Chapter Four

CHAPTER 4

Interpreting the MMPI-2 Standard Scales

65 T score level corresponds to the 92nd percentile, and elevations past this score take on clinical meaning
A T score of 60-64 is considered moderately elevated
Low scores on most scales are not interpreted as having any particular meaning, except:
Scale 0 (Social Introversion, Si) –low scores represent extroverted behaviour
Scale 5 (Masculinity-Femininity, Mf)

Scale Development and Item Content

In most cases, the MMPI standard scales were developed using an empirical-contrast method:
Hathaway and McKinley-included items that differentiated between a sample of “normal” subjects and a sample of patients
Most of the MMPI-2 standard scales contain heterogeneous item content, which can make them difficult to interpret
Interpretation of the standard scales is made easier by evaluating the relative contribution of the specific content subscales (Harris and Lingoes, 1955).
Harris and Lingoes developed their content themes for scales 2, 3, 4, 6, 8, and 9 by rationally placing the items on the scale into similar content groups.
This strategy enables the interpreter to understand a particular scale elevation by evaluating a person’s response to specific item content.
Should only be consulted if the T score on the parent scale (2,3,4,5,8, and 9) is at least moderately elevated (ie., ≥ 60)

Scale 1: Hypochondriasis (Hs)

Scale Development:
McKinley and Hathaway defined hypochondriasis as: “Abnormal, psychoneurotic concern over bodily health”
For details on the patients used for scale development see pg. 63.

Item Content:
Items represent a broad range of physical symptoms (ie., general aches, pains, fatigue, stomach and breathing problems, sleep difficulties, dizziness, etc).
Scale 1 items are obvious and overlap with other neurotic scales (ie., scales 2, 3 and 7), particularly scale 3, which includes 20 Hs items.


Illustrative Empirical Research
Hs has been widely researched and found to be related to excessive medical complaints, chronic pain, and extreme hypochondriacal concern (see pgs 63-63, and Fig. 4-2 for examples of research studies)

Descriptors:
High scorers have excessive bodily concerns, numerous vague somatic symptoms and undefined complaints; are not viewed as very responsive to psychological therapy
See Table 4-1 (pg 66) for Interpretive Guidelines.


Scale 2: Depression (D)

Scale Development:
Provides a measure of symptomatic depression
Clinical picture assessed by this scale: poor morale, lack of hope in the future, dissatisfaction with life, and a low mood.
See pg 65 for description of patient sample used for scale development

Item Content:
Items related to low mood, low self-esteem, lack of interest in things and feelings of apathy.
Harris and Lingoes found several distinct subsets of item content (Note: subtests are only interpreted if the score on scale 2 is greater than or equal to 60, and the subscale’s scores is greater than or equal to 65). See pg 66-67
D1-Subjective Depression (32 items)
D2-Psychomotor Retardation (14 items)
D3-Physical Malfunctioning (11 items)
D4-Mental Dullness (15 items)
D5-Brooding (10 items)

Illustrative Empirical Research
Research has found that the MMPI D scale is related to the presence of mood disorders, and differentiates between depressed inpatients and normals

Descriptors
High scorers seen as depressed, unhappy, pessimistic, etc; tend to be motivated to receive treatment (see Table 4-2 for Interpretive Guidelines)


Scale 3: Hysteria (Hy)

Scale Development:
In original MMPI, authors interested in providing an objective measure of conversion hysteria (today called conversion disorder).
For patient description see pg 68.

Item Content:
Content of this scale is complex, and is composed of seemingly unrelated items: somatic complaints, denial of psychological problems, and social extroversion or social facility
Harris and Lingoes grouped the scale 3 items into 5 subscales, see pgs 69-70 (only interpreted with high scores, see above, scale D):
Hy1-Denial of Social Anxiety (6 items)
Hy2-Need for Affection (12 items)
Hy3-Lassitude-Malaise (15 items)
Hy4-Somatic Complaints (17 items)
Hy5-Inhibition of Aggression (7 items)
Items seem contradictory but reflect the incongruities of conversion disorder itself.

Illustrative Empirical Research
Moderate elevations (60-64) are commonly produced by individuals trying to put their best foot forward in a job application
Elevated Hy scores reflect a proclivity toward developing somatic complaints in response to stress
In subset of chronic pain patients, high scores parallel high Hs scores

Descriptors
High scores tend to react to stress by developing physical symptoms (headaches, chest pains, etc.)
Individuals with Hy as their highest score tend to be psychologically immature, childish, self-centered, narcissistic, and egocentric.
May show initial enthusiasm about treatment but efforts to change their behaviour often ineffective (see Table 4-3 for interpretive guidelines)

Scale 4: Psychopathic Deviate (Pd)

Scale Development:
Developed as a measure of antisocial tendencies or psychopathic behaviour
Original sample from inpatient hospital or federal prison reformatory (see pg 71 for details)

Item Content:
Item content is heterogeneous, making interpretation complex
High scores correlated with behaviours indicating family or behaviour problems of an aggressive, interpersonally manipulative, and impulsive nature
The Harris-Lingoes subscales can help with interpretation (Pg 72):
Pd1-Familial Discord (11 items)
Pd2-Authority Problems (10 items)
Pd3-Social Imperturbability (12 items) ie., feel confident and comfortable in social situations; exhibitionistic and opinionated
Pd4-Social Alienation (18 items) ie., feel misunderstood, alienated, from others etc
Pd5-Self-Alienation (15 items)-ie., uncomfortable and unhappy with themselves, etc.

Illustrative Empirical Research
High Pd elevations tend to be related to membership in deviant groups (ie., psychopathic personalities, delinquents, shoplifters, prisoners, and drug addicts).
However, moderate scale elevations occur among diverse groups (ie., applicants for police department positions, skydivers, actors, etc)- may be due to willingness to take risks and to unconventional/extroverted lifestyles.
Research has shown that Pd is more closely associated with negative emotionality, especially alienation, than with other aspects of antisocial behaviour.

Descriptors
High scorers found to engage in antisocial behaviour, have rebellious attitudes toward authority figures, stormy family relationships and blame parents, and history of underachievement.
Moderate scores (60-64) should not be interpreted as reflecting the more extreme antisocial personality features
Treatment prognosis considered poor because they are resistant to change in therapy
See Table 4-4 for interpretative guidelines

Scale 5: Masculinity-Femininity (Mf)

Scale Development:
Different from other scales in that the construct is not a clinical syndrome
Designed to identify personality features of “male sexual inversion” or homosexual men who had a feminine interest pattern
High T scores for men and women indicate a deviation from the interest pattern assumed to be typical for their gender
It is one of the most difficult standard scales to interpret
Homosexuality no longer a diagnosis, thus no need for a clinical measure to identify homosexuality; now seen as a measure of “the tendency toward masculinity or femininity of interest pattern”
Validity of scale has been questioned, ie., responses from homosexual men were the predominant method of selecting items defining feminine interests in the original item pool

Item Content:
Scale 5 items are heterogeneous, most relating to interests and occupational choices (ie., librarian, nurse and drawing flowers for women; soldier, sports reporter and forest ranger for men)
Item content is obvious to test taker

Illustrative Empirical Research
Has not been extensively researched compared to other scales
Some support of indication of homosexuality in men, no support for women

Descriptors
The appropriateness and utility of this scale has been questioned
Mf scale is not a “symptom” scale
Elevations reflect interests, values and personality charateristics
Interpretation differs by gender, educational level, socioeconomic status, and elevation levels

Descriptors for Men
High elevations in men traditionally interpreted as indicating more feminine interest patterns and behaviors (but affected by man’s SES and educational level).
Low scoring men can be characterized as “macho”
See Table 4-5 for interpretive guidelines

Descriptors for Women
High scores are unusual compared to other women
But lack of studies, questionable developmental strategy of items, and conflicting findings with educated women, suggest using caution in making interpretive statements (see Table 4-5)

Scale 6: Paranoia (Pa)

Scale Development:
Assesses the behaviour pattern of suspiciousness, mistrust, delusional beliefs, excessive interpersonal sensitivity, rigid thinking, and externalization of blame commonly found in paranoid disorders
However, one problem is that some individuals with may second guess the test and be wary/mistrustful of endorsing items that would produce a high Pa score, resulting in low Pa scores

Item Content:
Three subgroups of item content (Harris-Lingoes, pg 81)
Pa1-Persecutory Items (17 items)
Pa2-Poignancy (9 items)- see themselves as high strung and sensitive
Pa3- Naivete (9 items)-seem to feel overly trusting and vulnerable to being hurt

Illustrative Empirical Research
Research in clinical samples indicate that Pa is related to severe psychopathology
Research in normals: As viewed by their husbands, women with high Pa scores, were moody, tended to get sad and blue, lacked emotional control, cried easily and had bad dreams
Pa scale may be moderately elevated in situations in which the individual is being evaluated under duress ie., family custody or pretrial criminal assessments.
Elevations greater than 70, however, are interpreted as more chronic or personality based problems and not simply situational distress

Descriptors
Individuals with very high scores (T> 80) often show frankly psychotic behaviour, disturbed thinking, delusions of persecution or grandeur, and ideas of reference
High elevations (T= 65-79) often manifest a paranoid predisposition. They are hypersensitive to reactions of others, feel they get a raw deal from life, etc
Moderate elevations (T scores of 60-64, inclusive) no specific correlates. May be due to interpersonal sensitivity items
Very low (< 35) should be interpreted with caution, especially in an inpatient context, may be viewed as paranoid if:
Pa is lowest scale on profile
At least one standard scale > 65
Validity configuration is defensive (both L and K are above a T score of 60 and above F)
See Table 4-6 for interpretive guidelines

Scale 7: Psychasthemia (Pt)

Scale Development:
Originally developed to assess a psychological disorder (psychathenia) that today would describe an anxiety disorder with obsessive-compulsive features

Item Content:
No specific content subscales because the items are very homogeneous, since scale was developed, in part, by internal consistency measures (ie., only measures with high correlations included)
Items assess anxiety or general maladjustment

Illustrative Empirical Research
Scale 7 has been associated with severe and debilitating anxiety
Correlated in inpatient psychiatric settings with severe guilt, low energy, depressed mood and hallucinations
In normal men and women, high Pt scores were rated by their spouses as having many fears, being nervous and jittery, being indecisive, lacking self-confidence, and having sleeping problems

Descriptors
People who score high on this scale tend to be anxious, tense and agitated. They report great discomfort, worry and feelings of apprehension
They are somewhat resistant to interpretations in therapy, express hostility toward their therapist, remain in therapy for longer than most patients, and usually make slow, gradual progress in therapy
For full interpretive guidelines see Table 4-7

Scale 8: Schizophrenia (Sc)

Scale Development:
Hathaway and McKinley attempted to develop several separate scales for the four recognized types of schizophrenia at the time, but was too difficult. As a result this scale is quite long and complex

Item Content:
Long and heterogeneous scale
High scores reflects a number of diagnostic possibilities, such as schizophrenia, persons with organic brain disorders or severe personality disorders, normal individuals with severe sensory impairments, and unconventional, rebellious and counterculture individuals (ie., hippies in the 1960s)
Harris and Lingoes subtypes (pg 86)
Sc1-Social Alienation (21 items) –feel misunderstood and mistreated, etc
Sc2-Emotional Alienation (10 items)-feelings of depression and despair
Sc3- Lack of Ego Mastery, Cognitive (10 items)- highs scorers fear losing their mind
Sc4- Lack of Ego Mastery, Conative (14 items)- high scorers feel life is a strain
Sc5-Lack of Ego Mastery, Defective Inhibition (11 items) –high scorers report feeling out of emotional control
Sc6-Bizzare Sensory Experiences (20 items)-high scorers feel their body is changing in unusual ways (blank spells, hallucinations, unusual thoughts etc)

Illustrative Empirical Research
Sc scale empirically related to a number of extreme personality characteristics and symptomatic behaviours, including the diagnosis of schizophrenia

Descriptors
Scores of 60-69: tend to have unconventional lifestyles and feel somewhat alienated from others
Very high scorers (70-79) tend to have a schizoid lifestyle, do not feel a part of the social environment, or are isolated, alienated and misunderstood
Extremely high scorers (T>80) may show blatant psychotic behaviour, confusion disorganization and disorientation.
See Table 4-8 for interpretive guidelines

Scale 9: Hypomania (Ma)

Scale Development:
Interested in developing a measure of manic or hypomanic behavior, ie., the tendency to act in euphoric, aggressive, and hyperactive ways.

Item Content:
Four Harris and Lingoes categories:
Ma1- Amorality (6 items)- may see others as selfish and dishonest, which provides justification for their behaving in this way as well
Ma2- Psychomotor Acceleration (11 items)-accelerated speech, overactive thought process, excessive motor activity
Ma3-Impertubability (8 items)- deny social anxiety
Ma4- Ego inflation (9 items)- Appraise themselves unrealistically

Illustrative Empirical Research
Research has found that patients with high Ma elevations were hyperactive, alcoholic, grandiose, and talkative
Normal individuals with high scores in this scale have been shown to be ebullient, overactive and guileful

Descriptors
Since many individuals in normal samples obtain high scores and some patients with affective disorder do not, need to keep level of elevation in mind when interpreting
Very high scorers (T ≥ 75) are viewed as hyperactive, have accelerated speech, and may have hallucinations
Many are viewed as creative, and ingenious; but little interest in routine or details
Unable to see own limitations
Episodes of irritability or hostility may occur
Viewed by others as outgoing and sociable
High scorers (T of 65-74) are viewed as energetic, active and talkative and as having a wide range of interests.
Although some normal individuals score in this range, they tend to encounter interpersonal problems as a result of this manipulativeness and lack of follow-through
Low scorers (T ≤ 35) report having low energy and activity levels, letharg and apathy and are difficult to motivate
See Table 4-9 for interpretive guidelines


Scale 0: Social Introversion (Si)

Scale Development:
Originally published as a separate measure of social introversion-extroversion
Scale developed by contrasting college students who scored high and low on another measure of introversion-extroversion

Item Content:
Three subscales (see Pg 91)
Si1- Shyness (14 items)-high scorers are shy in interpersonal situations
Si2- Social Avoidance (8 items)-high scorers tend to avoid groups, are unfriendly and socially withdrawn
Si3- Self-Other Alienation (17 items) –high scorers report feeling alienated from others and themselves

Illustrative Empirical Research
Research showed that high scorers viewed as slow paced, lacking originality, insecure and indecisive, socially over controlled
Low scorers viewed as outgoing, sociable, assertive and adventurous

Descriptors
Si scale measures a bipolar personality dimension in which high scores assess social introversion and low scores reflect social extroversion
High scorers (T ≥ 65) are socially introverted, more comfortable alone, have few close friends, shy
Tend to be uncomfortable with the opposite gender, hard to get to know and sensitive to what others think
However are troubled by lack of involvement with other people
Tend to worry a great deal
Low scorers (T ≤ 45) are sociable, extroverted, outgoing, friendly
Strong need to be around other people
Interested in status and power; seek out competitive situations
May be immature, self-indulgent and superficial
See Table 4-10 for interpretive guidelines

Case Example of the Standard Scores and Their Subscales

The most effective approach to incorporating the Harris-Lingoes MMPI-2 subscales into clinical profile interpretation is to use them to clarify particular interpretations of the parent scale.
See example of Ann, Figure 4-4 0n pg 96

Limitations of the Harris-Lingoes Content Interpretation Approach

First, they assess content factors only on a particular MMPI-2 scale
They do not sufficiently assess the full range of content I the MMPI-2
Second, many of the subscales are very short and since reliability depends in part on length, many have low reliabilities

Highlight Summary: Alice’s Standard Scale Profile

For example of interpretation see Fig 4-5 and pgs 97-98.