SSR: Can Simulated Patients Learn to Stigmatize Themselves? Modeling Self-Stigma through Internal Monologue

Simulating patients with large language models (LLMs) is a promising tool for mental health training, but existing approaches fail to capture a key clinical reality: self-stigma. Patients experiencing self-stigma, the internalization of negative stereotypes, often exhibit context-sensitive resistance, such as avoidance, denial, or self-blame, which current models render as static or uniformly compliant behavior. To address this, we introduce a novel simulation framework grounded in the psychological 3A1H model of self-stigmatization. Our core innovation is the creation of a \textbf{Stigmatized Self-Reflection} (\textbf{SSR}) dataset, where we augment mental health dialogues with internal monologues that reflect stigma-aware reasoning. By fine-tuning LLMs with this data using a chain-of-thought approach, we train patient agents to dynamically adjust their level and expression of stigma based on conversational triggers. Evaluations demonstrate that our approach significantly outperforms specialized baselines, generating more authentic and situationally appropriate patient responses. This work provides a crucial step towards realistic stigma simulation for clinical training and empathetic dialogue systems.

Synthetic or Authentic? Building Mental Patient Simulators from Longitudinal Evidence

Patient simulation is essential for developing and evaluating mental health dialogue systems. As most existing approaches rely on snapshot-style prompts with limited profile information, homogeneous behaviors and incoherent disease progression in multi-turn interactions have become key chellenges. In this work, we propose DEPROFILE, a data-grounded patient simulation framework that constructs unified, multi-source patient profiles by integrating demographic attributes, standardized clinical symptoms, counseling dialogues, and longitudinal life-event histories from real-world data. We further introduce a Chain-of-Change agent to transform noisy longitudinal records into structured, temporally grounded memory representations for simulation. Experiments across multiple large language model (LLM) backbones show that with more comprehensive profile constructed by DEPROFILE, the dialogue realism, behavioral diversity, and event richness have consistently improved and exceed state-of-the-art baselines, highlighting the importance of grounding patient simulation in verifiable longitudinal evidence.