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.
Wednesday, January 31, 2007
Chapter One
CHAPTER 1
Objective Personality Assessment using the MMPI-2 and MMPI-A
Research began in 1939 (Hathaway & McKinley) to develop an inventory to aid in assessing and diagnosing patients with mental disorders
MMPI has become the most widely used and researched objective personality inventory in the world
Used in many settings (psychiatric clinics, hospitals, medical settings, adolescents, inmates, alcohol/drug treatment units, military personnel, applicants for highly responsible positions)
1940s-50s first translations; by 1989 there were over 140 MMPI translations in 46 countries
Successful because:
useful and practical technique for assessing individuals reporting mental health symptoms and problems,
many research studies document its reliability/validity,
useful predictive information in a cost-effective manner,
detection of invalid records
simple language, simple administration & scoring
clinical familiarity of profile variables
reliable evaluations
possible to evaluate the credibility of a person’s self report (using validity scales)
person’s score can be interpreted using norms
Development of the MMPI
- Hathaway & McKinley believe self-report provides useful information
- Patients who endorsed similar items/symptoms on the MMPI are diagnostically more alike than different
- Individuals endorsing more symptoms of a particular kind are viewed as experiencing a more serious problem
- Empirical Scale-Construction strategy: any item on a scale was assigned to that scale only if it objectively discriminated a given criterion group (e.g. individuals with depression) from their normative sample (e.g. healthy participants)
- “Blind/Dustbowl Empiricism”- Hathaway & McKinley’s strategy of classifying items with constructs based solely on comparing the responses of normal subjects with groups of well-classified patients (see pg. 3)
Revisions of the MMPI
- changes in the DSM,
- items become out of date, some items were objectionable,
- original normative sample was white, rural subjects from Minnesota, while instrument was used across the US with broadly diverse clients
- 1982, revision of MMPI was not to radically change it, but to modernize and restandardize an instrument of demonstrated reliability and validity
MMPI Restandardization Committee’s goals:
delete objectionable, nonworking, outdated items, and replace with items addressing contemporary clinical problems and applications
to ensure continuity with the original instrument, keep the MMPI validity, standard, and several supplementary scales virtually intact
develop new scales to address problems not covered in the original MMPI
collect new, randomly solicited samples of adults and adolescents, representative of the US population, to develop age-appropriate norms
develop new normative distributions that would better reflect clinical problems
collect a broad range of clinical data for evaluating changes to be made in the original scales and for validating the new scales
Development of the MMPI-2
- normative sample of 2,600 subjects (1,462 women & 1,138 men)
- balanced for gender and demographic characteristics (e.g. ethnic group)
- a number of normative and clinical studies provided validation for the MMPI-2 standard scales and the new content scales. Studies were conducted with: inpatient psychiatric facilities, alcohol treatment settings, mothers at risk or child abuse, outpatients in marital distress, antisocial personalities, posttraumatic stress-disordered veterans, older men, military personnel, college students
- Present-day subjects tend to endorse more items in the pathological direction, producing higher mean scores. This is likely due to the change in test administration (originally item omissions were allowed, now they are discouraged)
- Original MMPI norms developed using a linear T-score transformation
o T-score distributions: mean of 50, standard deviation of 10
o Original MMPI: consider T score of 70 a cutoff for “clinically significant” (95th percentile)
o MMPI-2: T score of 65 (92nd percentile) is the optimal score level for separating known clinical groups from the normative sample; indicates “clinical range”
- MMPI-2 content scales assess:
o Symptomatic behaviour (Anxiety, Fears, Obsessiveness, Depression, Health concerns, Bizarre mentation)
o Personality factors (Type A behaviour, Cynicism)
o Externalizing behaviour (Anger, Antisocial practices)
o Negative self view (Low self esteem)
o Clinical problem areas (Family problems, Work interference, Negative treatment indicators)
Development of the MMPI-A
- Experimental “Form TX” for adolescents, to see if a separate version of the MMPI for adolescents would prove useful and valid
- 704-item Form TX administered to 815 girls and 804 boys in normative sample, ages 14-18, as well as in an extensive clinical evaluation study
- new items added to address adolescent problems and behaviours (e.g. attitudes about school and parents, peer-group influence, eating problems)
- items about youthful behaviours that were worded in the past tense in MMPI-2, were changed to present tense for MMPI-A
Table 1.1. (pg. 10) Reasons for Acceptance of the MMPI-2 and MMPI-A in Psychological Assessment
easy to administer, available in booklets, cassette tape, computer administration; takes 1-1.5 hours to complete
individuals self-administer, answering T or F; sixth grade reading level
many foreign language versions of the MMPI-2 and MMPI-A are in use
relatively easy to score (and computer scoring available)
appraises test-taking attitudes of the client
objectively interpreted instrument (empirically validated scales possess clearly established meanings)
good reliability
clear, valid descriptions of people’s problems, symptoms, personality characteristics; scale elevations and code-type descriptions provide useful terminology for clinicians
enable practitioners to predict future behaviours and responses to different treatment approaches
provides a valuable method for providing test feedback about personality characteristics, symptoms, etc. to clients
Objective Personality Assessment using the MMPI-2 and MMPI-A
Research began in 1939 (Hathaway & McKinley) to develop an inventory to aid in assessing and diagnosing patients with mental disorders
MMPI has become the most widely used and researched objective personality inventory in the world
Used in many settings (psychiatric clinics, hospitals, medical settings, adolescents, inmates, alcohol/drug treatment units, military personnel, applicants for highly responsible positions)
1940s-50s first translations; by 1989 there were over 140 MMPI translations in 46 countries
Successful because:
useful and practical technique for assessing individuals reporting mental health symptoms and problems,
many research studies document its reliability/validity,
useful predictive information in a cost-effective manner,
detection of invalid records
simple language, simple administration & scoring
clinical familiarity of profile variables
reliable evaluations
possible to evaluate the credibility of a person’s self report (using validity scales)
person’s score can be interpreted using norms
Development of the MMPI
- Hathaway & McKinley believe self-report provides useful information
- Patients who endorsed similar items/symptoms on the MMPI are diagnostically more alike than different
- Individuals endorsing more symptoms of a particular kind are viewed as experiencing a more serious problem
- Empirical Scale-Construction strategy: any item on a scale was assigned to that scale only if it objectively discriminated a given criterion group (e.g. individuals with depression) from their normative sample (e.g. healthy participants)
- “Blind/Dustbowl Empiricism”- Hathaway & McKinley’s strategy of classifying items with constructs based solely on comparing the responses of normal subjects with groups of well-classified patients (see pg. 3)
Revisions of the MMPI
- changes in the DSM,
- items become out of date, some items were objectionable,
- original normative sample was white, rural subjects from Minnesota, while instrument was used across the US with broadly diverse clients
- 1982, revision of MMPI was not to radically change it, but to modernize and restandardize an instrument of demonstrated reliability and validity
MMPI Restandardization Committee’s goals:
delete objectionable, nonworking, outdated items, and replace with items addressing contemporary clinical problems and applications
to ensure continuity with the original instrument, keep the MMPI validity, standard, and several supplementary scales virtually intact
develop new scales to address problems not covered in the original MMPI
collect new, randomly solicited samples of adults and adolescents, representative of the US population, to develop age-appropriate norms
develop new normative distributions that would better reflect clinical problems
collect a broad range of clinical data for evaluating changes to be made in the original scales and for validating the new scales
Development of the MMPI-2
- normative sample of 2,600 subjects (1,462 women & 1,138 men)
- balanced for gender and demographic characteristics (e.g. ethnic group)
- a number of normative and clinical studies provided validation for the MMPI-2 standard scales and the new content scales. Studies were conducted with: inpatient psychiatric facilities, alcohol treatment settings, mothers at risk or child abuse, outpatients in marital distress, antisocial personalities, posttraumatic stress-disordered veterans, older men, military personnel, college students
- Present-day subjects tend to endorse more items in the pathological direction, producing higher mean scores. This is likely due to the change in test administration (originally item omissions were allowed, now they are discouraged)
- Original MMPI norms developed using a linear T-score transformation
o T-score distributions: mean of 50, standard deviation of 10
o Original MMPI: consider T score of 70 a cutoff for “clinically significant” (95th percentile)
o MMPI-2: T score of 65 (92nd percentile) is the optimal score level for separating known clinical groups from the normative sample; indicates “clinical range”
- MMPI-2 content scales assess:
o Symptomatic behaviour (Anxiety, Fears, Obsessiveness, Depression, Health concerns, Bizarre mentation)
o Personality factors (Type A behaviour, Cynicism)
o Externalizing behaviour (Anger, Antisocial practices)
o Negative self view (Low self esteem)
o Clinical problem areas (Family problems, Work interference, Negative treatment indicators)
Development of the MMPI-A
- Experimental “Form TX” for adolescents, to see if a separate version of the MMPI for adolescents would prove useful and valid
- 704-item Form TX administered to 815 girls and 804 boys in normative sample, ages 14-18, as well as in an extensive clinical evaluation study
- new items added to address adolescent problems and behaviours (e.g. attitudes about school and parents, peer-group influence, eating problems)
- items about youthful behaviours that were worded in the past tense in MMPI-2, were changed to present tense for MMPI-A
Table 1.1. (pg. 10) Reasons for Acceptance of the MMPI-2 and MMPI-A in Psychological Assessment
easy to administer, available in booklets, cassette tape, computer administration; takes 1-1.5 hours to complete
individuals self-administer, answering T or F; sixth grade reading level
many foreign language versions of the MMPI-2 and MMPI-A are in use
relatively easy to score (and computer scoring available)
appraises test-taking attitudes of the client
objectively interpreted instrument (empirically validated scales possess clearly established meanings)
good reliability
clear, valid descriptions of people’s problems, symptoms, personality characteristics; scale elevations and code-type descriptions provide useful terminology for clinicians
enable practitioners to predict future behaviours and responses to different treatment approaches
provides a valuable method for providing test feedback about personality characteristics, symptoms, etc. to clients
Chapter Two
CHAPTER 2
Administering, Scoring, and Profiling the MMPI-2 and MMPI-A
Selecting the Proper Form
- MMPI-A recommended for use with adolescents 14-18 years old; MMPI-2 for adults age 18+
- Clinicians working with 18-year olds should be aware of how the MMPI-2 and MMPI-A norm sets can produce different T scores based on the same raw score.
- Generally MMPI-2 norms will result in slightly higher T scores for the standard scales than would the use of MMPI-A norms
- In general, the MMPI-A item content is more appropriate for 18-year olds still living at home with parents and attending high school; the MMPI-2 is more appropriate for 18-year olds living away from their parents’ home, either in college or employed full time.
- Some clinicians question whether to use the MMPI-A for 19, 20 year olds or the MMPI-2 form for 16, 17 year olds (e.g. appropriate form is not available, a 16-year old being tried in adult court…). Test manuals clearly state that it is inappropriate to make individual predictions for those outside the age range of the instrument.
- 12-13 year old adolescents excluded from the MMPI-A Restandardization project’s normative sample because they produced a greater number of invalid profiles than did older adolescents. Clinicians should consider whether a 12-13 year old has the reading level, breadth of experiences, and patience to complete an MMPI-A. If successfully administered to a 12 or 13-year old, follow the scoring norms in the test manual
- Question whether client can read and understand English well enough to respond to the items. Sixth grade English-language reading level required. Foreign language versions of the MMPI-2 and MMPI-A are available.
Administering the MMPI-2 and MMPI-A
- test should be administered in a professional manner to encourage a serious, task-oriented attitude on the part of the test-taker
- comfortable, private, supervised setting should be provided
- client should have enough work space to feel that their responses can be made privately, without concern about answers being observed
- desirable to explain the reasons for administering the MMPI-2 or MMPI-A , to ensure validity of the self-report.
Special Administration Considerations for Adults
- in some situations (e.g. personnel screening) applicants want to present themselves in a positive light, may be defensive about responses, resulting in invalid profiles. Some assessors attempt to obtain more valid recodrds by having applicants retake the test after alerting them to the fact that they were initially “too defensive” and produced unusable results. Usually re-taking the test results in less defensive profiles
- Some research has shown (pg 17) that subjects re-taking the test with special instructions about defensiveness (as above) usually have a valid second profile without significantly increasing their elevations on clinical scales. However, 14% of applicants had a valid second profile with significant scale elevations the second time, indicating that some applicants do “mask” psychological problems which can be detected on retest under conditions of altered instructions
Special Administration Considerations for Adolescents
Ensure the adolescent is a willing participant in the testing and approaches the task in a cooperative manner
Ensure the testing situation is private and free from intrusions/distractions
Ensure the adolescent understands the test instructions
Ensure the adolescent understands the MMPI-A instructions (requires a 6th grade reading level)
Provide sufficient breaks and reinforcements
Table 2.1 (pg. 19) shows words on the MMPI-A that adolescents commonly question,
along with standardized definitions and examples to clarify
MMPI-2 and MMPI-A Formats
- Paper and pencil versions (hardcover and softcover)
- Audiocassette versions
- Computer-Administered versions
o Some people (adolescents) prefer
o Takes less time to complete
o Scales can be scored and computer interpreted immediately after
Abbreviated and Short Forms for the MMPI-2 and MMPI-A
- Some researchers attempted to develop effective shortened versions of the oritinal MMPI to reduce the testing time for clients. However, none were found to provide sufficient information and were not recommended for clinical use.
Computer Adaptive Administration
- Item administration contingent on previous responding is technically possible, but this format has not yet been developed for clinical use
Scoring the MMPI-2 and MMPI-A
- Hand Scoring
o Trained individual hand scores the answer sheet and draws profiles by hand, time consuming (15-40 minutes)
o All scales (except VRIN and TRIN inconsistency scales) are scored by counting the number of items endorsed on the particular scale. Scoring templates are place over the answer sheet, responses are recorded on the appropriate place on the profile sheet
o Computer Scoring, Mail-in scoring
Plotting MMPI-2 and MMPI-A Profiles
- visual summary of the scale elevations and patterns of scores
- separate profiles are used for males and females
Uniform T Scores
- Restandardization Committee established uniform T scores, that would allow all the scale scores to fall at equivalent percentile ranks
K Correction
- Five of the MMPI-2 raw scores (Hs, Pd, Pt, Sc, Ma) are adjusted by adding a correction, based on the K score, in an effort to compensate for test defensiveness (not used for adolescents)
Coding the MMPI-2 and MMPI-A Profiles
The Welsh Code
o Each of the MMPI-2 and MMPI-A standard scales has a number that serves as the basis for coding
o Each standard scale is represented by its number
(Hs 1) (D 2) (Hy 3) (Pd 4) (Mf 5) (Pa 6) (Pt 7) (Sc 8) (Ma 9) (Si 0)
o Write down the numbers representing the scales in order of T-score elevation, from highest to lowest
o Enter the appropriate symbols to denote scale elevation
(# 30-39) (: 40-49) (/ 50-59) (- 60-64) (+ 65-69) (‘ 70-79) (“ 80-89)
(* 90-99) (** 100 or more)
See pages 32-35 for more information on writing the Welsh code for a profile
Administering, Scoring, and Profiling the MMPI-2 and MMPI-A
Selecting the Proper Form
- MMPI-A recommended for use with adolescents 14-18 years old; MMPI-2 for adults age 18+
- Clinicians working with 18-year olds should be aware of how the MMPI-2 and MMPI-A norm sets can produce different T scores based on the same raw score.
- Generally MMPI-2 norms will result in slightly higher T scores for the standard scales than would the use of MMPI-A norms
- In general, the MMPI-A item content is more appropriate for 18-year olds still living at home with parents and attending high school; the MMPI-2 is more appropriate for 18-year olds living away from their parents’ home, either in college or employed full time.
- Some clinicians question whether to use the MMPI-A for 19, 20 year olds or the MMPI-2 form for 16, 17 year olds (e.g. appropriate form is not available, a 16-year old being tried in adult court…). Test manuals clearly state that it is inappropriate to make individual predictions for those outside the age range of the instrument.
- 12-13 year old adolescents excluded from the MMPI-A Restandardization project’s normative sample because they produced a greater number of invalid profiles than did older adolescents. Clinicians should consider whether a 12-13 year old has the reading level, breadth of experiences, and patience to complete an MMPI-A. If successfully administered to a 12 or 13-year old, follow the scoring norms in the test manual
- Question whether client can read and understand English well enough to respond to the items. Sixth grade English-language reading level required. Foreign language versions of the MMPI-2 and MMPI-A are available.
Administering the MMPI-2 and MMPI-A
- test should be administered in a professional manner to encourage a serious, task-oriented attitude on the part of the test-taker
- comfortable, private, supervised setting should be provided
- client should have enough work space to feel that their responses can be made privately, without concern about answers being observed
- desirable to explain the reasons for administering the MMPI-2 or MMPI-A , to ensure validity of the self-report.
Special Administration Considerations for Adults
- in some situations (e.g. personnel screening) applicants want to present themselves in a positive light, may be defensive about responses, resulting in invalid profiles. Some assessors attempt to obtain more valid recodrds by having applicants retake the test after alerting them to the fact that they were initially “too defensive” and produced unusable results. Usually re-taking the test results in less defensive profiles
- Some research has shown (pg 17) that subjects re-taking the test with special instructions about defensiveness (as above) usually have a valid second profile without significantly increasing their elevations on clinical scales. However, 14% of applicants had a valid second profile with significant scale elevations the second time, indicating that some applicants do “mask” psychological problems which can be detected on retest under conditions of altered instructions
Special Administration Considerations for Adolescents
Ensure the adolescent is a willing participant in the testing and approaches the task in a cooperative manner
Ensure the testing situation is private and free from intrusions/distractions
Ensure the adolescent understands the test instructions
Ensure the adolescent understands the MMPI-A instructions (requires a 6th grade reading level)
Provide sufficient breaks and reinforcements
Table 2.1 (pg. 19) shows words on the MMPI-A that adolescents commonly question,
along with standardized definitions and examples to clarify
MMPI-2 and MMPI-A Formats
- Paper and pencil versions (hardcover and softcover)
- Audiocassette versions
- Computer-Administered versions
o Some people (adolescents) prefer
o Takes less time to complete
o Scales can be scored and computer interpreted immediately after
Abbreviated and Short Forms for the MMPI-2 and MMPI-A
- Some researchers attempted to develop effective shortened versions of the oritinal MMPI to reduce the testing time for clients. However, none were found to provide sufficient information and were not recommended for clinical use.
Computer Adaptive Administration
- Item administration contingent on previous responding is technically possible, but this format has not yet been developed for clinical use
Scoring the MMPI-2 and MMPI-A
- Hand Scoring
o Trained individual hand scores the answer sheet and draws profiles by hand, time consuming (15-40 minutes)
o All scales (except VRIN and TRIN inconsistency scales) are scored by counting the number of items endorsed on the particular scale. Scoring templates are place over the answer sheet, responses are recorded on the appropriate place on the profile sheet
o Computer Scoring, Mail-in scoring
Plotting MMPI-2 and MMPI-A Profiles
- visual summary of the scale elevations and patterns of scores
- separate profiles are used for males and females
Uniform T Scores
- Restandardization Committee established uniform T scores, that would allow all the scale scores to fall at equivalent percentile ranks
K Correction
- Five of the MMPI-2 raw scores (Hs, Pd, Pt, Sc, Ma) are adjusted by adding a correction, based on the K score, in an effort to compensate for test defensiveness (not used for adolescents)
Coding the MMPI-2 and MMPI-A Profiles
The Welsh Code
o Each of the MMPI-2 and MMPI-A standard scales has a number that serves as the basis for coding
o Each standard scale is represented by its number
(Hs 1) (D 2) (Hy 3) (Pd 4) (Mf 5) (Pa 6) (Pt 7) (Sc 8) (Ma 9) (Si 0)
o Write down the numbers representing the scales in order of T-score elevation, from highest to lowest
o Enter the appropriate symbols to denote scale elevation
(# 30-39) (: 40-49) (/ 50-59) (- 60-64) (+ 65-69) (‘ 70-79) (“ 80-89)
(* 90-99) (** 100 or more)
See pages 32-35 for more information on writing the Welsh code for a profile
Chapter Three
CHAPTER 3
Assessing the Validity of MMPI-2 Profiles
The MMPI-2 and the MMPI-A can both be faked
However, in most cases, when we know a person is trying to distort his/her responses, we’re able to appraise the person’s message and the extent of their response distortion
The determination of scale invalidity from a test score is a somewhat arbitrary process. Scores on a particular scale are continuous distributions; the determination of “valid” vs. “invalid” is a dichotomous process
In clinical interpretation, it is customary to use “cutoff scores” to determine the validity of performance on a validity scale.
Such cutoff scores represent a “best guess” estimate
Item Omissions, Inconsistent Responding, and Fixed Responding
Cannot Say Score (?)
The total number of items the test-taker didn’t answer
Provides insight into the subject’s cooperativeness
If the person omits more than 30 items within the first 370 questions, the protocol is considered invalid
Possible reasons for omissions include: test defensiveness, indecisiveness, fatigue, low mood, carelessness, poor reading skill, or perception that the item is irrelevant
Variable Response Inconsistency (VRIN)
VRIN is made up of 67 pairs of items, used to detect inconsistent responding; the scale is scored by summing the number of inconsistent responses
VRIN >= 80 indicates inconsistent random responding; MMPI protocol is invalid
VRIN 70-79 are potentially invalid
True Response Inconsistency (TRIN)
Consists of 23 pairs of items to which the same response is inconsistent
TRIN is scored as follows: inconsistencies in true pairs - inconsistencies in false pairs + 9
TRIN >= 80 indicates inconsistent responding due to “yea”- or “nay”-saying
“yea-saying” = TRIN>=80T
“nea-saying” = TRIN>=80F
VRIN 70-79 suggests possible inconsistent responding
All-True or All-False Pattern
An extremely low true or false percentage, less than 20%, represents a highly distorted response pattern (due to conscious manipulation or careless responding)
All true:
Elevates Pa, Pt, Sc, and Ma scales
F scale elevation is very high
L and K scores are very low
All scales (except SOD) are significantly elevated
All false:
L and K extremely elevated
F scale elevated
Produces a “neurotic” appearing profile
Most scales are attenuated (HEA is elevated)
Measures of Random and Exaggerated Responding
Infrequency (F) Scale
Theory is that people attempting to claim psychological problems that they don’t have will go to extremes and endorse symptoms from broad and inconsistent problem areas—in excess of what most patients would endorse (called “plus-getting”)
60 items representing a wide-range of symptoms and aberrant attitudes
“normal” persons usually endorse <5
note for our child people: the F scale for adults does not work for adolescents
F scale is also a good indicator of random responding
Endorsing approx. 30 items means the person may be engaging in random item endorsement, or committing an error in response recording
In sum, high-ranging F scores may reflect:
1. Possible recording error
2. Random responding
3. Possible disorientation
4. Severe psychopathology
5. Possible malingering
6. Different cultural background (see Table 3-4, on pg. 47 of text)
Infrenquency Back (Fb) Scale
Used to detect deviant/random responding after item 370
Suggested interpretations include:
1. If both Fb and F are elevated over T = 110, no interpretation of Fb is necessary as the clinical and content scales may be invalid by F scale criteria
2. If the F scale T score is <89, and Fb is <89, a generally valid approach is indicated
3. If the F scale T score is <89,>90, an interpretation of Fb is needed (see Table 3-5, pg. 48 of text, for guidelines)
Psychopathology Infrequency Fp Scale
Measure of infrequency that has been added to the basic profile; provides perspective on the veracity of the client’s symptom claiming
Fp items are rare or extreme within a sample of persons with severe psychological disability
Fp thus assesses the extent to which the subject is claiming more problems than people in an inpatient psychiatric facility
F-K (Dissimulation) Index
Another way of evaluating symptom exaggeration is to contrast performance on the F scale with performance on the K scale
High symptom checking (high F) plus low defensiveness (low K) suggests an invalid performance
Determined by subtracting the raw score of K from the raw score of F
Gough (the creator of the F-K scale) said that F-K score of 9 or greater suggests an invalid profile due to symptom exaggeration
Others have since suggested a score of 12 or higher to be invalid
Using the F-K index to discover “fake good” profiles has not worked well in practice, and is not recommended for clinical use
Measures of Defensiveness and Claims of Extreme Virtue
Lie (L) Scale
Measures the tendency to distort responses by claiming excessive virtue
15 items center around the assertion of great virtue (“I do not always tell the truth” [False])
T > 65 suggests the individual is claiming a degree of virtue not commonly found
L scale is also associated with personality characteristics that suggest naivete, lack of psychological mindedness, rigid thinking, unrealistic self-image, and neurotic defensiveness.
See Table 3-7, pg. 51 of text, for guidelines on interpreting L
K Scale
Measures test defensiveness (modifies 5 scales: Hs, Pd, Pt, Sc, and Ma)
Items are much less “obvious” than the L scale
Assesses willingness to disclose personal information and discuss problems
High scores (>65) reflect uncooperative attitude and reluctance to disclose personal information
Low scores (<45) suggest openness and frankness K s positively correlated with intelligence and educational level; this should be taken into consideration when interpreting scores Adjustment is probably necessary for persons with less than a high school education Some debate has emerged re: whether K actually improves discrimination However, non K corrected scores are not recommended for clinical interpretation, due to a lack of research on them See Table 3-8, pg. 52 of text for K interpretive guidelines Superlative Self-Presentation (S) Scale Measures test defensiveness Five subscales offer a breakdown of item content: 1. S1 – Beliefs in human goodness – items concerned with basic human goodness 2. S2 – Serenity – e.g., “I have never felt better in my life than I do now [True]” 3. S3 – Contentment with life – morale-related items 4. S4 – Patience/ denial of irritability – endorsing content on this scale suggests the person is calm, cool, and patient 5. S5 – Denial of moral flaws – items deal with denial of flaws Elevations on these subscales suggest particular content areas wherein the client is denying difficulty. Persons taking the MMPI-2 in personnel screening situations are typically defensive on all 5 subscales; persons evaluated in family custody cases tend to have high elevations on S4 and S5 Patterns of Response Invalidity Fake-good profile Presenting an overly-favorable self-view L is prominent, suggesting extremely high virtue This profile is associated with child-custody evaluations, personnel screening, and injury litigation Defensive Profile Found in persons unwilling to disclose personal information (e.g., reluctant therapy cases; persons being assessed against their will) High K and S elevations This profile doesn’t clearly explain the person’s adjustment problems; a cautious statement re: the subject’s reluctance to report problems should be made When basic or content scale elevations occur in the context of a defensive record, the results should not be considered invalid, but rather should be interpreted with the understanding that test profles are likely to underrepresent problems Exaggerated Symptom Pattern Shown below is a marginally valid profile; it should be interpreted with great caution, as the individual clearly intended to present more problems than he or she actually is The highly exaggerated profile shown below is a clear case of a mixed and confused clinical picture, in which a number of extreme and possibly unrelated symptoms are endorsed The below profile was obtained in a worker’s comp. case wherein a person was claiming physical injury, when no work-related injury incident had been reported Invalid Exaggerated Pattern The extremely exaggerated profile shown below should not be interpreted, save to note that it is an exaggerated, and likely faked, record. The persons has endorsed a broad range of unrelated symptoms, and the high VRIN score further supports the notion that the respondent has not answered items in a consistent, selective, task-oriented manner.
Assessing the Validity of MMPI-2 Profiles
The MMPI-2 and the MMPI-A can both be faked
However, in most cases, when we know a person is trying to distort his/her responses, we’re able to appraise the person’s message and the extent of their response distortion
The determination of scale invalidity from a test score is a somewhat arbitrary process. Scores on a particular scale are continuous distributions; the determination of “valid” vs. “invalid” is a dichotomous process
In clinical interpretation, it is customary to use “cutoff scores” to determine the validity of performance on a validity scale.
Such cutoff scores represent a “best guess” estimate
Item Omissions, Inconsistent Responding, and Fixed Responding
Cannot Say Score (?)
The total number of items the test-taker didn’t answer
Provides insight into the subject’s cooperativeness
If the person omits more than 30 items within the first 370 questions, the protocol is considered invalid
Possible reasons for omissions include: test defensiveness, indecisiveness, fatigue, low mood, carelessness, poor reading skill, or perception that the item is irrelevant
Variable Response Inconsistency (VRIN)
VRIN is made up of 67 pairs of items, used to detect inconsistent responding; the scale is scored by summing the number of inconsistent responses
VRIN >= 80 indicates inconsistent random responding; MMPI protocol is invalid
VRIN 70-79 are potentially invalid
True Response Inconsistency (TRIN)
Consists of 23 pairs of items to which the same response is inconsistent
TRIN is scored as follows: inconsistencies in true pairs - inconsistencies in false pairs + 9
TRIN >= 80 indicates inconsistent responding due to “yea”- or “nay”-saying
“yea-saying” = TRIN>=80T
“nea-saying” = TRIN>=80F
VRIN 70-79 suggests possible inconsistent responding
All-True or All-False Pattern
An extremely low true or false percentage, less than 20%, represents a highly distorted response pattern (due to conscious manipulation or careless responding)
All true:
Elevates Pa, Pt, Sc, and Ma scales
F scale elevation is very high
L and K scores are very low
All scales (except SOD) are significantly elevated
All false:
L and K extremely elevated
F scale elevated
Produces a “neurotic” appearing profile
Most scales are attenuated (HEA is elevated)
Measures of Random and Exaggerated Responding
Infrequency (F) Scale
Theory is that people attempting to claim psychological problems that they don’t have will go to extremes and endorse symptoms from broad and inconsistent problem areas—in excess of what most patients would endorse (called “plus-getting”)
60 items representing a wide-range of symptoms and aberrant attitudes
“normal” persons usually endorse <5
note for our child people: the F scale for adults does not work for adolescents
F scale is also a good indicator of random responding
Endorsing approx. 30 items means the person may be engaging in random item endorsement, or committing an error in response recording
In sum, high-ranging F scores may reflect:
1. Possible recording error
2. Random responding
3. Possible disorientation
4. Severe psychopathology
5. Possible malingering
6. Different cultural background (see Table 3-4, on pg. 47 of text)
Infrenquency Back (Fb) Scale
Used to detect deviant/random responding after item 370
Suggested interpretations include:
1. If both Fb and F are elevated over T = 110, no interpretation of Fb is necessary as the clinical and content scales may be invalid by F scale criteria
2. If the F scale T score is <89, and Fb is <89, a generally valid approach is indicated
3. If the F scale T score is <89,>90, an interpretation of Fb is needed (see Table 3-5, pg. 48 of text, for guidelines)
Psychopathology Infrequency Fp Scale
Measure of infrequency that has been added to the basic profile; provides perspective on the veracity of the client’s symptom claiming
Fp items are rare or extreme within a sample of persons with severe psychological disability
Fp thus assesses the extent to which the subject is claiming more problems than people in an inpatient psychiatric facility
F-K (Dissimulation) Index
Another way of evaluating symptom exaggeration is to contrast performance on the F scale with performance on the K scale
High symptom checking (high F) plus low defensiveness (low K) suggests an invalid performance
Determined by subtracting the raw score of K from the raw score of F
Gough (the creator of the F-K scale) said that F-K score of 9 or greater suggests an invalid profile due to symptom exaggeration
Others have since suggested a score of 12 or higher to be invalid
Using the F-K index to discover “fake good” profiles has not worked well in practice, and is not recommended for clinical use
Measures of Defensiveness and Claims of Extreme Virtue
Lie (L) Scale
Measures the tendency to distort responses by claiming excessive virtue
15 items center around the assertion of great virtue (“I do not always tell the truth” [False])
T > 65 suggests the individual is claiming a degree of virtue not commonly found
L scale is also associated with personality characteristics that suggest naivete, lack of psychological mindedness, rigid thinking, unrealistic self-image, and neurotic defensiveness.
See Table 3-7, pg. 51 of text, for guidelines on interpreting L
K Scale
Measures test defensiveness (modifies 5 scales: Hs, Pd, Pt, Sc, and Ma)
Items are much less “obvious” than the L scale
Assesses willingness to disclose personal information and discuss problems
High scores (>65) reflect uncooperative attitude and reluctance to disclose personal information
Low scores (<45) suggest openness and frankness K s positively correlated with intelligence and educational level; this should be taken into consideration when interpreting scores Adjustment is probably necessary for persons with less than a high school education Some debate has emerged re: whether K actually improves discrimination However, non K corrected scores are not recommended for clinical interpretation, due to a lack of research on them See Table 3-8, pg. 52 of text for K interpretive guidelines Superlative Self-Presentation (S) Scale Measures test defensiveness Five subscales offer a breakdown of item content: 1. S1 – Beliefs in human goodness – items concerned with basic human goodness 2. S2 – Serenity – e.g., “I have never felt better in my life than I do now [True]” 3. S3 – Contentment with life – morale-related items 4. S4 – Patience/ denial of irritability – endorsing content on this scale suggests the person is calm, cool, and patient 5. S5 – Denial of moral flaws – items deal with denial of flaws Elevations on these subscales suggest particular content areas wherein the client is denying difficulty. Persons taking the MMPI-2 in personnel screening situations are typically defensive on all 5 subscales; persons evaluated in family custody cases tend to have high elevations on S4 and S5 Patterns of Response Invalidity Fake-good profile Presenting an overly-favorable self-view L is prominent, suggesting extremely high virtue This profile is associated with child-custody evaluations, personnel screening, and injury litigation Defensive Profile Found in persons unwilling to disclose personal information (e.g., reluctant therapy cases; persons being assessed against their will) High K and S elevations This profile doesn’t clearly explain the person’s adjustment problems; a cautious statement re: the subject’s reluctance to report problems should be made When basic or content scale elevations occur in the context of a defensive record, the results should not be considered invalid, but rather should be interpreted with the understanding that test profles are likely to underrepresent problems Exaggerated Symptom Pattern Shown below is a marginally valid profile; it should be interpreted with great caution, as the individual clearly intended to present more problems than he or she actually is The highly exaggerated profile shown below is a clear case of a mixed and confused clinical picture, in which a number of extreme and possibly unrelated symptoms are endorsed The below profile was obtained in a worker’s comp. case wherein a person was claiming physical injury, when no work-related injury incident had been reported Invalid Exaggerated Pattern The extremely exaggerated profile shown below should not be interpreted, save to note that it is an exaggerated, and likely faked, record. The persons has endorsed a broad range of unrelated symptoms, and the high VRIN score further supports the notion that the respondent has not answered items in a consistent, selective, task-oriented manner.
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.
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.
Chapter Five
CHAPTER 5
INTERPRETING MMPI-2 PROFILE TYPES (CODE TYPES)
Profile or code types are MMPI-2 clinical scale summary indexes that include the most prominent scale elevations in a configuration of the standard MMPI-2 scales.
Code-type interpretation was developed as recognition that in many cases, more than one standard scale was usually elevated. They are based on the analysis of scale patterns.
A code type is defined by the highest elevated scale or scales in the standard profile and their rank order in terms of elevation.
Scales most included in the research on code types: Hs, D, Hy, Pd, Pa, Pt, Sc, Ma.
For research on special populations include other scales, such as Mf and Si.
Single profile (profile spike): one single standard scale if elevated in the critical range.
Two point profile (more frequently researched): 2 clinical scales are elevated in the critical range (T≥65). The code defining such an occurrence would be something like 2-7/7-2.
Three-point code (frequent in different areas of research) occurs when 3 clinical scales are elevated in the profile (ex. 2-4-7, found in alcohol- and drug-treatment programs).
Four-point code is relatively rare. 1-2-3-4 can be found in medical settings.
How to use the code types
RULES
the profile should be clearly defined) i.e. 2 or more scales reach interpretative significance using the definitions discussed in the following). The more well-defined the code types is the better there is a match with the correlate literature.
there must be sufficient research on behavioural descriptions for the code. If a code type is an infrequent one, the scale-by-scale interpretation strategy should be used.
Rather than statistical analyses which have limited application and do not provide a more accurate classification, code types are practical, easy to apply and summarize better the most important elements of a given profile.
Code-type definitions and stability
Typically, a large number of cases is required to obtain a sufficient number of subjects with a particular code. Researchers grouped similar type codes, to obtain a higher number sample (ex. 2-7 and 7-2), ignoring the score level and the rank order of the elevated scales. HOWEVER, both these features do have their own importance in differentiating characteristics.
The order of the scales within the code type might make an important difference regarding the relative importance of empirical descriptors, therefore it’s best to emphasize the correlates of the higher elevated scale of the code type.
Same with the difference in elevations of the code types, because the s elevation describes the likelihood that the empirical correlates apply to the case (the higher the elevation, the more confident we can be that the person indeed is exhibiting said behaviours)
MMPI has good test-retest reliability, ranging from medium to high.
The stability of the codes depends on how well the code is defined and there are reports of low congruence on retest. On the other hand, codes with more extreme scores (that is those that were well-defined by a substantial point separation between the scale scores in the code type and those not included in the code) tended to be similar at rests.
The greatest code-type agreement at rests was obtained for profiles with a 10-point T-score spread between the code type and the rest of the profile code.
Rules of thumb for assessing the stability of a profile code:
Profile code types that are 10 points or more above the next highest score are very likely to be found at retest.
Profile code types that are 5-9 points above the next score are likely to remain constant on retest.
Profile code types that are 4 or fewer points above the next score may shift on later retest but future profiles will probably maintain some elements and correlates of the initial code types.
Similarity of the traditional MMPI and MMPI-2 code types
· Types are quite consistent between the two types
· The need to make T scores fall at equivalent percentile values has affected some codes, especially the ones with less of a clear definition
· 90% of the profiles with a 5-point profile code definition have the same codes on both interviews.
· Limitations to using the MMPI-2 codes:
i. There may be some slight shifting of scales within the profile code between the two forms because of the difference in standardization samples and T-score transformation procedures. It is said that discrepancies are minor, but keep them in mind.
ii. There are code types which have scarce empirical descriptors. It is a good idea in this case to interpret not only based on the code-types but also based on the individual profiles and content scales. See chapter 8 on how to do that.
Research on MMPI/MMPI-2 code types
Meehl showed that using actuarial tables to interpret the profiles is a better strategy than clinical interpretation. Subsequent research supported his findings.
Two-point code-type descriptors
Correlates were obtained by collecting groups of patients who had similar code types and studying their behavioural characteristics by use of Q-sort ratings, history or other assessment methods.
1-2/2-1 Code type
Symptoms and behaviours
- Extreme somatic problems or chronic pain.
- Complain though there might be no physical basis for their illness.
- Overly concerned with health and bodily functions
- Overreact to minor physical dysfunctions.
- Common somatic symptoms: weakness, fatigue, dizziness.
- They appear tense, anxious, restless, irritable, dysphoric, brooding and unhappy. Hypersensitive.
- Loss of initiative
- Report depressed mood, withdrawal and reclusiveness.
- Very self-conscious in talking to others.
- They doubt their own abilities.
- Vacillate even in minor matters.
Personality characteristics
- Self-conscious, introverted and shy in social situations.
- Passive dependent and harboring hostility towards those perceived as not offering enough attention and emotional support.
Predictions
- Excessive alcohol or prescription drug use as a tension reduction mechanism.
- Diagnosed as neurotic (Hypochondriacal, anxious or depressive).
- Poor prognosis for traditional psychotherapy because they can tolerate high levels of discomfort before becoming motivated to change. Also, they resist psychological interpretation of symptoms.
- Tend to use repression and somatization.
- Lack of insight and self-understanding therefore they resist accepting responsibility for own behaviour.
- Any treatment gains are short lived.
1-3/3-1 code type
Symptoms and behaviours
- Report vague physical complaints that might increase under stress and disappear when stress subsides.
- No severe anxiety or depression
- Can function at reduced level of efficiency.
- Preference for medical explanations of symptoms and resistance to psychological interpretations.
- Tendency to deny and rationalize, seeming uninsightful.
- They view themselves as normal, responsible and without fault, with no appropriate concern for their own symptoms and problems.
- Overly optimistic and Pollyannaish.
Personality characteristics
- Seen as immature, egocentric and selfish.
- Viewed as passive, dependent and insecure when their strong needs for attention, affection and sympathy are not met.
- Viewed as outgoing and socially extroverted, but with superficial relationships.
- Self-preoccupied and lacking genuine involvement with ppl.
- Manipulative in social relations, lacking skills in dealing with the opposite gender and low in heterosexual drive.
- Resentment and hostility toward those who seem to not offer enough attention.
- Are seen as overcontrolled and passive-aggressive in relationships.
- Occasional anger outbursts.
- Usually conforming and conventional in attitudes and beliefs.
Predictors
- Diagnosed with psychophysiologic disorder and anxiety disorder, such as conversion or psychogenic pain disorders.
- Not likely to be motivated for psychotherapy.
- Expect definite answers and simple solutions to their problems.
- Will terminate therapy prematurely when the therapist fails to respond to their demands.
1-4/4-1 Code type
Symptoms and behaviours
- Severe hypochondriacal symptoms, especially nonspecific headaches and stomach distress.
- Indecisive and anxious
- Socially extroverted but lacking skills with the opposite gender
- Rebellious toward home and parents but do not express these feelings openly.
- Likely to be dissatisfied, pessimistic, demanding and grouchy.
- Acting out behaviours leading up to their somatic complaints.
Personality characteristics
- Personality problems are central.
- Maladjustment probably cause by acting-out behaviours and poor judgement
Predictors
- Excessive use of alcohol
- Lack of drive. Problems sustaining work or productive activity.
- Poorly defined goals and motivation.
- Usually resistant to traditional psychotherapy.
1-8/8-1
Symptoms and behaviours
- Long-term psychological problems.
- Feelings of hostility and aggression which cannot be expressed in a modulated, adaptive manner.
- Either inhibited and “bottled up” or overly belligerent and abrasive.
- Feel unhappy, depressed, confused and distractible.
- Flat affect
- Feel socially inadequate and have difficulties relating to the opposite gender.
Personality characteristics
- Long-term personality issues.
- Feel socially inadequate and lack trust in ppl.
- Isolated and alienated
- Report having a nomadic lifestyle.
Predictions
- Schizophrenia diagnosis. Bizarre somatic complaints that will make Tx difficult
- If not schizophrenic, they might still exhibit severe, chronic, unusual, intractable symptoms.
1-9/9-1
Symptoms and behaviours
- Extreme distress.
- Anxious, tense, restless with somatic complaints.
- Aggressive and belligerent if their somatic complaints are minimized.
- May be ambitious and have high drive level, but they tend to lack clear goals, becoming frustrated by an inability to achieve a high level.
Personality characteristics
- Passive-dependent personality style
- They try to deny personality problems.
Predictors
- Reluctant to accept psychological explanations for their medical problems
- Code found in brain-damaged persons who have difficulty coping with organic deficits.
2-3/3-2
Symptoms and behaviours
- No anxiety, but report feeling nervous, tense, worried, sad and depressed.
- Somatic complaints: fatigue, exhaustion, physical weakness, gastrointestinal complaints.
- Lack of interest and involvement in life.
- Report unable to get started.
- Decreased physical activity and lethargy.
Personality characteristics
- Passive, docile, dependent.
- History of self-doubt, inadequacy, insecurity, helplessness.
- Engage in behaviours that elicit nurturance from others but do not obtain what they consider adequate recognition for their symptoms.
- Hurt by minor criticism
- Overcontrolled and unable to express feelings
- They deny unacceptable impulses, avoid social involvement and feel especially uncomfortable around the opposite gender.
- Sexual maladjustment, impotence and frigidity.
Predictors
- Diagnosed with depressive disorder
- Not very responsive to psychotherapy
- Lack introspective ability.
- Able to function at a low level of efficiency for long periods.
- Able to tolerate a high level of unhappiness without seeking behaviour change.
- Seem driven to succeed but are afraid to place themselves in directly competitive situations.
- Feel a need to increase their responsibility in life, but dread the pressure associated with this.
2-4/4-2
Symptoms
- History of legal problems and impulsive behaviour.
- Unable to delay gratification of impulses
- Get into trouble with others.
- Little respect for social standards and values.
- Tendency to act out…excessive drinking.
- Appear to be frustrated by their lack of accomplishments.
- Resentful of demands placed by others
- After acting out, they express guilt and remorse, lacking sincerity about changing.
Personality characteristics
- Appear sociable and outgoing, making a favourable first impression
- Manipulate others, showing maladaptive personality traits
- Cause resentment in long-term relationships
- Façade of competence and self-assurance.
- In reality, they are overly self-conscious and dissatisfied with themselves.
- Passive-dependent.
Predictors
- Suicidal ideation and attempts (ESPECIALLY IF BOTH SCALES ARE VERY ELEVATED)
- Express need for help and desire to change, but have poor prognosis for psychotherapy success.
- Likely to terminate therapy prematurely when the outside stress subsides.
2-7/7-2
Symptoms and behaviours
- Appear anxious, tense, nervous and depressed.
- Report feeling unhappy, sad and tend to worry excessively.
- Feel vulnerable to real and imagined threats.
- Typically anticipate problems before they occur and overreact to minor stress as if it is a major catastrophe.
- Somatic complaints, fatigue, exhaustion, tiredness, weight loss, slow personal tempo, slowed speech and retarded thought process.
- Brood and ruminate.
- Strong need for achievement and recognition, with high expectations for themselves and others.
- May feel guilty when goals are not met.
- Perfectionistic attitudes and a history of being conscientious.
- May be excessively religious and extremely moralistic.
Personality characteristics
- Appear docile and passive-dependent in relationships
- Report problems in being assertive
- Show capacity for forming deep emotional ties
- Tend to lean on ppl to an excessive degree.
- Solicit nurturance from others.
- Long term issues with feelings of inadequacy, insecurity and inferiority.
- Intropunitive in dealing with feelings of aggression.
Predictors
- Diagnosed with MDD, OCD or anxiety disorders.
- Usually motivated for psychotherapy.
- Remain in therapy longer than other patients.
- Pessimistic about overcoming problems
- Indecisive and rigid in thinking.
- These traits tend to interfere with their problem-solving ability, but they DO improve with treatment (THANK GOD!!! I was starting to wonder why we even bother with psychotherapy and not just prescribe drugs)
2-8/8-2
Symptoms and behaviours
- Anxious, agitated, tense and jumpy
- Report sleep disturbance and inability to concentrate
- Disturbed affect and somatic symptoms
- Clinically depressed.
- Soft slowed speech and thought.
- In interviews, they appear emotional and tearful. Otherwise seen as apathetic and indifferent.
- Anger and problems with interpersonal relations
- Report forgetfulness, confusion and inefficiency in carrying out responsibilities.
- Viewed as unoriginal and stereotyped in problem solving and thinking.
- Underestimate the seriousness of problems and engage in unrealistic self-appraisal,
- Overly sensitive to the reactions of others
- Suspicious of others’ motivations
- History of being emotionally hurt. They fear getting hurt more so they avoid close relationships.
- Feelings of despair and worthlessness.
Personality characteristics
- Dependent, unassertive, irritable and resentful.
- Fear losing control over own emotions.
- Deny impulses but experience dissociative periods.
- Chronic, incapacitating symptoms
- Guilt ridden and self-punitive.
Predictors
- Serious maladjustment
- Underevaluate problems
- Most common diagnoses: MDP, schizophrenia, schizoaffective type, severe personality disorder.
- Suicidal thoughts. Create specific plans for it.
2-9/9-2
Symptoms and behaviours
- Self-centered and narcissistic
- Ruminate a great deal about self-worth.
- Express concern about achieving a high level but then set themselves up for failure.
- Identity crisis (for younger persons)
- Anxious, tense, somatic complains (gastrointestinal tract)
- History (if not current) of depression.
Personality characteristics
- Denial that hides feelings of inadequacy and worthlessness.
- Diagnosis: Bipolar disorder.
- Profile seen sometimes among persons with brain-damage who have lost control or are trying to cope with deficits through excessive activity.
- Use of alcohol as an escape from stress and pressure.
3-4/4-3
Symptoms and behaviours
- Chronic and intense anger
- Harboring hostile and aggressive impulses but cannot express them appropriately.
- Problems of self-control
- Although usually overcontrolled, they experience occasional brief episodes of assaultative, violent acting-out.
- Lack insight into the origins and consequences of their aggressiveness
- Extrapunitive.
- Do not see their behaviour as problematic.
- No anxiety or depression, but somatic complaints are present.
- Upset not related to external stress.
- Sexual maladjustment and promiscuity.
Personality characteristics
- Long-term ingrained feelings of hostility toward family members.
- Demand attention and approval from others
- Overly sensitive to rejection. Hostile when criticized
- Outwardly conforming, but inwardly rebellious.
Predictors
- Suicidal thoughts and attempts following acting-out episodes
- Diagnoses: passive-aggressive personality disorder, emotionally unstable personality.
3-6/6-3
Symptoms and behaviours
- Symptoms not incapacitating
- Moderate tension, anxiety, physical complaints
- May not recognize hostile feelings
- Appear defiant, uncooperative and hard to get along with.
- Appear suspicious and resentful.
- Self-centered and narcissistic.
- Tend to deny psychological problems.
Personality characteristics
- Chronic and deep feelings of hostility towards family members and ppl close to them.
- Not likely to express negative feelings directly
Predictions
- Naïve attitudes toward others
- Gullible at times
3-8/8-3
Symptoms and behaviours
- Psychological turmoil: anxiousness, tension, nervousness and fearfulness.
- Disturbed thinking, including somatic delusions.
- Might display phobias
- Symptomatic depression and feelings of hopelessness behind a smiling façade.
- Indecisiveness even for minor matters.
- Physical complaints.
- Vague and evasive when talking about complaints and difficulties.
- Disturbed thinking, concentration problems, lapses of memory, unusual ideas, loose ideational associations, obsessive ruminations, delusions, hallucinations, irrelevand and incoherent speech.
Personality characteristics
- Immature and dependent.
- Strong need for attentions and affection.
- Intropunitive interpersonal behaviour.
Predictions
- Apathetic, pessimistic and not actively involved or interested in life activities.
- Limited rehab efforts.
- Insight-oriented therapy might not be very effective.
- Seem unoriginal and stereotyped in problem solving.
- Diagnosis: schizophrenia.
- Responsive to supportive therapy.
4-6/6-4
Symptoms and behaviours
- narcissistic, immature, self-indulgent.
- Excessive and unrealistic demands on relationships.
- Attention and sympathy seekers.
- Suspicious of others and resentful of the demands made on them.
- Relationship problems, especially with the opposite gender.
- Mistrustful of the motives of others.
- Avoid deep emotional involvement.
- Seen as irritable, sullen, generally obnoxious, resentful of authority.
- In a study of imprisoned Palestinian and Israeli terrorists, it was found that the overall mean profile of the participants was 4-6/6-4. In addition, religious fundamentalists scored high on 8 in addition to 4 and 6.
Personality characteristics
- Personality adjustment problems
- Passive-dependent
- Hostility and anger
Predictions
- Denial of any serious psych problems through rationalization and transfer of blame onto others.
- Cannot accept responsibility for their own behaviours. Unrealistic and grandiose in self-appraisals.
- Unreceptive to psychotherapy
- Diagnosis: passive-aggressive personality disorder and paranoid personality disorder, or paranoid schizophrenia.
4-7/7-4
Symptoms and behaviours
- Alternate periods of gross insensitivity to the consequences of their actions and excessive concern about the effects of their behaviour.
- Episodes of acting out followed by temporary guilt and self-condemnation.
- Vague somatic complaints
- Tension, fatigue, exhaustion.
- Report inability to face pressing environmental problems.
Personality characteristics
- feelings of dependency and personal insecurity
Predictors
- Therapy: they respond to support and reassurance.
- Hard to make personality changes that remain permanent
- Too insecure so they require constant reassurance of self-worth (basically, get ready, he’ll need a cookie-reward even for breathing, which we all know even algae do at some level…sorry…becoming mean here)
4-8/8-4
Symptoms and behaviours
- Serious psychological problems
- Lack of fit in society. Act out in asocial ways.
- Viewed as odd, nonconforming, resentful of authority.
- Likely to exhibit unusual religious or political views.
- Likely to behave in erratic ways.
- Withdrawal into fantasy or might strike out in anger as defense to being hurt.
- Impulse control issues.
- Viewed as angry, irritable and resentful (charming bunch, eh? Kinda inviting the hurt, me thinks).
- Delinquency, criminal acts or sexual deviation. Excessive drug/alcohol abuse.
- May be afraid of inability to perform sexually. May indulge in antisocial sexual acts to demonstrate sexual adequacy. VERY FREQUENT PROFILE FOR RAPISTS.
- Withdrawn and isolated socially.
- Periods of suicidal ideation.
- Distrustful of others. Avoid close relationships.
- Seen as impaired in empathic ability and lacking basic social skills.
Personality characteristics
- Poor self concept is central
- Set up for rejection and failure which fuels their feelings of insecurity
- Exaggerated needs for attention and affection
Predictors
- History of underachievement and marginal maladjustment
- Diagnoses: severe personality disorders (antisocial, paranoid, schizoid) and schizophrenia.
- Accept little responsibility for their behaviours.
- Not good outcome to therapy.
- Rationalize and blame others for own difficulties.
- World is seen as threatening and rejecting therefore they might have difficulties establishing a therapeutic relationship.
4-9/9-4
Symptoms and behaviours
- Marked disregard for social standards and values.
- Antisocial behaviour with poorly developed conscience, loose morals and fluctuating ethical values (there’s Machiavelli for you)
- Antisocial acts abound (alcoholism, fighting, sexual acting out)
- Seen as selfish, self-indulgent and impulsive.
- Cannot delay gratification of impulses
- Poor judgment, acting with no thought of consequences.
- Fail to learn from punishing experiences (no don’t spank…it’ll only hurt your hand)
- Low frustration tolerance, moodiness, irritability, caustic manner.
- Feelings of anger and hostility expressed in negative emotional outbursts.
- Viewed as energetic, restless, overactive and needing to seek out emotional stimulation and excitement.
- Seem uninhibited, extroverted and talkative, creating a good first impression.
- Relationships are superficial and wear out in time.
Behaviour characteristics
- Narcissistic and incapable of deep emotional ties.
- Keep others at distance emotionally
- Social façade successful, hiding the lack of self-confidence and of security.
- Might present features of immature, insecure and dependent personality.
Predictors
- Do not accept responsibility for actions.
- Will not seek Tx unless urged so by others.
- Rationalize their own shortcomings and failures
- Place blame on others
- Legal, work or personal problems are time persistent.
6-8/8-6
Symptoms and behaviours
- Inferiority, insecurity, low self-confidence and poor self-esteem.
- May feel guilty about perceived failures.
- Withdrawal from activities and emotional apathy.
- Not involved with other ppl.
- Seen as suspicious, and distrustful of others, avoiding deep emotional ties and seeming deficient in social skills.
- More comfy when alone.
- Resent demands placed on them.
- Moody, irritable, unfriendly and negativistic.
- Psychotic behaviour may be present.
- Thinking: autistic, fragmented, tangential and circumstantial.
- Bizarre thought content, difficulties in concentrating, attention deficit, memory issues.
- Poor judgment.
- May exhibit severe confusion, delusions of persecution/grandeur, feelings of unreality and preoccupation with obscure or abstract matters.
- Blunted affect.
- Rapid and incoherent speech, withdrawal into fantasy and daydreaming. Might have difficulty differentiating reality from fantasy.
- Seem to lack effective defenses.
- Regress under stress and pressure.
Personality characteristics
- Severe long-term psychological problems.
- Schizoid lifestyle.
Predictors
- Diagnosis: schizophrenia. This profile is confirmed in other countries also.
- Tx: psychotropic medication, placement into a supportive, structured environment if they are viewed as a danger to themselves.
6-9/9-6
Symptoms and behaviours
- Overly sensitive and mistrustful
- Feel vulnerable to real or imagined threat.
- Might feel anxious much of the time and may be fearful and trembling.
- Overreact to minor stress.
- Respond to severe setbacks by withdrawing into fantasy.
- Signs of thought disorder, complain of difficulties in thinking and concentration problems.
- Delusions, hallucinations, irrelevant and incoherent speech, appear disoriented and perplexed.
Personality characteristics
- Strong need for affection
- Passive-dependent in relationships
Predictors
- may be diagnosed as schizophrenic (paranoid type) or mood disorder.
- Difficult to implement psychological Tx because person is disorganized, unproductive, ruminating. Also overideational and obsessional.
- Problems expressing emotions in adaptive, modulated ways.
- Alternate between overcontrol and uncontrolled emotional outbursts.
7-8/8-7
Symptoms and behaviours
- Great turmoil
- Not hesitant in admitting that they have psychological problems (Wow!!! I’m flabbergasted)
- Lack defenses to keep themselves comfortable and anxiety free.
- Report feeling depressed, worried, tense and nervous.
- Confused and in a state of panic, showing indecisiveness and poor judgment.
- Do not profit from experience.
- Overly introspective, ruminative and ideational.
Behavioural characteristics
- Chronic feelings of insecurity, inadequacy and indecisiveness.
- Not socially poised or confident. Withdrawn from social interactions.
- Passive-dependent. Cannot take dominant role in relationships.
- Troubles with mature heterosexual relationships, inadequate in traditional gender roles.
- Extreme or unusual sexual practices
Predictors
- Anxiety disorder
- Increased SC scale is associated with likelihood of psychotic and personality disorder.
- Might not show blatant psychotic symptoms.
- Good to think about medications to control the intense anxiety and thinking problems.
8-9/9-8
Symptoms and behaviours
- Social withdrawal and isolation.
- Uncomfortable in heterosexual relationships. Poor sexual adjustment.
- Seen as hyperactive, emotionally labile, agitated and excited.
- Loud and excessively talkative.
- Unrealistic in appraising themselves, grandiose, boastful and fickle.
- Denial of problems.
- Vague and circumstantial.
- Feelings of inferiority and inadequacy. Low self esteem and limited involvement in competitive situations.
Personality behaviours
- Self-centered, infantile in expectations of others
- Demand too much attention, becoming resentful and hostile when demands are not met.
- Resist and ear close emotional involvement (then how the heck can anyone love them and give them attention?!!!)
- Unable to focus on issues.
- Viewed as odd, unusual, autistic.
- Circumstantial thinking, bizarre speech, delusions and hallucinations sometimes.
Predictors
- Diagnosis: schizophrenia, or severe personality disorder.
- Severe thought disturbance can occur: confused, perplexed, disoriented, difficulty thinking and concentrating.
- May state no need for help, might not enter willingly therapy.
- Thought they feel a need to achieve, their actual performance tends to be mediocre.
Three-point code-type descriptors
1-2-3
Symptoms and behaviours
- psychological distress and difficulty adjusting psychologically.
- Lack stamina.
- Feel weak, fatigued, tense and nervous much of the time.
- Physical symptoms as a reaction to stress. Most reported: abdominal pain, headaches.
- Overreact to minor or normal physical changes with extreme concern.
- Dysphoria. Worry.
Personality characteristics
- Passive in relationships.
- If interacting, they simply complain and whine.
- Dependent, to be taken care of.
- Hostile and irritable if needs not met.
Predictors
- Low sex drive, problems in heterosexual adjustment.
- Diagnosis: somatoform disorder in a passive-aggressive or dependent personality.
- Do not recognize the psychological component in their problems.
- Uninsightful, feeling no control over their symptoms.
- Poor candidates for insight-oriented psychotherapy.
- Stress-management: develop problem-solving skills to cope with the stress.
- Clinical individuals have a hostile interaction style, carried over into therapy.
- Not receptive to suggestions from others.
2-4-7/2-7-4
Symptoms and behaviours
- Alcohol/drug abuse.
- Alternate b/w periods of gross insensivity to the consequences of own actions and excessive concern about the effects of behaviours.
- Episodes of acting out then temporary guilt and self-condemnation.
- Vague somatic complaints, tension, fatigue, feeling exhausted ad unable to face environments pressure.
- Marital/work problems
Personality characteristics
- Dependency and personal insecurity.
- Severe personality problems.
- Self-oriented and hedonistic behaviour.
Predictors
- Permanent personality changes are difficult to make.
- Act out instead of dealing with conflict.
2-7-8
Symptoms and behaviours
- Chronic psychological maladjustment.
- Overwhelmed by anxiety, tension and depression.
- Feel helpless, alone inadequate and insecure.
- Attempt to control worries through intellectualization and unproductive self-analysis.
- Difficulty concentrating and making decisions.
- Functioning at very low levels of efficiency.
- Overreaction to minor stress, with rapid behavioural deterioration.
- Blame others for their problems.
- Chaotic lifestyle. Poor work history.
- Preoccupied with obscure religious ideas.
Personality characteristics
- Lack basic social skills.
- Behaviourally withdrawn.
- Relate to others ambivalently, never fully trusting or loving.
- Might never establish lasting, intimate relationships.
- The relations they do have are unrewarding, impoverished by feelings of insecurity and inadequacy.
Predictors
- Chronic behavioural pattern.
- Disorganized and unhappy existence.
- Episodes of intense and disturbed behaviour because of elevated stress level.
- Severe psychological disorder.
- Diagnosis: severe neurotic with anxiety disorder or dysthymic disorder in a schizoid personality.
- Seek and require professional help.
- Intensive therapy required due to chronicity.
- So many psychological concerns that it’s difficult to focus in therapy. Need a lot of emotional support.
- Low self-esteem. Feelings of inadequacy.
- Difficult for them to get energized towards the therapeutic action.
- Low expectation for positive therapy change therefore therapist must provide a positive, optimistic attitude.
- Overideational, unproductive rumination.
- Not good with unstructured, insight-oriented therapy. Might deteriorate if asked to do introspection.
- Might respond to supportive treatment and goal-oriented therapy.
- CLEAR SUICIDAL RISK.
INTERPRETING MMPI-2 PROFILE TYPES (CODE TYPES)
Profile or code types are MMPI-2 clinical scale summary indexes that include the most prominent scale elevations in a configuration of the standard MMPI-2 scales.
Code-type interpretation was developed as recognition that in many cases, more than one standard scale was usually elevated. They are based on the analysis of scale patterns.
A code type is defined by the highest elevated scale or scales in the standard profile and their rank order in terms of elevation.
Scales most included in the research on code types: Hs, D, Hy, Pd, Pa, Pt, Sc, Ma.
For research on special populations include other scales, such as Mf and Si.
Single profile (profile spike): one single standard scale if elevated in the critical range.
Two point profile (more frequently researched): 2 clinical scales are elevated in the critical range (T≥65). The code defining such an occurrence would be something like 2-7/7-2.
Three-point code (frequent in different areas of research) occurs when 3 clinical scales are elevated in the profile (ex. 2-4-7, found in alcohol- and drug-treatment programs).
Four-point code is relatively rare. 1-2-3-4 can be found in medical settings.
How to use the code types
RULES
the profile should be clearly defined) i.e. 2 or more scales reach interpretative significance using the definitions discussed in the following). The more well-defined the code types is the better there is a match with the correlate literature.
there must be sufficient research on behavioural descriptions for the code. If a code type is an infrequent one, the scale-by-scale interpretation strategy should be used.
Rather than statistical analyses which have limited application and do not provide a more accurate classification, code types are practical, easy to apply and summarize better the most important elements of a given profile.
Code-type definitions and stability
Typically, a large number of cases is required to obtain a sufficient number of subjects with a particular code. Researchers grouped similar type codes, to obtain a higher number sample (ex. 2-7 and 7-2), ignoring the score level and the rank order of the elevated scales. HOWEVER, both these features do have their own importance in differentiating characteristics.
The order of the scales within the code type might make an important difference regarding the relative importance of empirical descriptors, therefore it’s best to emphasize the correlates of the higher elevated scale of the code type.
Same with the difference in elevations of the code types, because the s elevation describes the likelihood that the empirical correlates apply to the case (the higher the elevation, the more confident we can be that the person indeed is exhibiting said behaviours)
MMPI has good test-retest reliability, ranging from medium to high.
The stability of the codes depends on how well the code is defined and there are reports of low congruence on retest. On the other hand, codes with more extreme scores (that is those that were well-defined by a substantial point separation between the scale scores in the code type and those not included in the code) tended to be similar at rests.
The greatest code-type agreement at rests was obtained for profiles with a 10-point T-score spread between the code type and the rest of the profile code.
Rules of thumb for assessing the stability of a profile code:
Profile code types that are 10 points or more above the next highest score are very likely to be found at retest.
Profile code types that are 5-9 points above the next score are likely to remain constant on retest.
Profile code types that are 4 or fewer points above the next score may shift on later retest but future profiles will probably maintain some elements and correlates of the initial code types.
Similarity of the traditional MMPI and MMPI-2 code types
· Types are quite consistent between the two types
· The need to make T scores fall at equivalent percentile values has affected some codes, especially the ones with less of a clear definition
· 90% of the profiles with a 5-point profile code definition have the same codes on both interviews.
· Limitations to using the MMPI-2 codes:
i. There may be some slight shifting of scales within the profile code between the two forms because of the difference in standardization samples and T-score transformation procedures. It is said that discrepancies are minor, but keep them in mind.
ii. There are code types which have scarce empirical descriptors. It is a good idea in this case to interpret not only based on the code-types but also based on the individual profiles and content scales. See chapter 8 on how to do that.
Research on MMPI/MMPI-2 code types
Meehl showed that using actuarial tables to interpret the profiles is a better strategy than clinical interpretation. Subsequent research supported his findings.
Two-point code-type descriptors
Correlates were obtained by collecting groups of patients who had similar code types and studying their behavioural characteristics by use of Q-sort ratings, history or other assessment methods.
1-2/2-1 Code type
Symptoms and behaviours
- Extreme somatic problems or chronic pain.
- Complain though there might be no physical basis for their illness.
- Overly concerned with health and bodily functions
- Overreact to minor physical dysfunctions.
- Common somatic symptoms: weakness, fatigue, dizziness.
- They appear tense, anxious, restless, irritable, dysphoric, brooding and unhappy. Hypersensitive.
- Loss of initiative
- Report depressed mood, withdrawal and reclusiveness.
- Very self-conscious in talking to others.
- They doubt their own abilities.
- Vacillate even in minor matters.
Personality characteristics
- Self-conscious, introverted and shy in social situations.
- Passive dependent and harboring hostility towards those perceived as not offering enough attention and emotional support.
Predictions
- Excessive alcohol or prescription drug use as a tension reduction mechanism.
- Diagnosed as neurotic (Hypochondriacal, anxious or depressive).
- Poor prognosis for traditional psychotherapy because they can tolerate high levels of discomfort before becoming motivated to change. Also, they resist psychological interpretation of symptoms.
- Tend to use repression and somatization.
- Lack of insight and self-understanding therefore they resist accepting responsibility for own behaviour.
- Any treatment gains are short lived.
1-3/3-1 code type
Symptoms and behaviours
- Report vague physical complaints that might increase under stress and disappear when stress subsides.
- No severe anxiety or depression
- Can function at reduced level of efficiency.
- Preference for medical explanations of symptoms and resistance to psychological interpretations.
- Tendency to deny and rationalize, seeming uninsightful.
- They view themselves as normal, responsible and without fault, with no appropriate concern for their own symptoms and problems.
- Overly optimistic and Pollyannaish.
Personality characteristics
- Seen as immature, egocentric and selfish.
- Viewed as passive, dependent and insecure when their strong needs for attention, affection and sympathy are not met.
- Viewed as outgoing and socially extroverted, but with superficial relationships.
- Self-preoccupied and lacking genuine involvement with ppl.
- Manipulative in social relations, lacking skills in dealing with the opposite gender and low in heterosexual drive.
- Resentment and hostility toward those who seem to not offer enough attention.
- Are seen as overcontrolled and passive-aggressive in relationships.
- Occasional anger outbursts.
- Usually conforming and conventional in attitudes and beliefs.
Predictors
- Diagnosed with psychophysiologic disorder and anxiety disorder, such as conversion or psychogenic pain disorders.
- Not likely to be motivated for psychotherapy.
- Expect definite answers and simple solutions to their problems.
- Will terminate therapy prematurely when the therapist fails to respond to their demands.
1-4/4-1 Code type
Symptoms and behaviours
- Severe hypochondriacal symptoms, especially nonspecific headaches and stomach distress.
- Indecisive and anxious
- Socially extroverted but lacking skills with the opposite gender
- Rebellious toward home and parents but do not express these feelings openly.
- Likely to be dissatisfied, pessimistic, demanding and grouchy.
- Acting out behaviours leading up to their somatic complaints.
Personality characteristics
- Personality problems are central.
- Maladjustment probably cause by acting-out behaviours and poor judgement
Predictors
- Excessive use of alcohol
- Lack of drive. Problems sustaining work or productive activity.
- Poorly defined goals and motivation.
- Usually resistant to traditional psychotherapy.
1-8/8-1
Symptoms and behaviours
- Long-term psychological problems.
- Feelings of hostility and aggression which cannot be expressed in a modulated, adaptive manner.
- Either inhibited and “bottled up” or overly belligerent and abrasive.
- Feel unhappy, depressed, confused and distractible.
- Flat affect
- Feel socially inadequate and have difficulties relating to the opposite gender.
Personality characteristics
- Long-term personality issues.
- Feel socially inadequate and lack trust in ppl.
- Isolated and alienated
- Report having a nomadic lifestyle.
Predictions
- Schizophrenia diagnosis. Bizarre somatic complaints that will make Tx difficult
- If not schizophrenic, they might still exhibit severe, chronic, unusual, intractable symptoms.
1-9/9-1
Symptoms and behaviours
- Extreme distress.
- Anxious, tense, restless with somatic complaints.
- Aggressive and belligerent if their somatic complaints are minimized.
- May be ambitious and have high drive level, but they tend to lack clear goals, becoming frustrated by an inability to achieve a high level.
Personality characteristics
- Passive-dependent personality style
- They try to deny personality problems.
Predictors
- Reluctant to accept psychological explanations for their medical problems
- Code found in brain-damaged persons who have difficulty coping with organic deficits.
2-3/3-2
Symptoms and behaviours
- No anxiety, but report feeling nervous, tense, worried, sad and depressed.
- Somatic complaints: fatigue, exhaustion, physical weakness, gastrointestinal complaints.
- Lack of interest and involvement in life.
- Report unable to get started.
- Decreased physical activity and lethargy.
Personality characteristics
- Passive, docile, dependent.
- History of self-doubt, inadequacy, insecurity, helplessness.
- Engage in behaviours that elicit nurturance from others but do not obtain what they consider adequate recognition for their symptoms.
- Hurt by minor criticism
- Overcontrolled and unable to express feelings
- They deny unacceptable impulses, avoid social involvement and feel especially uncomfortable around the opposite gender.
- Sexual maladjustment, impotence and frigidity.
Predictors
- Diagnosed with depressive disorder
- Not very responsive to psychotherapy
- Lack introspective ability.
- Able to function at a low level of efficiency for long periods.
- Able to tolerate a high level of unhappiness without seeking behaviour change.
- Seem driven to succeed but are afraid to place themselves in directly competitive situations.
- Feel a need to increase their responsibility in life, but dread the pressure associated with this.
2-4/4-2
Symptoms
- History of legal problems and impulsive behaviour.
- Unable to delay gratification of impulses
- Get into trouble with others.
- Little respect for social standards and values.
- Tendency to act out…excessive drinking.
- Appear to be frustrated by their lack of accomplishments.
- Resentful of demands placed by others
- After acting out, they express guilt and remorse, lacking sincerity about changing.
Personality characteristics
- Appear sociable and outgoing, making a favourable first impression
- Manipulate others, showing maladaptive personality traits
- Cause resentment in long-term relationships
- Façade of competence and self-assurance.
- In reality, they are overly self-conscious and dissatisfied with themselves.
- Passive-dependent.
Predictors
- Suicidal ideation and attempts (ESPECIALLY IF BOTH SCALES ARE VERY ELEVATED)
- Express need for help and desire to change, but have poor prognosis for psychotherapy success.
- Likely to terminate therapy prematurely when the outside stress subsides.
2-7/7-2
Symptoms and behaviours
- Appear anxious, tense, nervous and depressed.
- Report feeling unhappy, sad and tend to worry excessively.
- Feel vulnerable to real and imagined threats.
- Typically anticipate problems before they occur and overreact to minor stress as if it is a major catastrophe.
- Somatic complaints, fatigue, exhaustion, tiredness, weight loss, slow personal tempo, slowed speech and retarded thought process.
- Brood and ruminate.
- Strong need for achievement and recognition, with high expectations for themselves and others.
- May feel guilty when goals are not met.
- Perfectionistic attitudes and a history of being conscientious.
- May be excessively religious and extremely moralistic.
Personality characteristics
- Appear docile and passive-dependent in relationships
- Report problems in being assertive
- Show capacity for forming deep emotional ties
- Tend to lean on ppl to an excessive degree.
- Solicit nurturance from others.
- Long term issues with feelings of inadequacy, insecurity and inferiority.
- Intropunitive in dealing with feelings of aggression.
Predictors
- Diagnosed with MDD, OCD or anxiety disorders.
- Usually motivated for psychotherapy.
- Remain in therapy longer than other patients.
- Pessimistic about overcoming problems
- Indecisive and rigid in thinking.
- These traits tend to interfere with their problem-solving ability, but they DO improve with treatment (THANK GOD!!! I was starting to wonder why we even bother with psychotherapy and not just prescribe drugs)
2-8/8-2
Symptoms and behaviours
- Anxious, agitated, tense and jumpy
- Report sleep disturbance and inability to concentrate
- Disturbed affect and somatic symptoms
- Clinically depressed.
- Soft slowed speech and thought.
- In interviews, they appear emotional and tearful. Otherwise seen as apathetic and indifferent.
- Anger and problems with interpersonal relations
- Report forgetfulness, confusion and inefficiency in carrying out responsibilities.
- Viewed as unoriginal and stereotyped in problem solving and thinking.
- Underestimate the seriousness of problems and engage in unrealistic self-appraisal,
- Overly sensitive to the reactions of others
- Suspicious of others’ motivations
- History of being emotionally hurt. They fear getting hurt more so they avoid close relationships.
- Feelings of despair and worthlessness.
Personality characteristics
- Dependent, unassertive, irritable and resentful.
- Fear losing control over own emotions.
- Deny impulses but experience dissociative periods.
- Chronic, incapacitating symptoms
- Guilt ridden and self-punitive.
Predictors
- Serious maladjustment
- Underevaluate problems
- Most common diagnoses: MDP, schizophrenia, schizoaffective type, severe personality disorder.
- Suicidal thoughts. Create specific plans for it.
2-9/9-2
Symptoms and behaviours
- Self-centered and narcissistic
- Ruminate a great deal about self-worth.
- Express concern about achieving a high level but then set themselves up for failure.
- Identity crisis (for younger persons)
- Anxious, tense, somatic complains (gastrointestinal tract)
- History (if not current) of depression.
Personality characteristics
- Denial that hides feelings of inadequacy and worthlessness.
- Diagnosis: Bipolar disorder.
- Profile seen sometimes among persons with brain-damage who have lost control or are trying to cope with deficits through excessive activity.
- Use of alcohol as an escape from stress and pressure.
3-4/4-3
Symptoms and behaviours
- Chronic and intense anger
- Harboring hostile and aggressive impulses but cannot express them appropriately.
- Problems of self-control
- Although usually overcontrolled, they experience occasional brief episodes of assaultative, violent acting-out.
- Lack insight into the origins and consequences of their aggressiveness
- Extrapunitive.
- Do not see their behaviour as problematic.
- No anxiety or depression, but somatic complaints are present.
- Upset not related to external stress.
- Sexual maladjustment and promiscuity.
Personality characteristics
- Long-term ingrained feelings of hostility toward family members.
- Demand attention and approval from others
- Overly sensitive to rejection. Hostile when criticized
- Outwardly conforming, but inwardly rebellious.
Predictors
- Suicidal thoughts and attempts following acting-out episodes
- Diagnoses: passive-aggressive personality disorder, emotionally unstable personality.
3-6/6-3
Symptoms and behaviours
- Symptoms not incapacitating
- Moderate tension, anxiety, physical complaints
- May not recognize hostile feelings
- Appear defiant, uncooperative and hard to get along with.
- Appear suspicious and resentful.
- Self-centered and narcissistic.
- Tend to deny psychological problems.
Personality characteristics
- Chronic and deep feelings of hostility towards family members and ppl close to them.
- Not likely to express negative feelings directly
Predictions
- Naïve attitudes toward others
- Gullible at times
3-8/8-3
Symptoms and behaviours
- Psychological turmoil: anxiousness, tension, nervousness and fearfulness.
- Disturbed thinking, including somatic delusions.
- Might display phobias
- Symptomatic depression and feelings of hopelessness behind a smiling façade.
- Indecisiveness even for minor matters.
- Physical complaints.
- Vague and evasive when talking about complaints and difficulties.
- Disturbed thinking, concentration problems, lapses of memory, unusual ideas, loose ideational associations, obsessive ruminations, delusions, hallucinations, irrelevand and incoherent speech.
Personality characteristics
- Immature and dependent.
- Strong need for attentions and affection.
- Intropunitive interpersonal behaviour.
Predictions
- Apathetic, pessimistic and not actively involved or interested in life activities.
- Limited rehab efforts.
- Insight-oriented therapy might not be very effective.
- Seem unoriginal and stereotyped in problem solving.
- Diagnosis: schizophrenia.
- Responsive to supportive therapy.
4-6/6-4
Symptoms and behaviours
- narcissistic, immature, self-indulgent.
- Excessive and unrealistic demands on relationships.
- Attention and sympathy seekers.
- Suspicious of others and resentful of the demands made on them.
- Relationship problems, especially with the opposite gender.
- Mistrustful of the motives of others.
- Avoid deep emotional involvement.
- Seen as irritable, sullen, generally obnoxious, resentful of authority.
- In a study of imprisoned Palestinian and Israeli terrorists, it was found that the overall mean profile of the participants was 4-6/6-4. In addition, religious fundamentalists scored high on 8 in addition to 4 and 6.
Personality characteristics
- Personality adjustment problems
- Passive-dependent
- Hostility and anger
Predictions
- Denial of any serious psych problems through rationalization and transfer of blame onto others.
- Cannot accept responsibility for their own behaviours. Unrealistic and grandiose in self-appraisals.
- Unreceptive to psychotherapy
- Diagnosis: passive-aggressive personality disorder and paranoid personality disorder, or paranoid schizophrenia.
4-7/7-4
Symptoms and behaviours
- Alternate periods of gross insensitivity to the consequences of their actions and excessive concern about the effects of their behaviour.
- Episodes of acting out followed by temporary guilt and self-condemnation.
- Vague somatic complaints
- Tension, fatigue, exhaustion.
- Report inability to face pressing environmental problems.
Personality characteristics
- feelings of dependency and personal insecurity
Predictors
- Therapy: they respond to support and reassurance.
- Hard to make personality changes that remain permanent
- Too insecure so they require constant reassurance of self-worth (basically, get ready, he’ll need a cookie-reward even for breathing, which we all know even algae do at some level…sorry…becoming mean here)
4-8/8-4
Symptoms and behaviours
- Serious psychological problems
- Lack of fit in society. Act out in asocial ways.
- Viewed as odd, nonconforming, resentful of authority.
- Likely to exhibit unusual religious or political views.
- Likely to behave in erratic ways.
- Withdrawal into fantasy or might strike out in anger as defense to being hurt.
- Impulse control issues.
- Viewed as angry, irritable and resentful (charming bunch, eh? Kinda inviting the hurt, me thinks).
- Delinquency, criminal acts or sexual deviation. Excessive drug/alcohol abuse.
- May be afraid of inability to perform sexually. May indulge in antisocial sexual acts to demonstrate sexual adequacy. VERY FREQUENT PROFILE FOR RAPISTS.
- Withdrawn and isolated socially.
- Periods of suicidal ideation.
- Distrustful of others. Avoid close relationships.
- Seen as impaired in empathic ability and lacking basic social skills.
Personality characteristics
- Poor self concept is central
- Set up for rejection and failure which fuels their feelings of insecurity
- Exaggerated needs for attention and affection
Predictors
- History of underachievement and marginal maladjustment
- Diagnoses: severe personality disorders (antisocial, paranoid, schizoid) and schizophrenia.
- Accept little responsibility for their behaviours.
- Not good outcome to therapy.
- Rationalize and blame others for own difficulties.
- World is seen as threatening and rejecting therefore they might have difficulties establishing a therapeutic relationship.
4-9/9-4
Symptoms and behaviours
- Marked disregard for social standards and values.
- Antisocial behaviour with poorly developed conscience, loose morals and fluctuating ethical values (there’s Machiavelli for you)
- Antisocial acts abound (alcoholism, fighting, sexual acting out)
- Seen as selfish, self-indulgent and impulsive.
- Cannot delay gratification of impulses
- Poor judgment, acting with no thought of consequences.
- Fail to learn from punishing experiences (no don’t spank…it’ll only hurt your hand)
- Low frustration tolerance, moodiness, irritability, caustic manner.
- Feelings of anger and hostility expressed in negative emotional outbursts.
- Viewed as energetic, restless, overactive and needing to seek out emotional stimulation and excitement.
- Seem uninhibited, extroverted and talkative, creating a good first impression.
- Relationships are superficial and wear out in time.
Behaviour characteristics
- Narcissistic and incapable of deep emotional ties.
- Keep others at distance emotionally
- Social façade successful, hiding the lack of self-confidence and of security.
- Might present features of immature, insecure and dependent personality.
Predictors
- Do not accept responsibility for actions.
- Will not seek Tx unless urged so by others.
- Rationalize their own shortcomings and failures
- Place blame on others
- Legal, work or personal problems are time persistent.
6-8/8-6
Symptoms and behaviours
- Inferiority, insecurity, low self-confidence and poor self-esteem.
- May feel guilty about perceived failures.
- Withdrawal from activities and emotional apathy.
- Not involved with other ppl.
- Seen as suspicious, and distrustful of others, avoiding deep emotional ties and seeming deficient in social skills.
- More comfy when alone.
- Resent demands placed on them.
- Moody, irritable, unfriendly and negativistic.
- Psychotic behaviour may be present.
- Thinking: autistic, fragmented, tangential and circumstantial.
- Bizarre thought content, difficulties in concentrating, attention deficit, memory issues.
- Poor judgment.
- May exhibit severe confusion, delusions of persecution/grandeur, feelings of unreality and preoccupation with obscure or abstract matters.
- Blunted affect.
- Rapid and incoherent speech, withdrawal into fantasy and daydreaming. Might have difficulty differentiating reality from fantasy.
- Seem to lack effective defenses.
- Regress under stress and pressure.
Personality characteristics
- Severe long-term psychological problems.
- Schizoid lifestyle.
Predictors
- Diagnosis: schizophrenia. This profile is confirmed in other countries also.
- Tx: psychotropic medication, placement into a supportive, structured environment if they are viewed as a danger to themselves.
6-9/9-6
Symptoms and behaviours
- Overly sensitive and mistrustful
- Feel vulnerable to real or imagined threat.
- Might feel anxious much of the time and may be fearful and trembling.
- Overreact to minor stress.
- Respond to severe setbacks by withdrawing into fantasy.
- Signs of thought disorder, complain of difficulties in thinking and concentration problems.
- Delusions, hallucinations, irrelevant and incoherent speech, appear disoriented and perplexed.
Personality characteristics
- Strong need for affection
- Passive-dependent in relationships
Predictors
- may be diagnosed as schizophrenic (paranoid type) or mood disorder.
- Difficult to implement psychological Tx because person is disorganized, unproductive, ruminating. Also overideational and obsessional.
- Problems expressing emotions in adaptive, modulated ways.
- Alternate between overcontrol and uncontrolled emotional outbursts.
7-8/8-7
Symptoms and behaviours
- Great turmoil
- Not hesitant in admitting that they have psychological problems (Wow!!! I’m flabbergasted)
- Lack defenses to keep themselves comfortable and anxiety free.
- Report feeling depressed, worried, tense and nervous.
- Confused and in a state of panic, showing indecisiveness and poor judgment.
- Do not profit from experience.
- Overly introspective, ruminative and ideational.
Behavioural characteristics
- Chronic feelings of insecurity, inadequacy and indecisiveness.
- Not socially poised or confident. Withdrawn from social interactions.
- Passive-dependent. Cannot take dominant role in relationships.
- Troubles with mature heterosexual relationships, inadequate in traditional gender roles.
- Extreme or unusual sexual practices
Predictors
- Anxiety disorder
- Increased SC scale is associated with likelihood of psychotic and personality disorder.
- Might not show blatant psychotic symptoms.
- Good to think about medications to control the intense anxiety and thinking problems.
8-9/9-8
Symptoms and behaviours
- Social withdrawal and isolation.
- Uncomfortable in heterosexual relationships. Poor sexual adjustment.
- Seen as hyperactive, emotionally labile, agitated and excited.
- Loud and excessively talkative.
- Unrealistic in appraising themselves, grandiose, boastful and fickle.
- Denial of problems.
- Vague and circumstantial.
- Feelings of inferiority and inadequacy. Low self esteem and limited involvement in competitive situations.
Personality behaviours
- Self-centered, infantile in expectations of others
- Demand too much attention, becoming resentful and hostile when demands are not met.
- Resist and ear close emotional involvement (then how the heck can anyone love them and give them attention?!!!)
- Unable to focus on issues.
- Viewed as odd, unusual, autistic.
- Circumstantial thinking, bizarre speech, delusions and hallucinations sometimes.
Predictors
- Diagnosis: schizophrenia, or severe personality disorder.
- Severe thought disturbance can occur: confused, perplexed, disoriented, difficulty thinking and concentrating.
- May state no need for help, might not enter willingly therapy.
- Thought they feel a need to achieve, their actual performance tends to be mediocre.
Three-point code-type descriptors
1-2-3
Symptoms and behaviours
- psychological distress and difficulty adjusting psychologically.
- Lack stamina.
- Feel weak, fatigued, tense and nervous much of the time.
- Physical symptoms as a reaction to stress. Most reported: abdominal pain, headaches.
- Overreact to minor or normal physical changes with extreme concern.
- Dysphoria. Worry.
Personality characteristics
- Passive in relationships.
- If interacting, they simply complain and whine.
- Dependent, to be taken care of.
- Hostile and irritable if needs not met.
Predictors
- Low sex drive, problems in heterosexual adjustment.
- Diagnosis: somatoform disorder in a passive-aggressive or dependent personality.
- Do not recognize the psychological component in their problems.
- Uninsightful, feeling no control over their symptoms.
- Poor candidates for insight-oriented psychotherapy.
- Stress-management: develop problem-solving skills to cope with the stress.
- Clinical individuals have a hostile interaction style, carried over into therapy.
- Not receptive to suggestions from others.
2-4-7/2-7-4
Symptoms and behaviours
- Alcohol/drug abuse.
- Alternate b/w periods of gross insensivity to the consequences of own actions and excessive concern about the effects of behaviours.
- Episodes of acting out then temporary guilt and self-condemnation.
- Vague somatic complaints, tension, fatigue, feeling exhausted ad unable to face environments pressure.
- Marital/work problems
Personality characteristics
- Dependency and personal insecurity.
- Severe personality problems.
- Self-oriented and hedonistic behaviour.
Predictors
- Permanent personality changes are difficult to make.
- Act out instead of dealing with conflict.
2-7-8
Symptoms and behaviours
- Chronic psychological maladjustment.
- Overwhelmed by anxiety, tension and depression.
- Feel helpless, alone inadequate and insecure.
- Attempt to control worries through intellectualization and unproductive self-analysis.
- Difficulty concentrating and making decisions.
- Functioning at very low levels of efficiency.
- Overreaction to minor stress, with rapid behavioural deterioration.
- Blame others for their problems.
- Chaotic lifestyle. Poor work history.
- Preoccupied with obscure religious ideas.
Personality characteristics
- Lack basic social skills.
- Behaviourally withdrawn.
- Relate to others ambivalently, never fully trusting or loving.
- Might never establish lasting, intimate relationships.
- The relations they do have are unrewarding, impoverished by feelings of insecurity and inadequacy.
Predictors
- Chronic behavioural pattern.
- Disorganized and unhappy existence.
- Episodes of intense and disturbed behaviour because of elevated stress level.
- Severe psychological disorder.
- Diagnosis: severe neurotic with anxiety disorder or dysthymic disorder in a schizoid personality.
- Seek and require professional help.
- Intensive therapy required due to chronicity.
- So many psychological concerns that it’s difficult to focus in therapy. Need a lot of emotional support.
- Low self-esteem. Feelings of inadequacy.
- Difficult for them to get energized towards the therapeutic action.
- Low expectation for positive therapy change therefore therapist must provide a positive, optimistic attitude.
- Overideational, unproductive rumination.
- Not good with unstructured, insight-oriented therapy. Might deteriorate if asked to do introspection.
- Might respond to supportive treatment and goal-oriented therapy.
- CLEAR SUICIDAL RISK.
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
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
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