Chapter Six

CHAPTER 6:
Interpreting the MMPI-2 Content Scales

An important Distinction:
- Empirically derived clinical scales of the MMPI-2 do not directly consider item responses as personal information. Rather, they assume that answers to MMPI-2 items are simple signs of problems types without regard to specific response content. The meaning of an empirical scale is based not on the makeup of constituent items but on the empirical relationships that have been established for the scale.
- Content scale interpretation is based on the view that responses to items are communications about one’s feelings, personality style, and past or current problems.

Content Scales:
- Most people taking the MMPI-2, under clinical conditions, provide accurate personality information
- If responses to the items are distorted the scores on the content may be suppressed somewhat
- Comprehensive and psychometrically sound approach to assessing item content dimensions in the original MMPI was developed by Wiggins
Þ Published a set of content homogeneous scales that represented the major dimensions in the item pool
Þ Each dimension had high internal consistency and strong predictive validity
Þ A new set of MMPI-2 and MMPI-A content scales was developed by Butcher, Graham, Williams, & Ben-Porath

MMPI-2 Content Scale Development
- Developed following a multistage, multi-method scale-construction strategy
- Derived from 704 item experimental booklet
- Groups were purified statistically using item-scale correlations on normal (college students and military personnel) and clinical samples
Þ Eliminated items that were uncorrelated with the total score of the scale
Þ Ensure that all the items on a particular scale actually assed to the scale homogeneity
Þ An item was kept on a scale only if it was most highly correlated with that scale
Þ Some item overlap was allowed on scales that measured general problems such as WRK and TRT
- Then rationally reviewed to ensure that the additional items met the criterion of content homogeneity
- The MMPI-2 restandardized sample was employed only for developing norms in the final stages of scale development
- T-score method was adopted (as with the validity scales) so that two types of scales would be comparable
Psychometric Properties of the MMPI-2 Content Scales

Internal Consistency
- Developed in part following an internal consistency strategy, have internal consistency
- Compare quite favorably to the Wiggins content scales for the original MMPI
- Consider the scale as having a single dimension that is readily interpretable by rational or intuitive strategies

Validity
- Acceptable external correlates for many of the scales based on the behavior rating of couples (client versus the spouses ratings of the client) in the MMPI-2 restandardization study
- Validity coefficients for the MMPI-3 content scales obtained in the normative study were equal to or higher than those obtained for the MMPI-2 clinical scales using the same external correlation ratings
- Examples:
Þ FAM scale was associated with martial and family problems
Þ ASP has been found to predict antisocial personality characteristics and is significantly related to DSM-III-R based antisocial PD
Þ ASP scale differentiated mothers who had been identified as being at high risk for abusing their children from other women taking the test
Þ ASP associated with negative parenting behavior such as harshness, hostility, and low understanding
Þ Chronic pain patients can be empirically distinguished from the MMPI-2 normative sample by using the HEA scale
- Content scales outperformed the clinical scales at times
Þ The BIZ and DEP scales separated inpatient depressed patients from schizophrenic patients more effectively than did MMPU-2 clinical scales
Þ At differentiating between alcohol-abusing groups
Þ In a treatment outcome study using the content scales DEP, ASP, ANX, and TRT and the MMPI-2 clinical scales, the content scales emerged as better predictors of outcome than the clinical scales

An Interpretive Strategy for the MMPI-2 Content Scales
- Relatively straightforward and requires few assumptions
- Endorsement of the items comprising a particular scale indicates admission of symptoms and attitudes contained in the items – assuming, of course, that the protocol is valid
- Interpreting these scales in not limited to predicting membership in a clinical group
- Because the content scales contain homogeneous item content, the clinician is able to employ the descriptive qualitative characteristics reflected in the scale’s items to describe the behavioral features the client acknowledges
- Add to interpretation
Þ Often help clinicians better understand clinical scale elevations by allowing them to confirm or eliminate certain behavioral features represented in the scale (e.g., high elevations on the Pt scale but a low elevation on OBS then rumination and obsessive behavior but may be experiencing more generalized anxiety without obsessive features)
Þ Provide information that is not available through the clinical scales because they contain new items in the MMPI-2 item pool
Þ Content scales add incremental validity to the clinical scales in clinical prediction studies



*content scales are grouped to provide information in several areas*





Negative Self-View
Provides clues to how the individual views him- or herself. Feelings or self-efficacy and of security about being able to function in life – it provides information about how confidently the individual deals with the demands of his or her life.

SCALE
DESCRIPTION
HIGH SCORES CAN INDICATE

Low Self-Esteem (LSE)

Addresses negative self-views and provides a relatively “symptom-free” measure of negative attitudes toward the self (excludes items related to depression and anxiety).
- Tend to characterize themselves in negative terms and have low opinions of themselves
- Do not believe that they are liked by others or that they are important
- Beliefs that they are unattractive, awkward, clumsy, useless, and a burden to others
- Lack self-confidence and find it hard to accept compliments
- Overwhelmed by all the faults they seen in themselves







The Internal Symptom Cluster
Addresses symptoms and maladaptive cognitions the individual might be experiencing. Clues to internal symptomatic behavior, maladaptive cognitive beliefs, and disabling thoughts are found in elevations on this cluster.

SCALE
DESCRIPTION
HIGH SCORES CAN INDICATE

Anxiety (ANX)

Addresses problems of generalized anxiety.
- Tension, somatic problems such as heart pounding and shortness of breath, sleep difficulties, excessive worries, and concentration problems
- Difficulties making decisions
- Aware of these symptoms

Fears (FRS)

Focuses on specific or phobias.
- Report an inordinate number of fears or phobias of many different situations or things
- Scale does not contain general symptoms of anxiety

Obsessiveness (OBS)

Addresses the cognitive processes of maladaptive rumination and obsessive thinking.
- Have tremendous difficulties making decisions and are likely to ruminate excessively about issues and problems, causing others to become impatient
- Some compulsive behaviors
- Excessive worries

Depression (DEP)

Assesses symptomatic depression.
- Having significant depressive thoughts
- Felling uncertain about their future and uninterested in their lives
- Likely to be unhappy and cry
- Believe that they are condemned or have committed unpardonable sins
- Consider other people unsupportive

Health Concerns (HEA)

Addresses health symptoms and concerns.
- Physical symptoms across several body systems
- Tend to worry about their health and report feeling sick more often than does the average person

Bizarre Mentation (BIZ)

Addresses severe symptoms of thought disorder.
- Likely to manifest psychotic thought processes
- Report auditory, visual, or olfactory hallucinations
- Recognize that their thoughts are strange and peculiar
- Paranoid ideation
- Special mission or powers
- Elevations greater than 65 suggest severe and unusual thinking problems



The External Aggressive Tendencies Cluster
These scales center around behavior control, negative attitudes toward others, and outward expression of emotions. Scores indicate how the individual is dealing with others. Elevations on these scales suggest that the individual has maladaptive behaviors, or attitudes about the way he of she attempts to deal with demands of their life situation.

SCALE
DESCRIPTION
HIGH SCORES CAN INDICATE

Anger (ANG)

Assesses loss of control while angry.
- Likely to have anger control problems
- Report being irritable, grouchy, impatient, hotheaded, annoyed, and stubborn
- Feel like searing or smashing things
- Lose self-control or been physically abusive

Cynicism (CYN)

Cynical beliefs and misanthropic attitudes.
- Have negative attitudes toward others and seems to expect hidden, negative motives behind the actions of others
- Hold negative attitudes of those close to them (fellow workers, family, and friends)

Antisocial Practices (ASP)

Antisocial personality characteristics.
- Hold misanthropic attitudes similar to high scorers on the CYN scale
- Likely to report problem behaviors during their school years
- Admit to enjoying the antics of criminals and believe that it is all right to get around the law, as long as it is not broken

Type A (TPA)

Address a driven, competitive, and hostile personality style.
- Hard-driving, fast-moving, and work-oriented individuals who frequently become impatient, irritable and annoyed when interpreted
- Do not like to wait to be delayed in tasks they are attempting
- Complain there is not enough time in a day to complete tasks
- Tend to be direct, blunt, and overbearing in relationships
- Others view them as aggressive and petty about minor details








General Problem Areas Cluster
Considers more complex problem areas, not simply symptoms, personality traits, attitudinal dispositions, or specific behaviors. These scales summarize problems in social relationships, perceptions and concerns over family problems, maladaptive attitudes and activities related to work adjustment, and clues as to whether the individual holds negative views about the change process that would interfere with a psychological intervention.

SCALE
DESCRIPTION
HIGH SCORES CAN INDICATE

Social Discomfort (SOD)

Assesses uneasiness in social situations.
- Very uneasy around others and prefer to be by themselves
- In social situations, they are likely to sit alone rather than join the group
- Shy and dislike parties and other group events

Family Problems (FAM)

Centers around family relationship problems.
- Experience considerable family discord
- Families are described as lacking in love and being quarrelsome and unpleasant
- Hating members of their families
- Childhoods are usually portrayed as abusive, and their marriages unhappy and lacking affection

Work Interference (WRK)

Addresses problems and negative attitudes related to work or achievement.
- Likely to possess negative work attitudes or personal problems that contribute to poor work performance
- Problems relate to low self-confidence, concentration difficulties, obsessiveness, tension and pressure, and indecision
- Others suggest problems due to lack of family support for their career choice, their own questioning of their career choice, and negative attitudes toward co-workers.

Negative Treatment Indicators
(TRT)

Focuses on attitudes or problems in accepting help or in changing behavior.
- Possess negative attitude toward doctors and mental health treatment
- Do not believe that anyone can understand or help them with their problems
- Acknowledge that they have problems they are not comfortable discussing with anyone
- May not want to change anything in their lives, and they feel that changing their present situation is impossible
- They prefer giving up rather than facing a crisis or difficulty

MMPI-2 Content Component Scales
- Developed according to strategies that would maximize the psychometric and semantic internal consistency of each scale
- A closer examination of these items indicates that, at least on a conceptual level, it is possible to identify clusters of items within the content scales.
Þ Some of the items on the DEP scales reflect dysphoric affect, whereas others show self-deprecatory cognitions that are commonly associated with depression
Þ Find two individuals both suffering from depression but manifesting a different symptomatic pattern – one focusing on dysphoric affective aspect of the disorder and the other showing more of the negative-self views and self-deprecatory behavior
- Research has recently determined that 27 subscales for 12 of the MMPI-2 content scales would likely be valuable clinical subscales (Table 6-16 p. 148). In other words, taking the 12 content scales and giving each of them a number of subscales.
Þ This change would refine interpretation when its content scale is elevated