AS's notes

INTRODUCTION TO THE CLINICAL SCALES

First, as we just said, since the mean is T = 50 and the sd is 10, you interpret the MMPI-2 largely by looking at those scores where T = > 1.5 sd, where T = > 65.

There are 10 clinical scales, and they are named: Hs,Dp,Hy, Pd,5,Pa,Pt,Sc,Ma,Si.

Review specifics of each scale in text. Some general notes, important observations for each are below.

Scale 1:
Contains lots of items that measure individual problems or difficulties with bodily or health concerns. A person does not have to have a physical disease, and in fact, a person with a specific sickness will usually only score in the moderate range. People with scores above 70—even if they have chronic illness—are likely to be exaggerating somewhat. Crude index of psychological mindedness: high scorers tend to be somaticizers.

Scale 2.
Criterion group were depressed bipolar folks.
Depression contains the suicide items. These are: 150, 303, 506, 520, 524, and 530. Less than 10% of people who spike on 2 endorse any of the suicide items. This is actually lower than most other code types.
Always review these 6 items. No other meaningful info about suicide on MMPI-2.
Scale 2 alone is relevant to symptoms of depression, but is not by itself an adequate diagnostic tool for MDD or dysthymia. This is because it not only covers obvious symptoms, but also has a specific target of reactive depression. It is a better state than trait measure. It also has lots of vegetative symptom indicators which are not always involved in DSM MDD. It also has a lot of cognitive state items, confusion, lack of concentration, etc.

Scale 3, HY:
Two basic item contents that are in fact negatively correlated except in those people who have histrionic complaints: a) complaints about head, arms, legs; b) items indicating that patient considers him/herself to be well socialized and well adjusted. Note that there are high and low scorer descriptors.
Lots of somatic items that overlap with scale 1.

Scale 4
Criterion group was young (17-22) so-called psychopaths. Primarily young people who got into trouble for minor stuff.
Remember, high scorers are unconventional and alienated from society as well as somewhat antisocial, angry, impulsive and unpredictable. They have antisocial attitudes, but are not necessarily overtly hostile. There is not much in terms of gender differences.
There is virtually no gender difference in external correlates.

Scale 5.
Criterion groups were male homosexual inverts (very female personalities) and another group of men with feminine interests. The same items are used for both men and women and the deviant responses are reversed. However, this reversal actually happens on the scoring key. You can see this on the example on the female scoring key. However, large differences exist in the external correlations between men and women. Low scoring men are very masculine. High scoring women (or low scoring on the same direction scored for men) are very feminine. High scoring men may be passive and feminine or may have lots of feminine interests and not so typically male interests.

Scale 6.
Measures suspiciousness, characterological anger and hostility, hypervigilance. High scorers are guarded and have a hard time making friends; they are self-righteous and tend to blame others for their problems. See p. 159.

Scale 7.
This is almost purely an anxiety scale, although it is broader than anxiety as conceived by the DSM. It is a misery scale, negative affect, and does not break down into subcomponents very well. Low scorers are perceived as hang-loose.

Scale 8.
Only as scale 8 starts to go over 75 does acute psychosis begin to become visible. Remember, chronic psychotics may not hardly elevate the scale. Scale 8 is the longest of the scales. Scale 8 is easily elevated by K-corrections, so when the K scale gets above a raw score = 18, plot a non-K corrected score using T scores in Appendix A 2.

Scale 9:
mania Nine taps into milder degrees of manic excitement, an elated and unstable mood, psychomotor excitation, flight of ideas, egocentricity, grandiosity. The criterion group consisted of those described as having moderate or low amount of mania because the highly manic would not co-operate with the testing.
Some studies have found that scale 9 distinguished between bipolar manic patients and schizophrenics and other psychiatric cases; whereas other studies have shown that this is not the case. However, scale 0 distinguishes manics from schiz, with schiz having greater on 0.
Scale 9 might have the most diversified content area. Low 9 is best predictor of depression. Watch out for low 9's as they start to recover: suicide potential.
9 energizes whatever else is in the 2 high point code-type. 4-9 is different from 6-9 and from 8-9.
There are no gender differences in raw scores on scale 9.
T-score differences are negatively correlated with age.

Scale 0
A good marker for introversion. It was not developed to detect a particular psychiatric syndrome. A prior introversion-extraversion test was used to classify subjects, and then items that discriminated high and low scorers on that test were selected to form Scale 0.
It is rare to get Scale 0 very high or very low. Therefore, interpret at T 60 and T 40. People who score much below 40 are likely to be highly superficial in their extroversion. High 9, low 0 or high 4 low 0 are likely to be very superficial in their interpersonal relations.
THE MMPI-2 CONTENT SCALES.

More than the clinical scales, the Content scales are self reports on very obvious items, that is, they have very high face validity and are highly susceptible to response bias.

They are more saturated with tendencies either toward over reporting or toward under reporting.

Deviant response is high in the true direction. Hence, very susceptible to true response bias.

Anx. Correlates .91 with scale 7. Why have it?

Fears. This is actually a fairly worthwhile scale, since it doesn’t duplicate anything else. It is largely a list of phobias.

OBS. Again, correlates > .85 with scale 7.

DEP. Again, correlates > .9 with scale 7. Does it have any specificity? Not much, although it shows incremental validity over Scale 2 in the prediction of depressed patients as determined by the SCID. But, may just be related to self-report nature of the SCID.

BIZ Biz has value in that, like Fears, it mentions specific thought disorder symptoms. It correlates only .78 with scale 8 and has incremental validity over Scale 8 in the dx of psychotic patients.

ANG is worthwhile also since it is a fairly pure measure of hostility and anger and doesn’t duplicate scale 7.

In general, don’t interpret the content scales with specificity unless they are about 10 T point higher than first factor measures like Welsh Anxiety.


SUPPLEMENTARY SCALES

** Factor markers, Welsh Anxiety and Welsh Repression. Mark the first 2 factors of the MMPI-2 when scales are factor analyzed, not nec when items are factor analyzed.

The first factor is a measure of generalized distress and unhappiness. When people attempting to look socially desirable, low A is also a marker of that.

Second factor is a measure of constriction, inhibition, slow downedness, even subtle aspects of depression.

ES- mostly just a duplication of A.

MAC-R—Not a good alcoholism or substance abuse scale. Rather, a measure of a kind of personality or character that is uninhibited, has some antisocial tendencies and some hypomanic features.

O-H This is a useful scale in that it can often be elevated or nearly so among people who give WNL profiles where you think they ought not do so. Even elevations between 65 and 70 can indicate someone who is very angry and likely to come unglued.

Re. One of the earlier content scales, it was developed to pick out “good citizen” types, people who are likely to vote and participate in civic minded organizations.

Gender role scales. Feminine has somewhat more validity than masculine as indicator of stereotypicaly interests. However, neither are very good.

PTSD scales. Pretty worthless. They are just Welsh A equivalents.

AAS Addiction admission. Well, in this scale, people admit their substance abuse problems. Far better measure of alcoholism/substance abuse mixed than the MAC-R. However, a number of items concern past use, so go over the items with the client.