Chapter 7: Psychopathology Flashcards
Diagnostic and Statistical Manual (DSM)
Based on a medical model of behavior and emotional problems
Multiaxial approach – 5 axes or dimensions
- Clinical syndromes
- Developmental disorders and personality disorders
- Physical disorders
- Severity of psychosocial stressors
- Level of adaptive functioning
New categories in DSM-5
- Hoarding Disorder
- Binge Eating Disorder
- Excoriation Disorder
- Mild Neurocognitive Disorder
- Disruptive Mood Dysregulation Disorder
- Premenstrual Dysphoric Disorder
- Social Communication Disorder
- Somatic Symptom Disorder
Future DSM’s Ideas
- Dimensional Model for Personality Disorders
- Caffeine Use Disorder
- Internet Use Gaming Disorder
- Suicidal Behavior Disorder
- Nonsuicidal Self-Injury
- Attenuated Psychosis Syndrome
What is the problem with comorbidity?
Comorbidity = 2 or more disorders for the same person
How does the book define mental disorder?
a psychological pattern associated with distress
and/or impairment of functioning that reflects dysfunction in the person. (p. 162)
What are the four ways of assessing mental disorders?
- Ask person directly - Use an interview or a self-report inventory
- Ask someone who knows the person – interview or rating scale
- Observe the person in their natural environment
- Observe the person in a standardized-test situation
What is the purpose of having tests for psychopathology?
- Answer a focused or specific diagnostic question
- Explain in a broad way the client’s dynamics, psychological functioning, and personality structure
How is a clinical interview described?
a conversation with a purpose
Structured vs. unstructured clinical interviews
Structured: follows interview schedule (series of questions)
Unstructured: open questions, “how do you feel about…”
For clinical interviews, what are some of the things the Mental Status Exam (MSE) look at?
- Appearance
- Behavior
- Orientation
- Memory
- Sensorium
- Mood and affect
- Intellectual functioning
- Perceptual processes
- Thought content
- Thought process
Describe the Structured Clinical Interview for DSM-III (SCID)
- Semi-structured interview
- Covers nine diagnostic areas
- Trained interviewers
Describe the Symptom Checklist 90R (SCL-90R)
A commonly used screening inventory
Brief self-report measure to evaluate psychopathological problems and symptoms, as well as outcomes of treatment
90 items
assess degree of distress over the past 7 days
ages 13 and older
10-15 min
5-point scale
High validity, reliability, and utility
Describe the Psychological Screening Inventory (PSI)
Developed empirically to differentiate between normal subjects and psychiatric patients
a screening device not a diagnostic instrument
130 true-false items
Five scales: alienation, social nonconformity, discomfort, expression, defensiveness
Describe the five scales of Psychological Screening Inventory (PSI)
alienation:
social nonconformity:
discomfort:
expression:
defensiveness:
Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2
What was the original purpose?
Name some Characteristics.
Original Purpose: Clinical prediction and personality description
Widely used objective personality measure
Assesses both personality structure and psychopathology—used more in clinical settings than as a fun, one-off personality test
Characteristics
* Easily administered and scored
* 6th grade reading level (MMPI)
* 8th grade reading level (MMPI-2)
* 60-90 minutes
* Interpretation
o Pattern or configuration of scales is important
* Reliability
o Test-retest is adequate
o Stability of configuration – not great
* Validity
o Compared MMPI profiles to relevant criterion groups
o Identify reliable nontest behavioral correlates
o Accuracy of interpretations of MMPI with clinicians
Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2
Current version? Items? Scales?
Currently using the MMPI-2-RF (2008)
338 items over 51 scales
Items are nonredundant—this is actually a shorter version of the test!
Recommended for administration on the computer
Includes possibility of comparing to reference groups
Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2
What are the 10 Clinical Scales?
- Hypochondriasis
- Depression
- Hysteria
- Psychopathic Deviate
- Masculinity/Femininity
- Paranoia
- Psychasthenia
- Schizophrenia
- Hypomania
10.Social Introversion
Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2
What are the 4 validity scales in the original and what are the 3 that were added in the second?
4 Validity Scales
1. Lie (L) – “Faking good” – items most people would not endorse
2. Infrequency (F) – Fewer than 10% of normal samples would endorse
3. Cannot say (CNS) – non-responding; items left blank
4. K – clinical defensiveness; differentiated between normal and psychiatric patients with normal profiles; suppressor variable
Added to the MMPI-2
5. Backpage Infrequency (Fb) – random responses on the back half of questions
6. Variable inconsistency (VRIN) – responses to item pairs with similar or opposite content
7. True response inconsistency (TRIN) – responses to item pairs with
Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2
Criterion keying, who was it based on?
Developers determined whether an item differentiated two groups: psychiatric group versus “normal” group
MMPI History: How were norms developed? What were some problems with the norms?
1943: developed at University of Minnesota using empirical keying approach–NOT psychodynamic
* Major validity and generalizability issues
* Reference group was small and mostly consisted of people with the same/similar SES
Norms represent late-1930s to early-1940s Minnesotans
* Terminology being used was not relevant to population being tested
* Many disorders were eluded
MMPI History: MMPI-2
What improvements were made?
- Standardized on a large, more representative sample (collected in mid 1980s)
- Clinical Scales left intact
- New items introduced via Content Scales
- New Validity Scales (VRIN, TRIN, Fb)
- Initial Skepticism
- Relatively quick acceptance by clinicians
- Disappointment by (some of) the scholarly community
MMPI History: MMPI-2
What were the new validity scales added?
MMPI History: MMPI-2
MMPI History: MMPI-2-RF 2008
Name the “creators” and the overall objective.
Ben-Porath & Tellegen (2008)
Overall Objective: Represent the clinically significant substance of the MMPI-2 item pool with a comprehensive set of psychometrically adequate measures:
* Improve efficiency
* Enhance construct validity
MMPI History: MMPI-2-RF
What was were thier strategies?
Overall Strategy:
* First restructure the Clinical Scales (resulting in the
Restructured Clinical [RC] Scales)
* Then augment the RC Scales with needed additional
measures
MMPI History: MMPI-2-RF
What were the five scales added?
- Higher-Order
- Specific Problems
- Interest
- PSY-5
- Validity
MMPI History: MMPI-2-RF
- Theoretically grounded and hierarchical scale structure
- The following were reported in the MMPI-2-RF Technical Manual
o Adequate reliability
o Good evidence of construct validity
o Broad range of replicable empirical correlates reflected in interpretive recommendations in MMPI-2-RF Manual for Administration, Scoring, and Interpretation
MMPI-2
Content analysis of the items led to the development of content subscales
111 critical items have been identified which were reflective of severe psychopathology
Factor analysis showed two dimensions:
1. Anxiety or general maladjustment
2. Repression or neuroticism
MMPI-2
Over the years, over 500 additional scales have been developed from the pool of MMPI items
Examples: Ego Strength, MacAndrew Alcoholism Scale, Psychopathology Five, Prejudice, Social status, Dominance, Success in baseball
“The MMPI is not so much a test as a set of responses from which any number of scales might be devised” (Murphy & Davidshofer, 2004, p. 492)
MMPI-2: Reliability
- Test-retest is adequate
- Alpha coefficients for normative samples had a range from .34 to .87, but scale is heterogeneous
MMPI-2: Validity
- Complex issue
- Three categories
- Studies that have compared the MMPI profiles of
relevant criterion groups which have found significant
differences - Identify reliable nontest behavioral correlates
* There are correlates, but generalizability may
not always be good - MMPI results and the clinician’s interpretations
which aren’t as supportive
- Studies that have compared the MMPI profiles of
MMPI-2: Are there racial differences?
Racial differences have been found, but study results are inconclusive.
Larger differences between African-Americans and whites, than those found with Hispanic and white subjects.
MMPI-3: What is the response format?
True/False versus Polytomous
Outcome: Retain T/F format
MMPI-3: What improvements were made?
Awkward/dated wording
Simplification
I love to go to dances. in now, I love to go dancing.
I am apt to take (now, likely to feel) disappointments so keenly (now, strongly) that I can’t put them out of my mind.
* 43 simplified items retained for MMPI-3 development
MMPI-3: Reason for new item development? Method of development?
New item development
* Objective: Identify content missing from, or insufficiently represented by the MMPI-2-RF item pool
Method:
* Consultation with 12 MMPI-2-RF experts
* Review of existing measures
* Development of 135 Trial Items
Outcome:
* 95 trial items; candidates for inclusion on the MMPI-3
MMPI-3: What are some new scales?
- Combined Response Inconsistency (CRIN)
- Eating Concerns (EAT)
- Compulsivity (CMP)
- Impulsivity (IMP)
- Self-Importance (SFI)
MMPI-3: How many items were changed, added, and dropped?
- 72 new items added
- 75 MMPI-2-RF items dropped
MMPI-3: 335 items - 220 original MMPI (47 revised for MMPI-2 or MMPI-3)
- 43 MMPI-2 items (5 revised for MMPI-3)
- 72 new MMPI-3
Reading level remains grade 4.5 - (Flesch-Kincaid)
Substantially Modified:
* Anxiety (AXY) Anxiety-Related Experiences (ARX)
* Stress/Worry (STW) Stress (STR); Worry (WRY)
* Interpersonal Passivity (IPP) Dominance (DOM)
Dropped:
* Gastrointestinal Complaints (GIC), Head Pain Complaints (HPC)
* Multiple Specific Fears (MSF)
* Aesthetic/Literary Interests (AES)
* Mechanical/Physical Interests (MEC)
MMPI-3: How many scales? Describe them.
52 Scales
* 10 Validity Scales
* 3 Higher-Order Scales
* 8 RC Scales
* 26 Specific Problems Scales
* 4 Somatic/Cognitive
* 10 Internalizing
* 7 Externalizing
* 5 Interpersonal
* 5 PSY-5 Scales
Millon Clinical Multiaxial Inventory (MCMI)
Published in 1977
Biopsychosocial view of personality functioning and psychopathology
Tried to address the criticisms of the MMPI
Two dimensions:
1. Source of reinforcement
2. Pattern of coping behavior
Millon Clinical Multiaxial Inventory (MCMI)
Clinical scales consistent with DSM
175 brief, self-descriptive true-false statements
24 Clinical scales
12-24 overlapping items which can appear in as many as 3 scales,
but with different weights
Millon Clinical Multiaxial Inventory (MCMI):
What were the four main categories?
- Clinical Personality Patterns
- Clinical Syndromes
- Severe Personality Pathology
- Severe Syndromes
