FAKING SPECIFIC DISORDERS: A STUDY OF

THE STRUCTURED INTERVIEW OF REPORTED SYMPTOMS (SIRS)

RICHARD ROOERS P. RANDALL KROPP
University of North Texas Clarke Institute of Psychiatry

R . MICHAEL BAGBY AND SUSAN E . DICKENS

Clarke Institute of Psychialry
University of Toronto

An untested assumption of malingering research is that persons who feign

mental illness will not attempt to fake a particular disorder, but will be con-
tent to fabricate non-specific and possibly global psychiatric impairment.
We tested the effectiveness of the Structured Interview of Reported Symp-
toms (SIRS)t o detect feigning of three diagnostic groupings: schizophrenia,
mood disorders, and PTSD on 45 psychologically knowledgeable correc-
tional residents. We found that the SIRS maintained its powers of discrimina-
tion with respect to clinical samples. Similar research on faking specific
disorders is needed on the MMPI-2and other psychological measures.

Greene (1988) observed that a critical assumption of malingering research is that

individuals will feign general psychological impairment rather than specific disorders.
In this vein, simulation studies of malingering (see Rogers, 1987, 1988) typically present
subjects with non-specific instructions to fake a mental illness and may or may not create
particular scenarios (e.g., workmen’s compensation or special consideration for failing
grades). Because clinical practice is informed by malingering studies, a crucial research
question is whether malingerers who fake a specific disorder are detectable.
MMPI research by Petersen and Viglione (1991) calls into question the detectability
of feigned disorders. They asked subjects (professionals from different fields and graduate
psychology students) to fake one of the following: chronic psychotic disorder, depres-
sion, or an acute anxiety reaction. Although common validity indices were effective in
the identification of the simulated psychotic disorders, none was successful in the assess-
ment of feigned depression, and only the DS-R (Dissimulation Scale-Revised; Gough,
1954, 1957) proved useful with acute reactions.
A recent development in the assessment of malingering and related response styles
is the Structured Interview of Reported Symptoms (SIRS; Rogers, 1986). Validational
research (Rogers, Gillis, Dickens, & Bagby, 1991) has demonstrated its discriminability
when both simulation and known-groups designs were employed. Other studies suggest
that the SIRS may be relatively robust and effective with correctional populations (Rogers,
Gillis, & Bagby, 1990) as well as with subjects who are informed about its detection
strategies (Rogers, Gillis, Bagby, & Montneiro, in press).
The current study investigated the ability of correctional subjects to fake specific
disorders during an administration of the SIRS. The feigning of three diagnostic groups
(i.e., schizophrenia, mood disorders, and post-traumatic stress disorder) was examin-
ed. Schizophrenia and mood disorders were selected because they are commonly known
disorders that are prevalent in bona fide patients (Kaplan & Sadock, 1988). Post-traumatic

This study was supported in part by a grant from the Ontario Law Foundation. We would like to thank
the residents and staff of the Ontario Correctional Institute for their participation and kind assistance in this
research.
Correspondence should be addressed to Richard Rogers, Department of Psychology, University of North
Texas, Denton, TX 76203-3587.

643
644 Journal of Clinical Psychology, September 1992, Vol. 48, No. 5

stress disorder (PTSD) was chosen because the genuineness of this diagnostic category
frequently is called into question in civil litigation. (See Lees-Haley, 1989; Resnick, 1988).
To assist subjects in their preparation, they were given descriptions of their particular
disorders from the appropriate sections of DSM-III-R (American Psychiatric Associa-
tion, 1987).

METHOD
Subjects
Subjects for the simulation conditions were drawn from the Ontario Correctional
Institute (OCI), a provincial facility that offers a wide range of psychological services.
All residents are required to complete a standard assessment that included interviews
and psychological testing. In addition, most are involved in some combination of counsel-
ing, group therapy, and psychoeducational discussion groups. Because of these clinical
experiences, we considered the subjects to be psychologically knowledgeable.
OCI subjects were 45 males with a mean age of 29.8 (SD = 7.9) and an average
of 10.6 years (SD = 2.8) of education. With respect to racial background, OCI sub-
jects are composed of 37 (82.2%) White, 2 (6.7%) Native Canadian, 1 (2.2%) Black,
1 (2.2%) Hispanic, and 3 (6.7%) on whom information was not provided.
For comparison purposes, a psychiatric sample (n = 15) was solicited from
METFORS, a forensic clinic that provides consultation to the criminal courts. This
sample was comprised of 15 male psychiatric patients with a mean age of 35.6 (SD =
7.1) and 10.8 years (SD = 2.8) of education. Racial background was composed of 11
(73.3%) White and 1 each (6.7%) Asian, Black, Hispanic, and Native Canadian sub-
jects. Common diagnoses were schizophrenic disorders (8 or 53.3%), mood disorders
(3 or 20.0%), alcohol (1 or 6.7%), and Axis I1 disorders (3 or 20.0%).
Procedure
The OCI subjects were given a written explanation of the nature of the study; we
obtained informed consent from those who volunteered. OCI subjects were assigned
randomly to one of three experimental conditions (i.e., simulation of a schizophrenia,
mood disorders, or PTSD).Subjects also received the relevant portions of the DSM-III-R for
their particular disorder in order to inform themselves about the disorder they were asked
to simulate (i.e., schizophrenic, pp. 187-195; mood, pp. 213-226; post-traumatic, pp.
247-251). Subjects also were provided with preparation time (minimum of 45 minutes,
but generally 2 to 4 hours). All subjects were given $5.00 for their participation in the
study and were offered an additional $5.00 incentive for a convincing presentation.' They
were instructed not to disclose their experimental condition to the interviewer, who re-
mained blind to their experimental condition.
Psychiatric patients were selected randomly and administered the SIRS as part of
their psychological assessment. They were given instructions to answer honestly during
the structured interview.
The two interviewers for the study were a clinical psychologist and doctoral intern,
both trained in the use of the SIRS. Although the reliability of the SIRS scales appears
to be very satisfactory (Mr = .96; Rogers et al., 1991), the two interviewers conducted
a further check of interrater reliability on 10 METFORS inpatients.
The interviews were blind to the experimental condition, which was disclosed dur-
ing the debriefing. After the debriefing, interviewers conducted a brief interview about
the presence of antisocial personality disorder (APD) for use in supplementary analysis.

'In reality, the incentive was given to all participants except one subject who readily admitted that he
had not followed the instructions and had answered honestly. He was excluded from the study.
 Faking Specific Disorders 645

REsu LTs

Estimates of interrater reliability were consistent with previous research (Rogers

et al., 1991). We found uniformly high reliabilities for SIRS scales with a M r of .98
and a range of .92 to .loo.
The discriminability of the SIRS scales was examined through a series of ANOVAs
with Duncan’s multiple range tests (alpha = .05). As reported in Table 1, SIRS scales
(i.e., Defensive Symptoms [DS], Rare Symptoms [RS], Improbable and Absurd Symp-
toms [IA], Symptom Combinations [SC], Blatant Symptoms [BL], Subtle Symptoms
[SU] Selectivity of Symptoms [SEL], Severity of Symptoms [SEV], and Reported vs.
Observed Symptoms [RO]) evidenced highly si nificant differences between all the groups
of simulators and bonafide patients with eta4 2 .30.The Symptom Onset (SO) scale
proved unsuccessful at differentiating among groups. In addition, subjects who feigned
PTSD were indistinguishable from inpatients on Overly Specified Symptoms (0s)and
Inconsistency of Symptoms (INC) and scored lower than other simulators on RO. Sub-
jects who simulated schizophrenic disorders scored higher than other simulators on the
RS and IA scales, both of which contain high proportions of psychotic symptoms.

Table 1
SIRS DGtferences among Simulators WhoAre Feigning Specific Disorders and Psychiatric Inpatients

Simulation of specific disorders

SIRS scales Schizophrenic Mood PTSD Inpatients F eta2

DA 6.40. 6.20. 5.53. 2.13b 3.41* .I5

DS 29.80. 29.93. 3 1. m a 18.20b 8.04*** .30
RS 10.40. 6.20b 5.47b 1.60, 14.66*** .44
IA 6.93. 3.4& 3.43b .67, 8.59*** .32
sc 8.33. 5.80. 6.0Os 1.27b 9.40*** .33
0s 3.93. 3.00, 2.07.b .67b 3.49. .16
so 3.27, 3.07. 2.93. 2.20, 1.73 .08
BL 16.87, 12.60. 14.07, 3.87b 14.22*** .43
su 17.53. 16.53n 18.07. 3.53b 20.90*** .53
SEL 19.67, 16.87, 18.00. 5.35b 22.25*** .54
SEV 14.73. 12.21. 14.13, 1.87b 18.91*** .50
INC 8.47. 7.00. 5.67.1, 2.80b 4.96** .21
RO 8.47, 6.20.b 4.93b 1.27, 9.go*** .35

Note. -Scales are scored, with the exception of DS, so that higher elevations are indicative of malinger-
ing. Groups with common subscripts are not significantly different at the .05level. SIRS = Structured Inter-
view of Reported Symptoms: PTSD = post-traumatic stress disorder; DA = Direct Appraisal of Honesty;
DS = Defensive Symptoms; RS = Rare Symptoms: 1A = Improbable and Absurd Symptoms; SC = Symp-
tom Combinations; 0s = Overly Specified Symptoms; SO = Symptom Onset and Resolution; BL = Blatant
Symptoms; SU = Subtle Symptoms; SEL = Selectivity of Symptoms; SEV = Severity of Symptoms: INC
=: Inconsistency of Symptoms; RO = Reported versus Observed Symptoms.
* p < .05. **p < .01. ***p < .001.

SUPPLEMENTARY
ANALYSIS
One limitation of the current study is its relatively small psychiatric sample. To
remedy this, we conducted supplementary analyses that included clinical groups from
Rogers et al. (1991). Table 2 compares simulators of specific disorders from the current
646 Journal of Clinical Psychology, September 1992, Vol. 48, No. 5

Table 2
SIRS Diyerences among Simulators Who Are Feigning SpecificDisorders and Psychiatric Patients
from Rogers et al. (1991)

Simulation of specific disorders Rogers et al. (1991)

SIRS scales Schizophrenic Mood PTSD Inpatients Outpatients F
DA 6.40. 6.20. 5.53, 3.73b 3.w 8.72"'
DS 29.80. 29.93a 31.00. 20.29b 29.14, 7.31***
RS 10.40, 6.2& 5.47b 1.53, .71, 39.62***
IA 6.93n 3.40b 3.43b .81, .21, 23.33***
sc 8.33, 5.80b 6.Wb 1.88, 1.32, 19.03***
0s 3.93, 3. O h 2.07b .69, .36c 10.37***
so 3.27. 3.07. 2.93, 1.85b .97, 12.10***
BL 16.87, 12.60a 14.07,b 3.40, 3.38, 44.32***
su 17.53, 16.53, 18.07. 5.94 6.12b 27.03***
SEL 19.67, 16.87, 18.00, 6.76b 6.83b 30.40***
SEV 14.73, 12.27, 14.13, 2.76b 1.52b 45.55***
INC 8.47, 7.00, 5.67,b 3.88b 2.32k 19.97***
RO 8.47. 6.20, 4.93a 1.71b 1.35b 16.89***

Note.-Scales are scored, with the exception of DS, so that higher elevations are indicative of malinger-
ing. Groups with common subscripts are not significantly different at the .05 level. SIRS = Structured Inter-
view of Reported Sympotms: PTSD = post-traumatic stress disorder; DA = Direct Appraisal of Honesty;
DS = Defensive Symptoms; RS = Rare Symptoms: IA = Improbable and Absurd Symptoms; SC = Symp-
tom Combinations; 0s = Overly Specified Symptoms; SO = Symptom Onset and Resolution; BL = Blatant
Symptoms; SU = Subtle Symptoms; SEL = Selectivity of Symptoms; SEV = Severity of Symptoms;
NC = Inconsistency of Symptoms; RO = Reported versus Observed Symptoms.
***p < .0001.

study to earlier SIRS data on 33 inpatients2 and 34 outpatients (Rogers et al., 1991).
A similar pattern of scale elevations emerged from this supplementary analysis with sig-
nificant differences between simulators (irrespective of the specific disorder feigned) and
patients (both inpatients and outpatients). One difference was found with DS, a scale
designed to measure defensiveness: outpatients manifested nearly identical elevations
to simulating groups.
As a final consideration, Rogers (1990a, 1990b) asserted that the use of antisocial
personality disorder (APD) as an indicator of malingering in forensic cases lacks em-
pirical support and is probably an illusory correlation. Previous research by Rogers,
Gillis, and Bagby (1990) found that correctional residents appeared no more capable
than others of feigning mental illness. As a refinement of that study, we established
which residents met the DSM-111-R criteria of APD (n = 16) and compared them to
those who did not (n = 29). A series of t-tests for SIRS scales both for the simulation
of specific diagnoses and collapsed across disorders failed t o yield any significant
differences when subjected t o the Dunn-Bonnferroni correction for family-wise Type
I error (alpha = .05). A more stringent test of the APD hypothesis would be the com-
parison of upper and lower quartiles; this was not possible given the present sample size.3

*The inpatient sample included unanalyzed data on seven subjects collected under the same experimental
conditions as Rogers et al. (1991).
'A larger study by Kropp and Rogers is underway to examine this very issue in relationship to PCL ratings.
 Faking Specific Disorders 647

DISCUSSION

The present findings help to address the generalizability of the SIRS across
simulation-specific diagnoses. The SIRS appears relatively robust in its ability to
distinguish simulators of specific diagnostic categories (schizophrenic, mood disorders,
and PTSD) from three diagnostically mixed groups of bona fide patients. For the SIRS
to be truly generalizable, it is important that the feigning of specific disorder be
discriminated from a wide range of true disorder^.^
Four scales (BL, SU, SEL, SEV) appeared to be totally unaffected by the disorder
faked. Others, such as RS and IA, evidenced differences among simulators, but con-
tinued to show significant differences between each simulated disorder and patient groups.
Even though the SIRS was not designed to measure specific syndromes (e.g. ,
schizophrenia), we found it interesting that some differences did occur as a result of
which specific disorder was feigned. This finding coupled with that of the Petersen and
Viglione (1991) study suggests that substantial differences in clinical presentation may
occur, dependent on the particular disorder that is faked.
In an examination of SIRS research (Rogers et al., 1990; Rogers, Gillis, Bagby,
& Montneiro, in press; Rogers et al., 1991) that included the present study, we found
that 8 of the 12 scales (RS, IA, SC, BL, SU, SEL, SEV, and RO') consistently
discriminated fakers (simulators and suspected malingerers) from bona fide patients and
controls. These scales appear effective with clinical, community, and correctional samples
and are generalizable to coached simulators and those who are feigning certain specific
disorders. The next step is the development of optimal cutting scores for the clinical use
of the SIRS in cases of suspected malingering. (See Rogers, Bagby, & Dickens, in press.)
One obvious disparity between Canadian and American prisons is differences in
minority representation. One limitation in generalizability of this study to American
corrections is the small percentages of Black and Hispanic inmates. Research is cur-
rently underway with inmates from a U.S. facility.
Based on the Petersen and Viglione (1991) research, the MMPI may not be par-
ticularly effective in the detection of feigned depression or anxiety disorders. In light
of this, clinicians may wish to combine the SIRS with the MMPI for the assessment
of possible malingering.

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STYLES OF PSYCHOLOGICAL ADJUSTMENT IN DIABETES:

A FOCUS ON KEY PSYCHOMETRIC ISSUES AND THE ATT39
G . WELCH A N D R. B. W . SMITH F. H. WALKEY
Wellington School of Medicine Victoria University
Wellington, New Zealand Wellington, New Zealand

While knowledge of the biomedical factors in diabetes has grown in a steady

and systematic fashion over the past 60 years, attempts to define, measure,
and understand the relevant psychological constructs have only begun
recently. In particular. there is need for psychometrically sound tests to tap
these dimensions. This study examined the psychometric characteristics of
the ATT39, a promising measure of psychological adjustment to diabetes.
The results, based on three patient samples and using the FACTOREP factor-
matching procedure, suggested that the A n 3 9 has a large single factor only.
This new subscale appears clinically to measure the integration of diabetes
and its treatment into the lifestyle and personality of a patient with diabetes.

Correspondence should be addressed to Dr. Carry Welch, Department of Psychological Medicine,

Wellington School of Medicine, P.O. Box 7343, Wellington, New Zealand.
This research was supported by a grant from Wellington Area Health Board Bequest Funds. We would
like to thank Dr. Stewart Dunn, Department of Medicine, University of Sydney, New South Wales, Australia,
for allowing us to re-analyse the original correlation matrix.