, Towson, United States.
Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland.
Eur J Psychotraumatol. 2021 Nov 19;12(1):1984048. doi: 10.1080/20008198.2021.1984048. eCollection 2021.
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.
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.
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.
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%.
The findings indicate that the instrument is not accurate in assessing potential symptom exaggeration or feigning in DID.
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个体的症状夸大和佯装与真实症状的挑战。执行有效性测量可能会对此有所帮助。
本研究旨在记录 DID 个体在伪装症状量表（SIMS）上的得分情况。第二个目的是将有指导的 DID 模拟者与健康对照组与 SIMS 的总分和子量表上的 DID 患者进行比较。第三个目的是检查 SIMS 在区分模拟 DID 与临床诊断 DID 方面的效用率。
我们比较了来自荷兰两个地点、一个瑞士地点和一个美国地点的参与者的 SIMS 数据。将 63 名 DID 患者与 77 名有指导的 DID 模拟者和 64 名健康对照组在 SIMS 上进行比较。多变量分析比较了各组在 SIMS 总分和子量表上的得分情况，随后进行 Games Howell 检验和单因素方差分析，以检验各组之间的差异。效用统计评估了 SIMS 在区分临床与模拟 DID 方面的准确性。
DID 模拟者在 SIMS 的每个子量表以及总分上的得分均显著高于 DID 个体和健康对照组。大多数（85.7%）DID 个体的得分超过了临界值，这通常被解释为可能存在症状夸大。即使控制了分离，DID 个体在除了低智商外的每个子量表上的得分都高于健康对照组。DID 组最常认可的子量表和项目与复杂创伤暴露和分离反应相关的症状一致。SIMS 总分的敏感性为 96%，但特异性为 14%，低得不可接受。
这些发现表明，该工具在评估 DID 中潜在的症状夸大或佯装方面并不准确。
