Patients With Personality: Realistic Patient Simulation through Controlled Diversity and Selective Disclosure

Large language models (LLMs) are increasingly used to simulate human behavior, but their ability to simulate $individual$ privacy decisions is not well understood. In this paper, we address the problem of evaluating whether a core set of user persona attributes can drive LLMs to simulate individual-level privacy behavior. We introduce PrivacySIM, an evaluation suite that benchmarks LLM simulation of user privacy behavior against the ground-truth responses of 1,000 users. These users are drawn from five published user studies on privacy spanning LLM healthcare consultations, conversational agents, and chatbots. Drawing on these user studies, we hypothesize three persona facets as plausible predictors of privacy decision-making: demographics, previous experiences, and stated privacy attitudes. We condition nine frontier LLMs on subsets of these three facets and measure how often each model's response to a data-sharing scenario matches the user's actual response. Our findings show that (1) privacy persona conditioning consistently improves simulation quality over no-persona conditioning, but even the strongest model (40.4% accuracy) remains far from faithfully simulating individual privacy decisions. (2) A user's stated privacy attitudes alone may not be the best predictor because they often diverge from the user's actual privacy behavior. (3) Users with high AI/chatbot experience but low stated privacy attitudes are the most challenging to simulate. PrivacySIM is a first step toward understanding and improving the capabilities of LLMs to simulate user privacy decisions. We release PrivacySIM to enable further evaluation of LLM privacy simulation.

LLM-based simulated clients are increasingly used to train novice counselors, evaluate LLM therapists, and generate synthetic data. However, current simulators produce overly cooperative clients that disclose too readily, accept therapeutic reframes without resistance, and resolve core issues within a single session. We trace these issues to profiles that lack causal depth and behavioral mechanisms that treat all content as equally accessible. We present PatientAct, a framework for client simulation grounded in established clinical theories. Our profiles integrate the 5Ps clinical case formulation, providing causal depth without tying the design to any single therapeutic modality. During simulation, profiles include a dynamic memory layer in which items carry trust thresholds (e.g., symptoms are available early, whereas formative memories require a sustained therapeutic alliance). At each turn, the client's emotional reaction and behavior are modeled before generating a response. If the therapist approaches gated content, PatientAct expresses resistance in terms of quantity, content, and style rather than defaulting to cooperation or a single resistance pattern. We evaluate our framework on 40 clinical situations and demonstrate that it generates diverse profiles with high clinical plausibility. Moreover, PatientAct significantly outperforms the baselines, yielding substantial gains in resistance quality and behavioral realism. Our code and data will be publicly available via github.com/Sahandfer/PatientHub.

Large Language Model (LLM) agents are increasingly deployed in settings where they interact with a wide variety of people, including users who are unclear, impatient, or reluctant to share information. However, collecting real interaction data at scale remains expensive. The field has turned to LLM-based user simulators as stand-ins, but these simulators inherit the behavior of their underlying models: cooperative and homogeneous. As a result, agents that appear strong in simulation often fail under the unseen, diverse communication patterns of real users. To narrow this gap, we introduce Persona Policies (PPol), a plug-and-play control layer that induces realistic behavioral variation in user simulators while preserving the original task goals. Rather than hand-crafting personas, we cast persona generation as an LLM-driven evolutionary program search that optimizes a Python generator to discover behaviors and translate them into task-preserving roleplay policies. Candidate generators are guided by a multi-objective fitness score combining human-likeness with broad coverage of human behavioral patterns. Once optimized, the generator produces a diverse population of human-like personas for any task in the domain. Across tau^2-bench retail and airline domains, evolved PPol programs yield 33-62% absolute gains in fitness score over the baseline simulator. In a blinded evaluation, annotators rated PPol-conditioned users as human 80.4% of the time, close to real human traces and nearly twice as frequently as baseline simulators. Agents trained with PPol are more robust to challenging, out-of-distribution behaviors, improving task success by +17% relative to training only on existing simulated interactions. This offers a novel approach to strengthen simulator-based evaluation and training without changing tasks or rewards.