MMPI-2 Flashcards
What does the MMPI-2 measure?
Measures personality traits; psychological adjustment factors; clinical symptomatology; psychopathology.
Originally developed to facilitate psychiatric diagnosis of hospitalized patients
Primary focus was on adult psychiatric classification
CNS
Can Not Say-
Number of omitted items
Possible reasons for elevation include defensiveness, lack of insight, and obsessiveness
Effects on profile: deflated scores and may make clinical scales uninterpretable
VRIN
Variable Response Inconsistency
This scale indicates the persons tendency to respond inconsistently
Detects random responding
Aids in the interpretation of infrequency scales
TRIN
True Response Inconsistency - detects fixed responding
It identifies those who true responses to items indiscriminately (acquiescence) or give false responses to items indiscriminately (nonacquiescence).
Important in detecting defensiveness
F
Infrequency
This scale identifies Over-Reporting
It detects deviant or atypical ways of responding to test items
Possible reasons for elevation include (un)intentional over-reporting, severe distress, severe psychopathology, fixed responding, and random responding
Fb
Back Side Infrequency
Designed to detect changes in responding between first and second half of the test
Fp
Infrequency Psychopathology
Designed to detect intentional over-reporting in individuals with psychopathology
More effective than F scale in identifying overreporting in situations where the test takers have received some coaching about how to overreport on the MMPI-2 w/o being detected as doing so.
Less influenced than the F scale by genuine psychopathology
K
Correction
Designed to detect unintentional underreporting (Sophisticated underreporting)
Possible reasons for elevation: defensiveness, denying symptoms OR psychological well-being and ego strength
L
Lie (“Look Good Scale”)
Designed to detect intentional under-reporting
Possible reasons for elevation: lack of insight, intentional under-reporting, and indiscriminant “false” responding
S
Superlative Self-Presentation
Designed to identify under-reporting
This is for the people who tend to present themselves as highly virtuous and free of psychological problems
Nondefensive with significant psychopathology
This could reflect patient being overwhelmed, over- vulnerability, defenses are not working. Could also be a suicide indication for adolescents
Random Responding
F, FB, and FP usually greater than 100.
K and S near 50
L is 60-70
Fake Bad profile
Characterized by a very elevated F-scale T-score (usually well above 100).
Also the Fp and FB scales are elevated (usually at the same level as the F-scale)
L and K are low
Cry for Help Profile
L and K are lower than F
Fake Good Profile
L and K have T-scores > 65
L and K are greater than F (which is usually around 40-50)
What is K correction, when is it used and on what clinical scales?
A K-correction is designed to detect unintentional under-reporting.
You must be careful using K-corrections in settings where defensiveness is common (pre-employment, custody hearings) so not to over-pathologize test-takers
What do the clinical scales measure?
The clinical scales are objectively derived, scored, and interpreted scales, that are associates with well-established symptoms and behaviors.
Elevation on these scales or patterns of scales provides:
1. Descriptive information related to personality and symptoms
2. Hypotheses about personality, diagnosis, and prognosis
Scale 1
(Hs) – Hypochondriasis: somatic concerns, lacking energy, dissatisfaction, sleep disturbance, demanding, complaining [at risk for somatic delusions`
Scale 2
(D) – Depression: lack of hope, dissatisfaction with life, poor morale, worry, decreased concentration, withdrawal, somatic complaints, decreased self-esteem [at risk for clinical depression]
Scale 3
(Hy) – Hysteria: somatic symptoms, sleep disturbance, lower insight, denial, immature, self-centered, demanding, suggestive [at risk for conversion disorder]
Scale 4
(Pd) – Psychopthic Deviate: rebellious, non-conforming, family problems, angry, irritable, superficial relationships, impulsive, delinquent, negative view of authority [at risk for antisocial pd]
Scale 5
(Mf) – Masculinity/Femininity: lacking traditional M/F interests – work and recreation, worries/fears/sensitivity, family relationships [at risk for sexual problems]
Scale 6
(Pa) – Paranoia: ideas of reference sensitivity, feelings of persecution, anger and resentfulness, rigidity, guardedness, withdrawal, suspicion [at risk for paranoid psychosis]
Scale 7
(Pt) – Psychasthenia: anxiety and depression, decreased self-confidence, doubt, unreasonable fears, feeling unaccepted, indecisiveness, distress and unhappiness [at risk for extreme fear/intrusions]
Scale 8
(Sc) – Schizophrenia: schizoid lifestyle, confusion, fearfulness, aloofness, fantasies, psychosis, thought/mood disturbances, social alienation and estrangement, dissatisfaction, decreased concentration [at risk for schizophrenia]
Scale 9
(Ma) – Hypomania: increased energy, elevated mood, increased speech and motor activity, irritability, impulsivity, decreased frustration tolerance, conceptual disorganization [at risk for bipolar disorder]
Scale 0
(Si) – Social Isolation: shyness/timidness, decreased self-confidence, submissiveness, reliability, decreased interest, over-controlled, maladjusted [at risk for social phobia}
High K
defensiveness
Low K
Cry for Help (be wary of malingering or secondary gain)
Why are some scales K-corrected?
Some scales are K-corrected because test-takers may be invested in looking healthier than they really are. A defensive person is less likely to recognize the purpose of these subtle items so they will not try to avoid detection.
Although an elevation of the K scale could indicate defensiveness, it could also indicate psychological awareness and well-being, so K-corrected scales should be interpreted with caution
Which clinical scales do not measure psychopathology?
The (Mf) - Masculinity/Femininity scale was initially developed to identify homosexuals and is not a valid measure of psychopathology.
Rather, it measures traditional interests and is not at all related to symptoms in clinical or normal groups
What are the Harris Lingoes subscales and what are they useful for?
The Harris-Lingoes subscales provide extra information regarding items endorsed
Reliability is decreased, however, because of fewer items and considerable item overlap between subscales also affects validity
Which clinical scales have Harris Lingoes subscales?
(D) (Hy) (Pd) (Pa) (Sc) (Ma) (Si)
How do you define a codetype?
Relative elevations of scales that produce more information through a configural interpretation than single scale analysis
When is it valid to interpret the Harris Lingoes subscales?
They should not be interpreted unless the parent scale is significantly elevated
What would Neurotic Triad aka Conversion V look like?
13/31, where 2 is considerably lower than the elevated 13/31
What would Borderline Personality Disorder profile look like?
2468
What would a Psychotic Tetrad profile look like?
6789
What are reconstructed scales?
The RC scales were developed in order to sort out degree of emotional distress vs. the degree of core construct of scale
(ie: depression, aberrant thinking)
They were designed to preserve descriptive properties of Clinical Scales while enhancing distinctiveness
Designed to get very clean symptoms for the clinical scales
It was anticipated that the removal of “Demoralization” (RCd) as a general factor from all of the clinical scales would result in a set of restructured scales that would be less intercorrelated and have greater discriminant validity than the original clinical scales
RCd
dem/ Demoralization:
Indication of overall emotional wellbeing
High scores reflect discomfort, turmoil, low self esteem, pessimism, expectation to fail in future, overwhelmed, inability to cope, depression, anxiety, somatic complaints, might raise alienation scales
RC1
som/ Somatic Complaints:
Similar to scale 1 (Hypochonriasis) and HEA (Health Concerns) Content Scale
High scores reflect large number of physical complaints and little psychological insight, chronic pain, preoccupation with bodily functions, development of physical symptoms as a result of interpersonal or psychological difficulties
Could see this in back pain clinics, hospitals, and/or medical wards
RC2
lpe/ Low Positive Emotions:
High scores reflect lack of positive emotional engagement in life, unhappiness and risk for clinical depression, lack of energy to deal with life demands, difficulty taking charge and making decisions, hopelessness/helplessness, introverted, passive and often withdrawn, isolation, pessimism, low expectations for success, and less likely to engage in competitive behaviors
Hopelessness is a red flag for suicide
Can see this on BDI
RC3
cyn/ Cynicism:
Corresponds to Scale 3 (Hysteria): Somatic complaints and lack of trust with others
This scale addresses the trust component
High scores reflect seeing others as untrustworthy, uncaring, concerned only about themselves and exploitative. These people might be difficult to work with in therapy
Low scores can reflect likeliness to be naïve, gullible, and overly trusting of others
RC4
asb/ Antisocial Behavior:
Purer measure of antisocial characteristics than clinical scale 4 and more behavioral expression of psychopathic deviate
High scores reflect difficulties conforming to societal norms and expectations, histories of difficulties with the law, increased risk for substance use, aggressive behavior and conflicted interpersonal relationships, argumentativeness, anger, antagonism, difficulties in school and work
RC6
per/ Ideas of Persecution:
Purer measure of persecutory thinking than clinical Scale 6
High scores reflect feeling targeted, controlled, victimization by outside forces, suspiciousness, and difficulty forming trusting relationships
T > 75 associated with delusions, hallucinations, other psychotic symptoms
RC7
dne/ Dysfunctional Negative Emotions:
High scores reflect experience of negative emotions (anxiety, depression, irritability), intrusive unwanted ideation, insecure and sensitivity to perceived criticism, rumination and brooding about self perceived failures, and passive and submissive interpersonal relationships
RC8
abx/ Aberrant Experiences:
More focused measure of sensory, perceptual, cognitive, and motor disturbances than Clinical Scale 8
High scores T > 65 likeliness of hallucinations, delusions, or bizarre sensory experiences, weird odors, impaired reality testing
T > 75 likely diagnosis of schizophrenia, delusional disorder, or schizoaffective disorder
RC9
hmp/ Hypomanic Activation:
High scores reflect racing thoughts, high energy level, heightened mood, irritability, aggressiveness, substance us poor impulse control, sensation seeking, risky behaviors
T > 75 may suggest manic episode of Bipolar Disorder
T between 60 – 70 may indicate extraverted person with adaptive high energy level
How do the Clinical Scales relate to the RC scales?
Designed to preserve descriptive properties of Clinical Scales while enhancing distinctiveness
Reliability: internal consistency is higher than the Clinical Scales, test re test is stable after one week
Validity: Convergent Validity is similar to and greater than Clinical Scales
Cleaner symptoms of Clinical Scales
How were these scales derived?
Originally developed by Wiggins (1969) using the entire MMPI item pool
Elimination of most item overlap between scales
MMPI-2 Content Scales developed by Butcher, Graham, Williams, and Ben-Porath (1990)
What information do content scales provide?
Scores are seen as direct communication from test taker; high scores reflect what they want examiner to know about them
ANX
Anxiety - tension, somatic problems, sleep difficulties, worries, poor concentration, fear of losing their minds, find life a strain, difficulties making decisions
BIZ
Bizarre Mentation - psychotic thought processes, hallucinations; may recognize that thoughts are strange and peculiar, paranoid ideation, may feel that they have a special mission or special powers
LSE
Low Self Esteem - low opinion of self, believe that they are not liked by others, hold many negative attitudes about self, lack self-confidence
SOD
Social Discomfort - very uneasy around others, preferring to be by themselves, likely to sit alone, see themselves as shy, dislike parties and other group events
FAM
Family Problems - 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
WRK
Work Interference - behaviors and attitudes likely to contribute to poor work performance, low self-confidence, concentration difficulties, obsessiveness, tension and pressure; possible lack of family support for career choice, personal questioning of career choice, and negative attitudes towards co-workers
TRT
Negative Treatment Indicators - negative attitudes towards mental health treatment, believe that no one can understand or help them; not comfortable discussing certain issues with anyone, may not want to or feel it possible to change anything in their lives, prefer giving up; scale is saturated with general maladjustment
CYN
Cynicism - expect hidden, negative motives behind the acts of others, distrust others, and likely hold negative attitudes about those close to them
ASP
Antisocial Practices - report problem behaviors during their school years and other antisocial practices, 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
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
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 developed over the course of the test’s history, updated periodically.
Included based on evidence that they provide information not available from the clinical scales and they augment clinical scale interpretation by focusing on more specific areas of personality function and dysfunction
The MMPI item pool was used to develop numerous scales by variously recombining the 567 items using item analytic, factor-analytic, and intuitive procedures.
Scales varied considerably in terms of what they were supposed to measure, the manner in which they were constructed, their reliabilities, the extent to which they were cross-validated, the availability of normative data, and the amount of additional validity data that were generated.
The extent to which existing research data supported a scale’s reliability and validity determined which scales were retained (Graham)
A
Anxiety
Used to supplement the Anxiety Content Scale and the PT scale, measuring poor overall adjustment, feelings of anxiety and being uncomfortable, negative emotion, dysphoria and decreased energy
High Scores: (normal population): Rather miserable and unhappy
High Scores: (clinical population): neurotic, maladjusted, submissive, and overcontrolled. Likely to have histories of previous mental health treatment. Usually indicative of high levels of discomfort and these individuals are therefore highly motivated for counseling or psychotherapy
R
Repression
High Scores: introverted, internalizing, adopted careful and cautious lifestyles (this is how they will react in therapy as well)
Es
Ego Strength
Empirically developed to predict response to psychotherapy:
High Scores: indicative of confidence, psychological resources, generally tending to show more positive change during treatment, fairly well adjusted emotionally. Normal populations: not likely to have serious emotional problems, Psychiatric populations: problems are likely to be situational rather than chronic, prognosis is good
Low Scores: are indicative of maladjustment
MacR
MacAndrew Alcoholism Scale-Revised
49 items that differentiate male alcoholic from non-alcoholic psychiatric patients (excluded overt alcohol items).
Involves measure of risk-taking behaviors, sensation-seeking, extroversion, exhibitionistic, increased risk for substance abuse.
Raw scores of > 28 positive, raw score of 24-27, possible alcohol problems.
THIS SCALE IS NOT VALID FOR WOMEN
PSY-5
Personality Psychopathology-5:
(overall scale that includes: Aggressiveness, Psychoticism, Disconstraint, Negative Emotionality/Neuroticism, Introversion/Low Positive Emotionality)
Developed to provide an overview of major personality trait features.
Linked to but conceptually distinct from other personality trait models (i.e., Cattell’s Five-Factor Model).
Blends the clinical and normal perspective of personality assessment.
Typically used for: Personality Disorder Research; Fitness for Job; Pre-Employment; non-clinical populations to look at personality organization
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 score are indicative of defensiveness and higher scores tend not to respond to provocation appropriately most of the time, but occasional exaggerated responses may occur
Low-scores are indicative of self-punitiveness, self-blaming, expression of angry feelings.
If this is high, it is important to go back and get a detailed history because it might include domestic violence, ideations about hurting others, gang involvement, restraining orders.
Also important to find out what is stopping them from acting out, because when that’s not there, they won’t be able to control the hostility
AAS
Addiction Admission
Rationally identified items with obvious item content.
Shows promise in distinguishing between substance abusers and general psychiatric patients.
T > 60 signifies the participant is acknowledging substance abuse, has a history of acting out, is impulsive and risk-taking, critical, argumentative, angry, and aggressive.
Must be careful here with interpretations as anyone NOT currently using, but in a 12-step program could potentially meet criteria here.
For this scale, the consumer must have insight enough to endorse, it is also easier to fake if it’s an obvious item as in the case of the AAS.
Look at the Mac-R and compare other alcohol scales as well to get the best measure of potential for use.
APS
Addiction Potential
Items that men and women in inpatient chemical dependency unit answered differently from men and women psychiatric inpatients and normative group.
Scale is made up of heterogeneous item content assessing: antisocial behavior; extroversion; excitement seeking, risk-taking, recklessness, satisfaction/dissatisfaction with self, powerlessness/lack of self-efficacy.
This is not measuring if they’re actually doing the behavior, more about what motivates them
PK
Post-Traumatic Stress Disorder-Keane
Measures intense emotional distress and anxiety and sleep disturbance (Not specific for noncombat PTSD, more research needs to be done for instance, regarding women subjected to domestic abuse, workers injured in work-related accidents, etc., as the scale was developed from protocols of combat veterans).
Cutoff scores vary across settings, is sensitive but not specific.
When looking at combat veterans seeking services in VA, Raw score of 28, T score > 83
MDS
Marital Distress
14 items identified by correlating MMPI-2 items with scores on Dyadic Adjustment Scale in couples in counseling and normative group.
Measures dissatisfaction with marriage or romantic relationship. Only to be used with married heterosexual couples.
Limited validity data available for this scale, thus it should be interpreted cautiously.
High scores indicate distress in the marriage… therefore not much help when assessing persons who are admitting to marital problems and seeking help for them
High scores may also alert clinicians about underlying symptoms such as anxiety and depression
What do critical items measure?
They are items whose content has been judged to be indicative of serious psychopathology.
They are related to 6 crisis areas: acute anxiety state; depressed suicidal ideation; threatened assault; situational stress due to alcoholism; mental confusion; and persecutory ideas).
Considerable overlap with scales F and 8.
Most critical items are keyed in the “true” direction; thus, caution must be taken when the person is displaying an acquiescence response set or exaggerating symptoms
When are critical items useful?
They are useful as a tool for leading the clinician to inquire further into areas assessed by the items.
They should not be over-interpreted!
They should never be used as a quick assessment of level of maladjustment.
Critical items perform poorly in separating normal and psychiatric samples.
Critical-item lists are not as reliable as scales because of the vulnerability to error of single-item responses
When is it appropriate to interpret the Content Component Scales?
Only when the parent content scales is greater than 60
Make sure you take into account test-taking attitude
