MMPI-2 Flashcards
What does the MMPI-2 measure?
The Minnesota Multiphasic Personality Inventory (MMPI) is the most widely used and researched standardized psychometric test of adult personality and psychopathology.[1] Psychologists and other mental health professionals use various versions of the MMPI to develop treatment plans; assist with differential diagnosis; help answer legal questions (forensic psychology); screen job candidates during the personnel selection process; or as part of a therapeutic assessment procedure.
So it’s not explicitly stated in the slides, but I’m assuming it’s facilitating psychiatric diagnosis among a more representative sample. As opposed to the MMPI, the MMPI-2 includes minority groups.
What is empirical keying and how was it used in the MMPI?
Empirical Keying: Empirical determination of items that differentiated between groups
Very innovative approach at the time
Test items selected or developed according to face validity
Focus on validity: Each item had to discriminate between groups successfully
What was the original standardization sample for the MMPI?
724 visitors to University of Minnesota hospital and outpatient clinics: became known as the
“Minnesota Normals”
Confirmed they were not under the care of a physician; ages 16-65
Demographics based upon 1930 census data for Minnesota: Typical examinee was 35 years old, married, lived in small town or rural area, had 8 years of general schooling, worked at skilled or semi-skilled trade (or was married to man at this level)
How reliable is the MMPI-2?
Test re test: Clinical scales .93 (Si) to .56 (Pa)
Describe the MMPI-2’s validity.
Convergent, discriminant and incremental in comparison to other measures of emotional functioning
Describe threats to validity.
Threats to Protocol Validity Non-Content-Based Invalid Responding Non-Responding Random Responding Intentional Unintentional Reading Difficulties Lack of comprehension Confusion Fixed Responding Acquiescence (yea saying) Counter-Acquiescence (nay saying) Content-Based Invalid Responding Over-Reporting “Faking bad” or “Malingering” Intentional Exaggeration vs. Fabrication Unintentional Negative Emotionality/Distress/Help Seeking Under-Reporting “Faking good” or defensiveness Intentional Minimization vs. Denial Unintentional Ego Defenses Social Desirability
What are the advantages of MMPI-2?
Provide information regarding the accuracy of self-report
Specify the type of distortion or impression management
Indicate the extent of distortion
Provide a dimensional perspective
Allow confidence in the clinical inferences made from the MMPI-2
Describe disadvantages of MMPI-2.
Only Caucasians in original MMPI development
MMPI-2 matched 1980 census for inclusion of ethnic minorities, but test could still be biased
Early studies found significant differences between Caucasian and ethnic minority groups
Later studies found small differences when groups were matched for age, education, and other demographics
Need to consider level of acculturation
Graham (2011, 5th edition of text) advises:
T scores 50 - 60 likely reflect issues of acculturation
T scores > 65 likely reflect symptoms and problems consistent with Caucasian group
Here are a few: the hispanic and Asian American population is underrepresented in the sample, sample exceeded estimates for educational level and occupational status (majority of the sample had 2 years of college - which is not the norm in the U.S.).
What is the age range for the MMPI-2?
ages 18 and older
What reading level is necessary to administer the MMPI-2?
6th grade reading level
What is a clinically significant score on the MMPI-2?
Clinical Elevation = 65+
What are the mean T-score and standard deviation and how are they related to MMPI-2 test interpretation?
T scores: Mean = 50 Standard Deviation = 10 Clinical Elevation = 65+ Low Score = < 40 (only interpreted for certain scales, e.g. K, 7, O)
CNS
Cannot Say (?) Non-responding A 567-Item “Scale” >10 omissions concern for validity; check scale Possible Reasons for Elevation: Lack of cooperation & defensiveness Lack of insight Obsessiveness Reading difficulties or confusion Effects on Profile: Deflated scores Depending on the scale location of the omitted items
VRIN
Variable Response Inconsistency Random Responding Designed to detect Random Responding 47 item pairs, 12 can be scored two ways T scores range from 30 to 120 Applications Detection of random responding VRIN ≥ 80 Detection of “hypervigilance” VRIN < 40 Aid in the interpretation of infrequency scales Use VRIN to evaluate random responding
TRIN
True Response Inconsistency Fixed Responding Designed to detect Fixed Responding (Acquiescence or Counter-Acquiescence) 20 item pairs, 3 symmetrical (both ways) Raw score converted to T score which will always be equal to or greater than 50 T score greater than 50 will be followed by a “T” or an “F” Fixed response set indicated if TRIN ≥ 80T OR TRIN ≥ 80F Applications Detection of response sets Interpretation of L, K, and S Use TRIN to evaluate fixed responding
F
Infrequency
Infrequency scales (confounded with distress)
Over-Reporting
Used to identify over-reporting
60 “infrequently endorsed” items among first 370 items in the booklet
Possible reasons for elevation:
Intentional over-reporting
Unintentional over-reporting
Random responding
Fixed responding
Severe psychopathology or severe distress
Use FP to evaluate intentional over-reporting
Fb
Back (Side) Infrequency
Infrequency scales (confounded with distress)
Over-Reporting
Designed to detect changes in responding between first (#s 1-370) and second half of the test
40 infrequently endorsed items appearing in second half of booklet
Possible reasons for elevation:
Intentional Over-reporting
Unintentional Over-reporting
Random Responding
Fixed Responding
Severe Psychopathology or Severe Distress
Fatigue
If T score FB > T score F+30, significant change in responding occurred
Fp
Infrequency Psychopathology
Psychiatric infrequency scale (malingering?)
Over-Reporting
Designed to detect intentional and unintentional over-reporting in individuals with psychopathology
27 items endorsed infrequently by a variety of clinical samples including psychiatric inpatients
Possible reasons for elevation:
Intentional over-reporting
Random responding
Fixed responding
FP > 70 and < 100 reflects degree of exaggeration of symptoms
If FP ≥ 100 AND VRIN < 70 AND TRIN < 70, intentional over-reporting is indicated
If F is elevated AND FP < 70, the elevated score on F likely reflects severe pathology, distress, or unintentional over-reporting
L
Lie Claiming excessive virtue Under-Reporting Designed to detect intentional under-reporting 15 obvious items All keyed “false” Possible reasons for elevation: Intentional under-reporting Lack of insight Very traditional values and beliefs Indiscriminant “false” responding
K
Correction
Defensiveness, reservations
Under-Reporting
Designed to detect unintentional under-reporting
30 “subtle” items
Defensive person less likely to recognize purpose of items and to avoid detection
All but one keyed “false”
Possible reasons for elevation:
Defensiveness, denying symptoms, problems, and negative characteristics more than the average person
Psychological well-being, ego strength, psychological resources
Effects of education
Minimal with MMPI-2
Recent research has not supported routine use of K-corrected clinical scale scores
Caution in settings where defensiveness is common (e.g., employment screening, child custody evaluations)
K-corrected scores may overpathologize test takers
Nonclinical applications:
Generate both K-corrected and non-K-corrected scores
Use non-K-corrected scale scores when the K-scale scores are significantly above or below average
S
Superlative Self-Presentation
Under-Reporting
Developed by Butcher and Han (1995) to identify under-reporting
Tendency to present as highly virtuous, responsible and free of psychological problems
Common in personnel screening, child custody
Contains subscales to assist in identifying specific areas of defensiveness:
Belief in human goodness
Serenity
Contentment with life
Patience and denial of irritability and anger
Denial of moral flaws
Patience and denial of irritability and anger
Denial of moral flaws
Non-defensive with significant psychopathology
If F is elevated AND FP < 70, the elevated score on F likely reflects severe pathology, distress, or unintentional over-reporting
Random Responding
Random responding: F, FB and FP usually greater than 100, K & S near 50 and L 60-70.
Faking Bad Profile
Faking Bad: F and FB have T scores greater than 100 while L and K are low.
Cry for Help Profile
Inverted V or Cry for Help: L and K lower than F. Check for secondary gain and be alert for malingering. Can be indicative of true distress.
Faking Good Profile
L and K T scores > 65 higher than F which has a T score in the 40-50 range suggests guardedness and defensiveness. V shaped or check mark shaped
What is K correction, when is it used and on what clinical scales?
Do not routinely use K-corrected scores
Always consider impact of correction-do not overpathologize test takers
Calculate both and compare and contrast
For clinical populations, use K- corrected scores
For Normals use, non corrected
Consider and discuss in interpretation
Used on 1,4,7,8,9
1
Hs - Hypochondriasis
32 Items (lost 1 item from MMPI)
Preoccupation with the body and fear of illness and disease
Homogeneous and unidimensional
Denial of good health
Admission of a variety of somatic symptoms
Medical Patients
Average T=60
T > 80 - Extreme somatic concern
- Consider somatic delusions
T = 60-80 - Somatic concerns - Sleep disturbance
- Lacks energy - Demanding - Dissatisfied - Complaining, whiny
T = 40-59 - Average
2
D - Depression
57 items (lost 3 items from MMPI)
Poor morale, lack of hope in the future, and general dissatisfaction with life
Denial of happiness, psychomotor retardation, withdrawal, and lack of interest
Denial of hostile impulses
Difficulty with concentration and memory
General dissatisfaction and discomfort with life circumstances
T > 70 - Serious clinical depression
T = 60-70 - Moderate depression
- Dissatisfaction with life situation - Worried - Somatic complaints - Withdrawn - Lacks self-confidence
T = 40-59 - Average
T < 40 - Low score; no interpretation
3
Hy - Hysteria
60 items (none lost from MMPI)
Developed to identify individuals who were having hysterical reactions to stress, e.g., psychogenic symptoms and loss of function
Two clusters of items
Denial of physical health and report of variety of physical complaints
Denial of psychological or emotional problems
Medical Patients
T > 80 - Consider conversion reaction
T = 60-80 - Somatic symptoms
- Sleep disturbance - Lacks insight concerning causes of symptoms - Denial - Immature, self-centered - Demanding - Suggestible - Affiliative
T = 40-59 - Average
T < 40 - Low score; no interpretation
4
Pd - Psychopathic Deviate
50 items (none lost from MMPI)
Developed to identify psychopathic personality type
Amoral, asocial individuals
Criterion group were not prisoners
Engaged in delinquent acts
Lying, stealing, sexual promiscuity, excessive drinking
Absence of satisfaction with life
Family problems, difficulty with authority
Delinquency, sexual problems
Scale assesses both social maladjustment and social confidence and poise
Graham: indicates rebelliousness
T > 75 - Asocial/antisocial behavior
T = 60-75 - Rebellious, non-conforming
- Family problems - Impulsive
- Angry, irritable - Extroverted
uncooperative (Women) - Creative
- Dissatisfied - Energetic
- Superficial Relationships
T = 40-59 - Average
T < 40 - Low score; no interpretation
5
Mf - Masculinity-Femininity
56 items (lost 4 from MMPI)
52 items keyed in same direction for both men and women
4 items dealing with sexual material keyed in opposite direction
T score is reversed for men and women
Scale was initially developed to identify homosexuals
Few items actually worked
Added items that differentiated men and women
Few items related to sexual topics
Most items associated with
Work and recreational interests
Worries, fears, and excessive sensitivity
Family relationships
Measures interests and is not related to symptoms or problems in inpatient, outpatient, or normal groups
MEN
T > 75 - May report sexual concerns, problems
T = 60-75 - Lacks traditional masculine interests
T = 40-59 - Average
T < 40 - Very traditional masculine interests
WOMEN
T > 75 - May report sexual concerns, problems
T = 60-75 - Lacks traditional feminine interests
T = 40-59 - Average
T < 40 - Very traditional feminine interests
(but not exclusively)
6
Pa - Paranoia 40 items (none lost from MMPI) Developed to identify patients with paranoid symptoms Ideas of reference Feelings of persecution Suspiciousness Excessive sensitivity Rigid opinions and attitudes T > 70 - Consider paranoid psychosis
T = 60-70 - Paranoid style - Guarded
- Extremely sensitive - Suspicious
- Angry, resentful - Withdrawn
T = 45-59 - Average
T < 45 - Low score; no interpretation
7
Pt - Psychasthenia 48 items (none lost from MMPI) Excessive doubt, compulsions, obsessions, unreasonable fears Item content reflects Uncontrollable or obsessive thoughts Feelings of fear and/or anxiety Self-doubt General distress and unhappiness T > 75 - Extreme fear, anxiety, tension - Intruding thoughts - Unable to concentrate
T = 60-75 - Moderate anxiety -Depression
- Bad dreams - Lacks self-confidence
- Guilt - Perfectionistic
- Indecisive - Feels unaccepted
T = 40-59 - Average
T < 40 - Low score; no interpretation
8
Sc - Schizophrenia 78 items (none lost from MMPI) Disturbance of thinking, mood, and behavior Misinterpretation of consensual reality Delusions and hallucinations Item content heterogeneous Frankly psychotic behavior and symptoms Social alienation and estrangement Poor family relations Worries and fears Dissatisfaction Concentration difficulties T > 75 - Distress and confusion - Acute psychological turmoil - Consider psychotic disorder diagnosis
T = 60-75 - Schizoid life-style - Fearful
- Confused - Aloof, uninvolved
- Excessive fantasy -Daydreaming
T = 40-59 - Average
T < 40 - Low score; no interpretation
9
Ma - Hypomania 46 items (none lost from MMPI) Elevated mood; accelerated speech and motor activity; irritability; flight of ideas; and brief periods of dysphoria Item content High activity level Excitability Irritability Grandiosity Family relationships T > 80 - Consider Bipolar Disorder, manic type
T = 70-80 - Excessive energy - Bossy
- Conceptual disorganization - Impulsive
- Unrealistic self-appraisal - Talks too much
- Low frustration tolerance
- Lacks direction
T = 60-69 - Active - Energetic
- Extraverted - Creative
- Rebellious
T = 40-59 - Average
0
Si - Social Introversion
69 items (lost one from MMPI)
Developed to assess the tendency to withdraw from social situations and responsibilities
Contrasted women who scored high on introversion-extroversion scale from those who had low scores
Two types of items
Social participation
General maladjustment and self-depreciation
T > 75 - Extreme social withdrawal/avoidance
T = 60-75 - Introverted, shy, timid
- Depressed, guilty - Slow personal tempo - Lacks self-confidence - Lacks interest - Submissive, compliant - Overcontrolled - Reliable, dependable - Values work
T = 40-59 - Average
T < 40 - Extraverted, gregarious - Self-reliant
- Energetic - Competitive
- Undercontrolled - Manipulative
Which clinical scales do not measure psychopathology?
5 and 0
What are the Harris Lingoes subscales and what are they useful for?
Provide information regarding the type of items endorsed on the corresponding clinical scale
Very few items on some makes them relatively unreliable; two subscales do not reach T of 65:
Hy1 (Denial of Social Anxiety)
Pd3 (Social Imperturbability)
Considerable item overlap between subscales affects validity
Should not be interpreted unless parent scale is significantly elevated
What clinical scales have Harris Lingoes subscales?
2-D, 3-Hy,4-Pd, 6-Pa, 8-Sc, 5-Ma, 0-Si
When is it valid to interpret the Harris Lingoes sub scales?
Provide information regarding the type of items endorsed on the corresponding clinical scale
Very few items on some makes them relatively unreliable; two subscales do not reach T of 65:
Hy1 (Denial of Social Anxiety)
Pd3 (Social Imperturbability)
Considerable item overlap between subscales affects validity
Should not be interpreted unless parent scale is significantly elevated
How do you define a code type?
Order clinical scales highest to lowest (exclude 5 and 0)
Only one code type per profile
Two-point code types: Identifies which two clinical scales are the highest
Three-point code types: Identifies which three clinical scales are the highest
Elevated vs. Non-elevated
Elevated: Scale scores ≥ 65; valid to make inferences about both symptoms and personality characteristics
Non-elevated: Scale scores < 65; valid to make inferences about personality characteristics but not symptoms
Well-defined code type: T scores of the scales comprising the code type are > 65, and are 5 or more T score points higher than the T scores on the remaining clinical scales
Advantage to well-defined code types
Stable up to 30 omitted items
Descriptors of code type more valid
Most defined two-point code types are interchangeable: 27/72 means we can basically make the same interpretation for the 2-7 code type as we do for the 7-2 code type
Can frequently find elevated and well-defined three point code types where descriptors have been empirically derived
Rules for defining three-point code type are the same as for two-point code type
All three scales are elevated and fall within 5 T scores of each other
Lowest scale of code type is 5 T-score points above the next highest scale
13/31
Often found in medical settings and it can be a frequently obtained profile in inpatient settings
Associated with chronic medical or physical problem, chronic pain, and an Axis III diagnosis
Resist psychological explanations for their difficulties, preferring medical answers
Common Descriptors
Wide range of somatic complaints including:
Headaches, back pain, numbness, nausea, vomiting, weakness, fatigue, dizziness
Sleep disturbance, low sex drive
Are preoccupied with physical health
Symptoms appear and disappear quickly in response to emotional stress
Present self as psychologically normal, responsible, and without fault
27/72
Outpatient Depression, anxiety, and self-degradation Sad and depressed Diagnosis of dysthymia Feeling hopeless, lacking energy, sleep disturbance, and fatigue Not achievement or work oriented Inpatient Admitted for depression Less likely to be delusional or psychotic Depressed mood and loss of interest Compulsions Withdrawn History of Treatment with ECT Generally have insight into condition
29/92
Persons with the 29/92 code type tend to be self-centered and narcissistic. They ruminate excessively about self-worth. Although they may express concern about achieving at a high level, it often appears that they set themselves up for failure. In younger persons, the 29/92 code type may be suggestive of an identity crisis characterized by lack of personal and vocational direction. Persons with this code type report feeling tense and anxious,and romantic complains, often centering in the upper gastrointestinal tract, are common. Although they may not appear to be clinically depressed at the time they are examined, their histories typically suggest periods of serious depression. Excessive use of alcohol may be employed as an escape from stress and pressure. They 29/92 code type suggests individuals who are denying underlying feelings of inadequacy and worthlessness and defending against and depression through excessive activity. Alternating periods of increased activity and fatuige may occur. Psychiatric patients with the 29/92 code type often have diagnoses of bipolar disorder. This code type sometimes is found for patients with brain damage who have lost emotional control or who are trying to cope with deficits through excessive activity. It should be emphasized, however, that this code type of other MMPI-2 information should not be used to diagnose brain damage.
48/84
In outpatients
More likely to have histories of sexual abuse
Report somatic complaints, anxiety, and depression
Described as experiencing acute psychological turmoil including anxiety, depression, agitation, sleep disturbance
Suspicious and paranoid delusional thinking, daydream excessively
In general
Don’t fit into environment
Seen as odd and peculiar
Angry and erratic
Act out in antisocial ways
Come into conflict with societal standards often for sexual behavior
Underachievement and marginal adjustment
68/86
Generally associated with a thought disorder
Most frequently found well-defined code type among inpatient men
In outpatients frequently associated with depression
Reaction to stress by withdrawal into fantasy
Paranoid ideation
Auditory hallucinations
Admitted to inpatient unit for worsening psychosis
Have a number of suicide attempts
Paranoid delusions
Schizophrenia diagnosis
Schizoid life style
46/64
One of the most frequently obtained code types in both inpatient and outpatient setting
Seen by therapists as non-conforming and feeling they got a raw deal from life
Poor family relationships and projection of blame onto family members
Psychotic symptoms may be present
Argumentative, sullen, and angry
Inpatients
Drug abuse
Marijuana, cocaine, polysubstance abuse
Contact with criminal justice system
Less likely to have chronic medical or physical problems
Homeless
Axis II Cluster B diagnosis
49/94
Common descriptors for outpatients Problems with authority figures Impulsivity Superficial relationships Characterized as Eccentric, cynical, narcissistic Generally free of anxiety and depression ETOH and Substance Abuse/Dependence Antisocial behaviors Delinquent acts Low frustration tolerance Extroverted, talkative, thrill seeking Poor judgment Difficulty delaying gratification Fail to consider the consequence of action Frequent Axis II diagnosis (Antisocial)
123
Outpatient
More likely to report anxiety, depression, somatic symptoms
Rated as sad and depressed
Feel as if life is a strain
Very strongly associated with somatization, and report multiple somatic complaints
Develop physical symptoms in response to stress
Preoccupied with health
Low energy level
Secondary gain associated with symptoms
Frequently observed among chronic pain patients undergoing treatment
Lack sex drive
Good marital and work adjustment
468
Have Axis I diagnosis of depression and Axis II diagnosis of Antisocial PD
History of psychiatric hospitalization, suicide attempts, and being physically abused
Described as circumstantial and tangential, defensive, and demand attention
Sad, depressed, and have suicidal ideation
Tend to be antisocial
Low tolerance for frustration
Critical, hostile, angry, aggressive, argumentative, and resentful
Anxious and agitated
Psychotic symptoms with paranoid ideation
Suspiciousness, feeling that they were getting a raw deal from life
Often feel like a failure
Neurotic Triad aka Conversion V
-if 1,2,3 are elevated, called the neurotic tryaid
Psychotic Tetrad
The psychotic tetrad
6 Pa: Paranoia (40): Suspiciousness, delusions of grandeur
and persecution
7 Pt: Psychasthenia (48): General neurotic symptoms,
including obsession, compulsion, fear, and guilt
8 Sc: Schizophrenia (78): Bizarre thoughts and behavior,
delusions, hallucinations
9 Ma: Hypomania (46): Emotional excitement and overactivity
BPD
multiple elevations 2468 who do we love to hate BPD
What are the Reconstructed Scales?
Developed by Tellegen, Ben-Porath, McNulty, Arbisi, Graham & Kaemmer (2003)
Original clinical scales were very heterogenous in content and not very independent of each other
Significant item overlap between scales
Factor analysis revealed that even when overlapping items were removed, some clinical scales were still strongly intercorrelated
Major source of variance was a factor labeled as anxiety, general maladjustment, or emotional distress
High scale scores inherently included this overlapping distress factor
RC Scales developed in order to sort out degree of emotional distress vs. degree of core construct of scale (e.g., depression, aberrant thinking
Designed to preserve descriptive properties of Clinical Scales while enhancing distinctiveness
Reliability
Internal consistency:Higher than Clinical Scales
Test-retest: Stable after retest interval of one week
Validity
Convergent validity: Similar to and greater than Clinical and Content Scales
Discriminant validity: Reduction of Demoralization factor
Some RC Scales are more focused measures of core constructs than counterpart scales
RCd
dem Demoralization
Provides indication of overall emotional well-being
High scorers expressing discomfort and turmoil
High scorers likely to have high scores on other RC, Clinical, and Content Scales, especially those with strong affective components
High scorers report:
Feeling discouraged and demoralized
Poor self-esteem and pessimism
Believe they have failed in past and expect to fail in future
Feeling overwhelmed
Incapable of coping with current life circumstances
Depression, anxiety, and somatic complaints
RC1
som Somatic Complaints
Similar to scale 1, Hypochondriasis and Health Concerns (HEA) Content Scale
High scorers:
Large number of physical complaints, including chronic pain
Preoccupied with bodily functions
Develop physical symptoms as a result of psychological or interpersonal difficulties
Report symptoms of depression and anxiety
RC2
lpe Low Positive Emotions
High scorers:
Lack of positive emotional engagement in life
Unhappy, demoralized, at risk for clinical depression
Lack energy to deal with life demands
Difficulty taking charge, making decisions, getting things done
Helpless and hopeless
Introverted, passive, withdrawn, bored, isolated
Pessimistic, have low expectations of success, not likely to engage in competitive situations
RC3
cyn Cynicism
Clinical scale 3 has two major components:
Somatic complaints
Avowal of excessive trust of others
Somatic component assigned to RC1, so RC3 assesses second component, scored in the opposite direction.
High scorers:
See other people as untrustworthy, uncaring, concerned only about themselves, and exploitive
Low scorers:
Likely to be naïve, gullible, overly trusting of others
RC4
asb Antisocial Behavior
Purer measure of antisocial characteristics than clinical scale 4
High Scorers:
Difficulties conforming to societal norms and expectations
Histories of difficulties with the law
At increased risk for substance abuse
Aggressive behavior, conflicted interpersonal relationships
Critical, argumentative, angry, antagonistic
Typically did not do well in school, have work-related problems
RC6
per Ideas of Persecution
Purer measure of persecutory thinking than clinical scale 6
High scorers:
Feel targeted, controlled, victimized by outside forces
Suspicious of motives of others
Difficulty forming trusting relationships
T ≥ 75 associated with delusions, hallucinations, other psychotic symptoms
RC7
dne Dysfunctional Negative Emotions
High scorers:
Experience negative emotions, including anxiety, irritability, and depression
Report intrusive, unwanted ideation
Very insecure, very sensitive to perceived criticism
Ruminate and brood about self-perceived failures
Passive and submissive in interpersonal relationships
RC8
abx Aberrant Experiences
More focused measure of sensory, perceptual, cognitive, and motor disturbances than clinical scale 8
High scorers:
T ≥ 65 likely reporting hallucinations, delusions, bizarre sensory experiences
Impaired reality testing
T ≥ 75 likely diagnosis of schizophrenia, delusional disorder, or schizoaffective disorder
RC9
hpm Hypomanic Activation High scorers: Thoughts racing High energy level Heightened mood Irritability Poor impulse control May be aggressive Substance abuse Sensation seekers Risk takers T ≥ 75 may suggest manic episode of Bipolar Disorder T = 60-70 may indicate extroverted person with adaptive high energy level
How do the RC Scales relate to Clinical scales?
High scale scores inherently included this overlapping distress factor
RC Scales developed in order to sort out degree of emotional distress vs. degree of core construct of scale (e.g., depression, aberrant thinking
Designed to preserve descriptive properties of Clinical Scales while enhancing distinctiveness
demoralization is taken out of rc scales, more pure measure
How were the Content Scales derived?
Originally developed by Wiggins (1969) using the entire MMPI item pool
Rational Identification of Content areas
Elimination of most item overlap between scales
Due to item deletions in MMPI-2, scale of Religious Fundamentalism no longer adequate
MMPI-2 Content Scales developed by Butcher, Graham, Williams, and Ben-Porath (1990)
What information do the Content Scales provide?
Interpretation: Consider 65 and above; view scores as direct communication from test takers; high scores reflect what the examinee wants the examiner to know about them
ANX
Anxiety High scorers on ANX report general symptoms of anxiety including: Tension Somatic problems Sleep difficulties Worries Poor concentration Fear of losing their minds Find life a strain Difficulties making decisions Appear to be readily aware of these symptoms and problems and are willing to admit to them No Content Component Scales
BIZ
Bizarre Mentation
High scores on BIZ:
Psychotic thought processes
Auditory, visual, or olfactory hallucinations
May recognize that thoughts are strange and peculiar
Paranoid ideation (e.g., the belief that they are being plotted against or that someone is trying to poison them)
May feel that they have a special mission or special powers
BIZ1 - Psychotic Symptomatology
BIZ2 - Schizotypal Characteristics
LSE
Low Self-Esteem
High scores on LSE:
Characterize individuals with low opinions of themselves
Believe that they are not liked by others or that they are unimportant
Hold many negative attitudes about themselves including beliefs that they are unattractive, awkward and clumsy, useless, and a burden to others
Lack self-confidence, and find it hard to accept compliments from others
May be overwhelmed by all the faults they see in themselves
LSE1 - Self Doubt
LSE2 - Submissiveness
SOD
Social Discomfort
SOD high scorers:
Very uneasy around others, preferring to be by themselves
When in social situations, likely to sit alone, rather than joining in the group
They see themselves as shy
Dislike parties and other group events
SOD1 - Introversion
SOD2 - Shyness
FAM
Family Problems
High scorers on FAM:
Considerable family discord
Families described as lacking in love, quarrelsome, and unpleasant
May report hating members of their families
May portray childhood as abusive, and marriages seen as unhappy and lacking in affection
FAM1 - Family Discord
FAM2 - Familial Alienation
WRK
Work Interference
High score on WRK:
Indicative of behaviors and/or attitudes likely to contribute to poor work performance
Some of the problems relate to low self-confidence, concentration difficulties, obsessiveness, tension and pressure, and decision making
Others suggest lack of family support for career choice, personal questioning of career choice, and negative attitudes towards co-workers
No Content Component Scales
TRT
Negative Treatment Indicators
High scores on TRT:
May indicate individuals with negative attitudes towards doctors and mental health treatment
Believe that no one can understand or help them
Have issues or problems that they are not comfortable discussing with anyone
May not want to change anything in their lives, nor do they feel that change is possible
Prefer giving up rather than facing a crisis or difficulty
Scale is saturated with general maladjustment
TRT1 - Low Motivation
TRT2 - Inability to Disclose
CYN
Cynicism
High scores on CYN:
Misanthropic beliefs
Expect hidden, negative motives behind the acts of others
Distrust others; people use each other and are only friendly for selfish reasons
Likely hold negative attitudes about those close to them, including fellow workers, family, and friends
CYN1 - Misanthropic Beliefs
CYN2 - Interpersonal Suspiciousness
ASP
Antisocial Practices
High scores on ASP:
Similar misanthropic attitudes as high scorers on CYN
Report problem behaviors during their school years and other antisocial practices such as being in trouble with the law, stealing or shoplifting
Report sometimes enjoying the antics of criminals and believe that it is all right to get around the law, as long as it is not broken
ASP1 - Antisocial Attitudes
ASP2 - Antisocial Behavior
In what way are the Content Component Scales useful?
When at least 10 T score points between component scales, can see what to emphasize / de-emphasize based upon higher / lower scores
When is it appropriate to interpret the Content Component Scales?
Interpret only when parent content scale T score ≥ 60
When at least 10 T score points between component scales, can see what to emphasize / de-emphasize based upon higher / lower scores
How were the Supplementary Scales developed?
An ad hoc collection of scales and sets of scales developed over the course of the test’s history
More than 450 scales have been developed over the years; updated periodically
Included based on evidence that they provide information not available from the Clinical Scales
Augment Clinical Scale interpretation by focusing on more specific areas of personality function and dysfunction
Organized into five categories:
Personality Psychopathology-5 Scales
(PSY-5)
Broad Personality Characteristics
Generalized Emotional Distress
Behavioral Dyscontrol
Gender Role
A
Anxiety
Anxious, uncomfortable
Poor overall adjustment
Negative emotion, dysphoria, decreased energy
R
Repression
Internalizing
Conventional, cautious
Es
Ego Strength
Empirically Developed to Predict Response to Psychotherapy
17 patients who improved within six months and 16 patients who did not improve
Low scores associated with: Maladjustment
High scores associated with: Confidence; psychological resources
Mac-R
MacAndrew Alcoholism Scale-Revised 49 items Items that differentiate male alcoholic from non-alcoholic psychiatric patients (excluded overt alcohol items) Risk-taking, sensation-seeking Extroverted, exhibitionistic Increased risk for substance abuse Interpretation Raw score > 28 positive Raw score of 24-27 possible alcohol problems Caution: Not valid scale with women
PSY-5
Personality Psychopathology - 5 (PSY-5) Scales
Aggressiveness (AGGR)
Psychoticism (PSYC)
Disconstraint (DISC)
Negative Emotionality/Neuroticism (NEGE)
Introversion/Low Positive Emotionality (INTR)
Developed to provide an overview of major personality trait features
Linked to but conceptually distinct from other personality trait models (Five Factor Model)
Blends the clinical and normal perspective of personality assessment
O-H
Overcontrolled Hostility
Developed by identifying items that were answered differently by extremely assaultive prisoners, moderately assaultive prisoners, nonviolent prisoners, and men never convicted of crimes
High Scores: Defensiveness
Low Scores: Self-punitiveness, self-blaming, expression of angry feelings
AAS
Addiction Admission
Rationally identified items
Obvious item content
Shows promise in distinguishing between substance abusers and general psychiatric patients
T > 60
Acknowledging substance abuse
History of acting out
Impulsive, risk-taking
Critical, argumentative, angry, aggressive
Items that men and women in inpatient CD unit answered differently from men and women psychiatric inpatients and normative group
Heterogeneous item content assessing: Antisocial behavior Extroversion Excitement seeking, risk-taking, recklessness Satisfaction / dissatisfaction with self Powerlessness / lack of self-efficacy
APS
Addiction Potential
PK
Post-Traumatic Stress Disorder Intense emotional distress Anxiety and sleep disturbance Cutoff scores vary across settings Sensitive but not specific Combat veterans seeking services in VA Raw score of 28 T score > 83 Not specific for noncombat PTSD Women subjected to domestic abuse Workers injured in work-related accidents
MDS
Marital Distress
14 items identified by correlating MMPI-2 items with scores on Dyadic Adjustment Scale in couples in counseling and normative group
Dissatisfaction with marriage or romantic relationship
What do Critical Items measure?
Items whose content is indicative of serious psychopathology
Several sets most useful Koss-Butcher and Lachar-Wrobel
Caution most items overlap with scales F and 8 and keyed True
Consider as clarifying responses
DO NOT OVER INTERPRET
Items indicate serious distress or psychopathology.
When are Critical Items useful?
Items whose content is indicative of serious psychopathology
Several sets most useful Koss-Butcher and Lachar-Wrobel
Caution most items overlap with scales F and 8 and keyed True
Consider as clarifying responses
DO NOT OVER INTERPRET
Several sets most useful Koss-Butcher and Lachar-Wrobel? No idea what that means. Think they are useful because they can quickly inform you of self-harming and suicidal ideation/behaviors. Also, can use to compare to other scales.
