Chapter Eleven

CHAPTER 11:
Interpreting the MMPI-A Standard Scales

Standard scales were empirically developed using samples of adult psychiatric patients contrasted w/adult controls subjects who were visitors to the U of Minnesota hospitals
Scales were never adjusted/adapted when used with adolescents
Some things were changed: phrasing youthful activities and behaviours in the present tense, shortening the instrument by deleting items from longer scales, deleting developmentally inappropriate/objectionable content
Scales 3, 6, 7 & 9 have same item content
Scales 1 & 2 have same item content as MMPI-2
Only 2 of the MMPI-A basic scales (5 & 0) had more than one or two items deleted
Item scale deletions included those with limited face or content validity, developmentally inappropriate content, and developmentally objectionable content
MMPI-A clinical samples were drawn from alcohol and drug problem treatment units, psychiatric inpatient units, special school for emotionally/behaviourally disturbed adolescents, and a day treatment center


General Interpretive Guidelines
Hs, D, Hy, Pd, Pa, Pt, Sc & Ma are interpreted using uniform T scores generated from the adolescent normative sample
Mf and Si scales use linear T scores (generated from adolescent normative sample)
MMPI-A profile has a shaded area b/w T scores of 60 and 64 to indicate moderate elevations (65 is cutoff for clinically significant elevations)
Can look at Table 11-2 (p. 250) to see percentages of elevated std scale scores in the normative and clinical samples (compare results you get with Table 11-2 to see if the client may not respond to the standard treatment protocol; ie. If show different scale elevation patterns)
Elevated score indicates a higher probability that the individual is more like the criterion group of people on which that scale is based (ie. Scale 8 (schizrophrenia): high on scale 8 may mean individual is more similar to the criterion group of schizophrenic adult patients than people with lower scores on that scale)
Harris-Lingoes and Si subscales can be used to determine which of the many possible descriptors to emphasize in interpretation
Item overlap in the Harris-Lingoes subscales can detract from their usefulness and since they’re short, they’re less reliable measures than the standard scales
Cautious interpretive strategy should be used for the Harris-Lingoes subscales since there have yet to be any studies that assess the validity of these scales for adolescents
Harris-Lingoes subscales are interpreted only when its standard scale is elevated (T scores > 60) and the Harris-Lingoes subscale is elevated at or above 65 T

Scale 1: Hypochondriasis (Hs)
More extreme scores suggest a greater preoccupation with health than occurs in patients with known illnesses
Boys and girls who score high are unlikely to be doing well in school, and report increasing problems (particularly academic)
Girls: more likely to report more family problems including parental marital disagreements and financial difficulties
Scale 1 elevations are slightly more common in girls than boys
Girls in clinical settings may have eating problems along with physical complaints
Parents of high-scoring boys described their sons as having many internalizing problems (being fearful, guilt prone, withdrawn, perfectionistic, clinging, worrying)
Incarcerated delinquent boys may have fears of dying or losing control, have concentration difficulties, or show cruelty to others

Scale 2: Depression (D)
High scorers likely to feel unsure of themselves and the future
High scores normally occur when individuals are in trouble (absence of high scores in ppl who are in trouble is an unexpected sign indicating the person isn’t responding the modal way)
Elevations on D = good prognostic indicators for psychotherapy; no elevation on D = a person may not be motivated for change
Validity of scale 2 has been confirmed as a measure of depression
More significant correlates were found for girls than boys
Girls in school settings with elevations on scale 2 are unlikely to be doing well in school and are more likely to report their parents’ arguments have worsened
Parents of clinical boys described their sons as guilt prone, fearful, withdrawn, perfectionistic, clinging, worrying
High scoring girls less likely to engage in acting-out behaviours (including sexual promiscuity) and much more likely to be socially withdrawn, with few or no friends, and to have eating problems, somatic concerns, and low self-esteem
Incarcerated boys may show depressed mood, restlessness, anorexia, self-pity, obsessions and compulsions, need for reassurance, nightmares, concentration difficulties, cruelty toward others
Elevation greater than or equal to 65 on Harris-Lingoes subscale D1 (subjective depression) = associated with increased suicidal risk
Only Harris-Lingoes T scores greater than or equal to 65 should be interpreted
D1 (subjective depression)
D2 (psychomotor retardation)
D3 (physical malfunction)
D4 (mental dullness)
D5 (brooding)

Scale 3: Hysteria (Hy)
Elevations on Hy may be associated with somatic complaints
Boys in school settings more likely to have problems in school; clinical boys (including delinquents), could be assessed for history of suicidal ideation and/or gestures
Elevations may be associated with tendency to develop physical problems as a reaction to stress or paralysis in outpatient boys
Incarcerated delinquent boys may have concentration difficulties, restlessness, anorexia, cruelty toward others, and depressive feelings (particularly in the afternoon)
Psychiatric inpatients with elevations >65 on H-L subscales Hy2 (need for affection) are unlikely to show anger towards adults, probably wouldn’t like new/exciting experiences or feelings, or use cocaine or other stimulants
Psychiatric inpatients with elevations > 65 on H-L subscale Hy5 (inhibition of aggression) may be perfectionistic and planful as well as unlikely to engage in verbal disagreements with adults or peers, talk before thinking, or act impulsively
Hy1 (denial of social anxiety)
Hy2 (need for affection)
Hy3 (lassitude-malaise) (deny good health, weak, restless, denies happiness)
Hy4 (somatic complaints)
Hy5 (inhibition of aggression) (dislikes crime articles, denies irritability or feeling like swearing, denies that seeing blood doesn’t bother them)

Scale 4: Psychopathic Deviate (Pd)
By far the most frequently elevated scale in the MMPI-A clinical sample
High scorers are often young, delinquent, affected little by remorse, not particularly responsive to censure or punishment
Elevations associated with numerous behaviour problems, family difficulties, poor school adjustment, poor school conduct, school dropout, suspensions, failures
Use of alcohol/drugs is likely in those with elevated cores
Difficulties with the law increase in clinical settings; high scoring girls and boys enjoy wild parties and new/exciting experiences even if they’re frightening, unusual or illegal
Parents of clinical adolescents report many externalizing behaviour problems: lying, cheating, disobedience, impulsivity, stealing, swearing, associating with bad peer group, poor school work, alcohol or drug use, remorselessness, secretive, threatening, cruel, argumentative, jealous, moody, temper outbursts
Incarcerated delinquent boys may show disturbances in mood, sleep, concentration, and may have anxiety symptoms
Boys are more likely to have a history of running away from home and could be evaluated for a history of being physically abused (clinical girls may also run away)
Clinical girls could be evaluated for having a history of sexual abuse and are likely to be sexually active
Based on original MMPI, adolescents with high Pd may be less motivated and open in therapy sessions
Adolescents who are being treated in inpatient psychiatric settings and have elevations on scale 4 are at risk for suicidal behaviours (alienation appears to be a factor with increasing risk if H-L subscale Pd5 is elevated; elevation on Pd4 for boys is another indicator for risk of suicidal gestures)
Content of H-L subscales > 65 can be used to resolve which of the many descriptors to emphasize for an elevated Pd score (> 60)
Pd1 (family discord)
Pd2 (authority problems)
Pd3 (social imperturbability)
Pd4 (social alienation)
Pd5 (self-alienation)

Scale 5: Masculinity/Femininity (Mf)
Elevated scores suggest an unusual interest pattern in boys compared with their peers: they endorse interests that are more stereotypically feminine and deny more stereotypically masculine interests. They may be less likely to act out. However, if other MMPI-A scales associated with externalizing behaviours are elevated, a tendency to act out should not be ruled out
High scoring boys were more intelligent, had higher grades, better school adjustment
Elevated scores in girls are unusual and suggest a more stereotypically masculine or “macho” interest pattern
High scoring girls less likely to have poor school conduct, are less likely to be highly intelligent, more likely to have poor school grades
Further research is needed to clarify the interpretation of scale 5 for girls
It has been suggested that scale 5 could be dropped from the MMPI-A without a significant loss of information
Scale 5 as general personality measures, NOT an indicator of psychopathology

Scale 6: Paranoia (Pa)
Pa elevations are related to both behavioural and academic problems for boys and girls in school settings
Likely to report more problems than the average young person, including school suspensions and poor grades
Girls may report school failures as well
Clinical girls: likely to report more disagreements with parents, able to anticipate consequences of their actions, may consider how their behaviour affects others, may be self-critical and doubtful
Parents of clinical boys describe them as hostile, withdrawn, being unliked and having poor peer relations, feelings of persecution, being immature, destructive, argumentative
Clinical boys’ treatment counselors say: overly dependent, clinging to adults, attention seeking, resentful, anxious, worried/obsessive and believe they’re bad and deserving of punishment
Inpatient boys may have difficulty making up their minds, like to do frightening activities, and may be involved emotionally with others
Psychiatric inpatients with Pa elevations: perfectionistic, planful, guilt prone
Girls in correctional facilities: elevated Pa may mark personality asset whereby the girls may have greater interpersonal sensitivity that makes them more likely ot make special efforts to be liked/appreciated
Incarcerated boys: suicidal ideations and gestures, cruelty to others, panic symptoms and fears of dying/losing control, restlessness, problems completing tasks, hopelessness/helplessness, anorexia, sleep disturbance, depressed mood, blame others
Elevations > 65 on Pa3 may suggest concern for others, having at least 1 enduring friend, being unlikely to act impulsively
High-scoring inpatient boys: planful and perfectionistic
Inpatient girls: likely to be self-critical and have self-doubts
Harris-Lingoes subscales:
Pa1 (persecutory ideas)
Pa2 (poignancy)
Pa3 (naivete)

Scale 7: Psychasthenia (Pt)
Correlates have yet to be found for adolescents in school settings with elevated Pt scores
Clinical girls: likely to be depressed and report more disagreements w/parents
Clinical boys could be evaluated for history of being sexually abused
Incarcerated boys: depressed mood, concentration difficulties, restlessness, pacing, excessive running/climbing, generalized anxiety, fears of dying/losing control, fear of public speaking, obsessions/compulsions, problems completing tasks, may bully/tease others
High Pt clinical boys may have limited self-confidence and clinical girls may mae suicide threats or steal

Scale 8: Schizophrenia (Sc)
Boys and girls in school settings with elevated Sc are more likely to have several behaviour problems in school and lower grades
Normative boys may be suspended from school; normative girls are less likely to have an outstanding personal achievement and more likely to report weight gain
Elevated Sc scores in clinical settings are associated with history of having been sexually abused
Girls are likely to report increase in disagreement with parents
Clinical boys: exhibit psychotic behaviours, hallucinations, delusions, ideas of reference, peculiar speech and mannerisms, grandiose beliefs
Parents of clinical boys say: many internalizing behaviour problems, fears and withdrawal, guilt prone, perfectionistic, worried, clinging behaviours, somatic complaints (stomachaches, nausea, headaches, dizziness)
Low self-esteem in clinical boys
Incarcerated boys: depressed mood, suicidal ideation/attempts, concentration difficulties, self-pity, dear of dying/losing control, obsessions/compulsions, problems completing tasks, impulsivitiy, excessive running/climbing, cruelty to others, blame others
Clinical boys may be shy and withdrawn, low self-confidence
Clinical girls may be aggressive, temper outbursts, act out, threaten suicide
Research on original MMPI: adolescents with high Sc elevations may have poor prognosis for psychotherapy because of distrust of therapist, less motivated for therapy, reluctant to discuss feelings, poor relationship w/therapists; also slow to adapt to treatment unit routines and expectations
H-L subscales
Sc1 (social alienation)
Sc2 (emotional alienation)
Sc3 (lack of ego mastery, cognitive) (concentration diff, feels things aren’t real)
Sc4 (lack of ego mastery, conative) (unhappy, has death wish, withdraws into daydreams)
Sc5 (lack of ego mastery, defective inhibition) (uncontrollable urges, blank spells, being touchy, emotional outbursts)
Sc6 (bizarre sensory experiences)

Scale 9: Mania (Ma)
Elevated Ma scores associated with school and home problems in girls from school settiungs
School behaviour problems in girls also, as is less likelihood of participating in social organizations at school
Academic underachievement in boys
Experience with variety of drugs (ex. Alcohol or amphetamines) particularly if individual is an inpatient or a boy
Inpatient: enjoy wild parties
Inpatient boys: like to do frightening things, often get into arguments with peers
Inpatient girls: argumentative (particularly w/adults), frequently speak w/o thinking
Suicidal behaviours are possible; incarcerated boys may use more lethal methods
Incarcerated boys: manic behaviours, elevated/expansive mood, shouting, complaining, irritability, anger, excess activity, oppositional behaviour, cruelty to animals, blame others
Elevation > 65 on Ma1: unlikely to have self-doubts or care for or be involved emotionally with others, likely to enjoy new/exciting experiences (even if frightening, unusual or illegal), abuse of cocaine or other drugs is possible, boys are at increased risk for suicidal behaviours
Elevation > 65 on Ma2: girls are at increased risk for suicide
Elevation > 65 on Ma3: may be increased risk for suicidal behaviours, likely to prefer wild parties and new experience (unusual, frightening, illegal), enjoy company of others with similar interests, boys show no difficulty making up their minds, boys don’t seem emotionally attached to others
Work w/original MMPI: scale 9 elevations may be related to enthusiasm, interest in many things, animated approach to problems
Ma elevations for adolescents using MMPI suggest poor motivation for therapy, little willingness to explore feelings, insensitivity to criticisms
H-L subscales:
Ma1 (amorality)
Ma2 (psychomotor acceleration)
Ma3 (imperturbability)
Ma4 (ego inflation)

Scale 0: Social Introversion (Si)
Si elevations strong indicator of problem in social relationships in clinical boys and girls; associated with social withdrawal and low self-esteem
Clinical girls: likely to have eating problems and report weight gain, depression, suicidal ideations/gestures, history of few or no friends
Therapists of clinical girls say: withdrawn, timid, shy, physically weak and uncoordinated, fearful, depressed; unlikely to have an interest in heterosexual relationships or to act sexually provocative
Elevated scale 0 appear to have inhibitory effect on girls; unlikely to use alcohol or drugs or to have delinquent behaviours reported by their parents or other acting-out behaviours
Clinical boys: unlikely to participate in school activities
3 subscales:
Si1 (shyness/self-consciousness)
Si2 (social avoidance)
Si3 (alienation – self and others)