Minnesota Multiphasic Personality Inventory

Minnesota Multiphasic Personality Inventory
Diagnostics
ICD-9-CM	94.02
MeSH	D008950

The Minnesota Multiphasic Personality Inventory (MMPI) is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology.

History and development

The original authors of the MMPI were Starke R. Hathaway, PhD, and J. C. McKinley, MD. The MMPI is copyrighted by the University of Minnesota. The standardized answer sheets can be hand scored with templates that fit over the answer sheets, but most tests are computer scored. Computer scoring programs for the current standardized version, the MMPI-2, are licensed by the University of Minnesota Press to Pearson Assessments and other companies located in different countries. The computer scoring programs offer a range of scoring profile choices including the extended score report, which includes data on the newest and most psychometrically advanced scales—the Restructured Clinical Scales (RC scales).^[1] The extended score report also provides scores on the more traditionally used Clinical Scales as well as Content, Supplementary, and other subscales of potential interest to clinicians. Use of the MMPI is tightly controlled for ethical and financial reasons. The clinician using the MMPI has to pay for materials and for scoring and report services, as well as a charge to install the computerized program.

MMPI

The original MMPI was developed in 1939 (Groth Marnat, Handbook of Psychological Assessment, 2009) using an [criterion] keying approach, which means that the clinical scales were derived by selecting items that were endorsed by patients known to have been diagnosed with certain pathologies.^{[2][3][4][5][6]} The difference between this approach and other test development strategies used around that time was that it was atheoretical (not based on any particular theory) and thus the initial test was not aligned with the prevailing psychodynamic theories of that time. The atheoretical approach to MMPI development ostensibly enabled the test to capture aspects of human psychopathology that were recognizable and meaningful despite changes in clinical theories.

MMPI-2

The first major revision of the MMPI was the MMPI-2, which was standardized on a new national sample of adults in the United States and released in 1989.^[7] It is appropriate for use with adults 18 and over. Subsequent revisions of certain test elements have been published, and a wide variety of subscales was also introduced over many years to help clinicians interpret the results of the original clinical scales. The current MMPI-2 has 567 items, all true-or-false format, and usually takes between 1 and 2 hours to complete depending on reading level. There is an infrequently used abbreviated form of the test that consists of the MMPI-2's first 370 items.^[8] The shorter version has been mainly used in circumstances that have not allowed the full version to be completed (e.g., illness or time pressure), but the scores available on the shorter version are not as extensive as those available in the 567-item version. The original form of the MMPI-2 is the 3rd most frequently utilized test in the field of psychology, behind the most used IQ and achievement tests.

MMPI-A

A version of the test designed for adolescents, the MMPI-A, was released in 1992.^[9] The MMPI-A has 478 items, with a short form of 350 items.

MMPI-2 RF

A new and psychometrically improved version of the MMPI-2 has recently been developed employing rigorous statistical methods that were used to develop the RC Scales in 2003.^[10] The new MMPI-2 Restructured Form (MMPI-2-RF) has now been released by Pearson Assessments. The MMPI-2-RF produces scores on a theoretically grounded, hierarchically structured set of scales, including the RC Scales. The modern methods used to develop the MMPI-2-RF were not available at the time the MMPI was originally developed. The MMPI-2-RF builds on the foundation of the RC Scales, which are theoretically more stable and homogenous than the older clinical scales on which they are roughly based. Publications on the MMPI-2-RC Scales include book chapters, multiple published articles in peer-reviewed journals, and address the use of the scales in a wide range of settings.^{[11][12][13][14][15][16][17][18][19][20][21][22][23]} The MMPI-2-RF scales rest on an assumption that psychopathology is a homogenous condition that is additive. ^{[24][25][26][27][28][29][30]}

Current scale composition

Clinical scales

Scale 1 (AKA the Hypochondriasis Scale) : Measures a person's perception and preoccupation with their health and health issues., Scale 2 (AKA the Depression Scale) : Measures a person's depressive symptoms level., Scale 3 (AKA the Hysteria Scale) : Measures the emotionality of a person., Scale 4 (AKA the Psychopathic Deviate Scale) : Measures a person's need for control or their rebellion against control., Scale 5 (AKA the Femininity/Masculinity Scale) : Measures a stereotype of a person and how they compare. For men it would be the Marlboro man, for women it would be June Cleaver or Donna Reed., Scale 6 (AKA the Paranoia Scale) : Measures a person's inability to trust., Scale 7 (AKA the Psychasthenia Scale) : Measures a person's anxiety levels and tendencies., Scale 8 (AKA the Schizophrenia Scale) : Measures a person's unusual/odd cognitive, perceptual, and emotional experiences, Scale 9 (AKA the Mania Scale) : Measures a person's energy., Scale 0 (AKA the Social Introversion Scale) : Measures whether people enjoy and are comfortable being around other people.

The original clinical scales were designed to measure common diagnoses of the era.

Number	Abbreviation	Description	What is measured	No. of items
1	Hs	Hypochondriasis	Concern with bodily symptoms	32
2	D	Depression	Depressive Symptoms	57
3	Hy	Hysteria	Awareness of problems and vulnerabilities	60
4	Pd	Psychopathic Deviate	Conflict, struggle, anger, respect for society's rules	50
5	MF	Masculinity/Femininity	Stereotypical masculine or feminine interests/behaviors	56
6	Pa	Paranoia	Level of trust, suspiciousness, sensitivity	40
7	Pt	Psychasthenia	Worry, Anxiety, tension, doubts, obsessiveness	48
8	Sc	Schizophrenia	Odd thinking and social alienation	78
9	Ma	Hypomania	Level of excitability	46
0	Si	Social Introversion	People orientation	69

Codetypes are a combination of the one, two or three (and according to a few authors even four), highest-scoring clinical scales (ex. 4, 8, 2, = 482). Codetypes are interpreted as a single, wider ranged elevation, rather than interpreting each scale individually.

Validity scales

The validity scales in all versions of the MMPI-2 (MMPI-2 and RF) contain three basic types of validity measures: those that were designed to detect non-responding or inconsistent responding (CNS, VRIN, TRIN), those designed to detect when clients are over reporting or exaggerating the prevalence or severity of psychological symptoms (F, Fb, Fp, FBS), and those designed to detect when test-takers are under-reporting or downplaying psychological symptoms (L, K)). A new addition to the validity scales for the MMPI-2 RF includes an over reporting scale of somatic symptoms scale (Fs).

Abbreviation	New in version	Description	Assesses
CNS	1	"Cannot Say"	Questions not answered
L	1	Lie	Client "faking good"
F	1	Infrequency	Client "faking bad" (in first half of test)
K	1	Defensiveness	Denial/Evasiveness
Fb	2	Back F	Client "faking bad" (in last half of test)
VRIN	2	Variable Response Inconsistency	answering similar/opposite question pairs inconsistently
TRIN	2	True Response Inconsistency	answering questions all true/all false
F-K	2	F minus K	honesty of test responses/not faking good or bad
S	2	Superlative Self-Presentation	improving upon K scale, "appearing excessively good"
Fp	2	F-Psychopathology	Frequency of presentation in clinical setting
Fs	2 RF	Infrequent Somatic Response	Overreporting of somatic symptoms

Supplemental Scales

To supplement these multidimensional scales and to assist in interpreting the frequently seen diffuse elevations due to the general factor (removed in the RC scales)^[31][32] were also developed, with the more frequently used being the substance abuse scales (MAC-R, APS, AAS), designed to assess the extent to which a client admits to or is prone to abusing substances, and the A (anxiety) and R (repression) scales, developed by Welsh after conducting a factor analysis of the original MMPI item pool.

Dozens of content scales currently exist, the following are some samples:

Abbreviation	Description
Es	Ego Strength Scale
OH	Over-Controlled Hostility Scale
MAC	MacAndrews Alcoholism Scale
MAC-R	MacAndrews Alcoholism Scale Revised
Do	Dominance Scale
APS	Addictions Potential Scale
AAS	Addictions Acknowledgement Scale
SOD	Social Discomfort Scale
A	Anxiety Scale
R	Repression Scale
TPA	Type A Scale
MDS	Marital Distress Scale

PSY-5 scales

Unlike the Content and Supplementary scales, the PSY-5 scales were not developed as a reaction to some actual or perceived shortcoming in the MMPI-2 itself, but rather as an attempt to connect the instrument with more general trend in personality psychology.^[33] The five factor model of human personality has gained great acceptance in non-pathological populations, and the PSY-5 scales differ from the 5 factors identified in non-pathological populations in that they were meant to determine the extent to which personality disorders might manifest and be recognizable in clinical populations. The five components were labeled Negative Emotionality (NEGE), Psychoticism (PSYC), Introversion (INTR), Disconstraint (DISC) and Aggressiveness (AGGR).

Scoring and interpretation

Like many standardized tests, scores on the various scales of the MMPI-2 and the MMPI-2-RF are not representative of either percentile rank or how "well" or "poorly" someone has done on the test. Rather, analysis looks at relative elevation of factors compared to the various norm groups studied. Raw scores on the scales are transformed into a standardized metric known as T-scores (Mean or Average equals 50, Standard Deviation equals 10), making interpretation easier for clinicians. Test manufacturers and publishers ask test purchasers to prove they are qualified to purchase the MMPI/MMPI-2/MMPI-2-RF and other tests^{[citation needed]}.

Recent Advancements in the MMPI-2

RC and Clinical Scales

The Restructured Clinical Scales are psychometrically improved versions of the original Clinical Scales, which were known to contain a high level of interscale correlation, overlapping items, and were confounded by the presence of an overarching factor that has since been extracted and placed in a separate scale (demoralization). The RC scales measure the core constructs of the original clinical scales. Critics of the RC scales assert they have deviated too far from the original clinical scales, the implication being that previous research done on the clinical scales will not be relevant to the interpretation of the RC scales. However, research on the RC scales assert that the RC scales predict pathology in their designated areas better than their concordant original clinical scales while using significantly fewer items and maintaining equal to higher internal consistency reliability and validity; further, unlike the original clinical scales, the RC scales are not saturated with the primary factor (demoralization, now captured in RCdem) which frequently produced diffuse elevations and made interpretation of results difficult; finally, the RC scales have lower interscale correlations and, in contrast to the original clinical scales, contain no interscale item overlap.^[34] The effects of removal of the common variance spread across the older clinical scales due to a general factor common to psychopathology, through use of sophisticated psychometric methods were described as a paradigm shift in personality assessment .^[35][36] Critics of the new scales argue that the removal of this common variance makes the RC scales less ecologically valid (less like real life) because real patients tend to present complex patterns of symptoms. However, this issue is addressed by being able to view elevations on other RC scales that are less saturated with the general factor and, therefore, are also more transparent and much easier to interpret.

Addition of the Lees-Haley FBS (Symptom Validity)

The following discussion concerns the Lees-Haley validity scale, FBS. After its addition to MMPI-2 the FBS was renamed "Symptom Validity" to address the concerns that its full name appears prejudicial, although the FBS acronym continues to be used in academic publications to refer to Lees-Haley's scale.^[37]

The FBS was developed by psychologist Paul Lees-Haley, who works mainly for defendants (insurance companies, etc.) in personal injury cases. The scale was introduced in MMPI after a review of the literature.

One of the critics of the Lees-Haley FBS is retired psychologist James Butcher, who reported that more than 45% of psychiatric patients he studied had FBS scores of 20 or more. These are relatively high scores that suggest symptom exaggeration. While Butcher contends that it is unlikely that so many psychiatric patients intentionally misled their physicians, his study has been criticized by numerous clinical neuropsychologists on methodological and conceptual grounds, including the likelihood that his subject pool included patients who may have had secondary gain motive to feign symptoms, that he ignored recommended gender-related cut-offs, and used a less sensitive or specific MMPI-2 scale as his 'gold-standard.'^[38]

An independent professional panel recommended that the Lees-Haley FBS be included in the standard Pearson scoring system.^[39]

Several studies by independent Neuropsychologists have since been published in respected peer-reviewed journals supporting the Lees-Haley FBS scale as highly sensitive and specific (when proper cut-offs are used) in identifying individuals who are exaggerating somatic symptoms (as opposed to psychiatric, mood, or neurological symptoms) in settings where the base-rate of malingering is typically high (litigation, pain clinics, etc.), as it was designed to do.^[40][41][42] The FBS is one of the validity scales that is frequently considered when examining populations with secondary gain motive, particularly disability seeking patients.^[43]

In 2008 Butcher and colleagues published a review of the available evidence in Psychological Injury and Law.^[44] Ben-Porath and colleagues rebutted the review.^[37] Butcher and colleagues have continued to debate the utility of the FBS. ^[45]

Notes

1. ^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN: University of Minnesota Press.
2. ^ Hathaway, S. R., & McKinley, J. C. (1940). A multiphasic personality schedule(Minnesota): I. Construction of the schedule. Journal of Psychology, 10, 249-254.
3. ^ Hathaway, S. R., & McKinley, J. C. (1942). A multiphasic personality schedule (Minnesota): III. The measurement of symptomatic depression. Journal of Psychology, 14, 73-84.
4. ^ McKinley, J. C, & Hathaway, S. R. (1940). A multiphasic personality schedule (Minnesota): II. A differential study of hypochondriasis. Journal of Psychology, 10,255-268.
5. ^ McKinley, J. C, & Hathaway, S. R. (1942). A multiphasic personality schedule (Minnesota): IV. Psychasthenia. Journal of Applied Psychology, 26, 614-624.
6. ^ McKinley, J. C, & Hathaway, S. R. (1944). A multiphasic personality schedule (Minnesota): V. Hysteria, Hypomania, and Psychopathic Deviate. Journal of Applied Psychology, 28, 153-174.
7. ^ Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A, & Kaemmer, B. (1989).The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN: University of Minnesota Press.
8. ^ Butcher, J. N., Hostetler, K. (1990). Abbreviating MMPI Item Administration. What Can Be Learned From the MMPI for the MMPI—2?. Psychological Assessment: A Journal of Consulting and Clinical Psychology, March 1990 Vol. 2, No. 1, 12-21
9. ^ Butcher, J.N., Williams, C.L., Graham, J.R., Archer, R.P., Tellegen, A., Ben-Porath, Y.S., & Kaemmer, B. (1992). Minnesota Multiphasic Personality Inventory-Adolescent Version(MMPI-A): Manual for administration, scoring and interpretation. Minneapolis, MN: University of Minnesota Press.
10. ^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN: University of Minnesota Press.
11. ^ Arbisi, P. A., Sellbom, M., & Ben-Porath, Y. S. (2008). Empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales in psychiatric inpatients. Journal of Personality Assessment, 90, 122-128.
12. ^ Castro, Y., Gordon, K. H., Brown, J. S., Cox, J. C., & Joiner, T. E. (In Press). Examination of racial differences on the MMPI-2 Clinical and Restructured Clinical Scales in an outpatient sample. Assessment.
13. ^ Forbey, J. D., & Ben-Porath, Y. S. (2007). A comparison of the MMPI-2 Restructured Clinical (RC) and Clinical Scales in a substance abuse treatment sample. Psychological Services, 4, 46-58.
14. ^ Handel, R. W., & Archer, R. P. (In Press). An investigation of the psychometric properties of the MMPI-2 Restructured Clinical (RC) Scales with mental health inpatients. Journal of Personality Assessment.
15. ^ Kamphuis, J.H., Arbisi, P.A., Ben-Porath, Y.S., & McNulty, J.L. (In Press). Detecting Comorbid Axis-II Status Among Inpatients Using the MMPI-2 Restructured Clinical Scales. European Journal of Psychological Assessment.
16. ^ Osberg, T. M., Haseley, E. N., & Kamas, M. M. (2008). The MMPI-2 Clinical Scales and Restructured Clinical (RC) Scales: Comparative psychometric properties and relative diagnostic efficiency in young adults. Journal of Personality Assessment. 90, 81-92.
17. ^ Sellbom, M., Ben-Porath, Y. S., & Bagby, R. M. (In Press). Personality and Psychopathology: Mapping the MMPI-2 Restructured Clinical (RC) Scales onto the Five Factor Model of Personality. Journal of Personality Disorders.
18. ^ Sellbom, M., Ben-Porath, Y. S., & Graham, J. R. (2006). Correlates of the MMPI-2 Restructured Clinical (RC) Scales in a college counseling setting. Journal of Personality Assessment, 86, 89-99.
19. ^ Sellbom, M., Ben-Porath, Y. S., McNulty, J. L., Arbisi, P. A., & Graham, J. R. (2006). Elevation differences between MMPI-2 Clinical and Restructured Clinical (RC) Scales: Frequency, origins, and interpretative implications. Assessment, 13, 430-441.
20. ^ Sellbom, M., Graham, J. R., & Schenk, P. (2006). Incremental validity of the MMPI-2 Restructured Clinical (RC) Scales in a private practice sample. Journal of Personality Assessment, 86, 196-205.
21. ^ Simms, L. J., Casillas, A., Clark, L .A., Watson, D., & Doebbeling, B. I. (2005). Psychometric evaluation of the Restructured Clinical Scales of the MMPI-2. Psychological Assessment, 17, 345-358.
22. ^ Sellbom. M., & Ben-Porath, Y. S. (2006). Forensic applications of the MMPI. In R. P. Archer (Ed.), Forensic uses of clinical assessment instruments. (pp. 19-55) NJ: Lawrence Erlbaum Associates.
23. ^ Sellbom, M., Ben-Porath, Y. S., Baum, L. J., Erez, E., & Gregory, C. (2008). Predictive validity of the MMPI-2 Restructured Clinical (RC) Scales in a batterers' intervention program. Journal of Personality Assessment, 90. 129-135.
24. ^ Sellbom, M., Ben-Porath, Y. S., Lilienfeld, S. O., Patrick, C. J., & Graham, J. R. (2005). Assessing psychopathic personality traits with the MMPI-2. Journal of Personality Assessment, 85, 334-343.
25. ^ Sellbom, M., Ben-Porath, Y. S., & Stafford, K. P. (2007). A comparison of measures of psychopathic deviance in a forensic setting. Psychological Assessment, 19, 430-436.
26. ^ Sellbom, M., Ben-Porath, Y. S., Graham, J. R., Arbisi, P. A., & Bagby, R. M. (2005). Susceptibility of the MMPI-2 Clinical, Restructured Clinical (RC), and Content Scales to overreporting and underreporting. Assessment, 12, 79-85.
27. ^ Sellbom, M., & Ben-Porath, Y. S. (2005). Mapping the MMPI-2 Restructured Clinical (RC) Scales onto normal personality traits: Evidence of construct validity. Journal of Personality Assessment, 85, 179-187.
28. ^ Sellbom, M., Fischler, G. L., & Ben-Porath, Y. S. (2007). Identifying MMPI-2 predictors of police officer integrity and misconduct. Criminal Justice and Behavior, 34, 985-1004.
29. ^ Stredny, R. V., Archer, R. P., & Mason, J. A. (2006). MMPI-2 and MCMI-III characteristics of parental competency examinees. Journal of Personality Assessment, 87, 113-115.
30. ^ Wygant, D. B., Boutacoff, L. A., Arbisi, P. A., Ben-Porath, Y. S., Kelly, P. H., & Rupp, W. M. (2007). Examination of the MMPI-2 Restructured Clinical (RC) Scales in a sample of bariatric surgery candidates. Journal of Clinical Psychology in Medical Settings, 14, 197-205.
31. ^ Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation. Minneapolis, MN2). An MMPI handbook: Vol. I. Clinical interpretation. Minneapolis: University of Minnesota Press.
32. ^ Caldwell, A. B. (1988). MMPI supplemental scale manual. Los Angeles: Caldwell Report.
33. ^ Harkness, A. R., McNulty, J. L., Ben-Porath, Y. S., & Graham, J. R. (2002). MMPI-2 Personality-Psychopathology Five (PSY-5) Scales: Gaining an overview for case conceptualization and treatment planning. Minneapolis, MN: University of Minnesota Press.
34. ^ Tellegen, A., Ben-Porath, Y. S., Sellbom, M., Arbisi, P. A., McNulty, J. L., & Graham, J. R. (2006). Further evidence on the validity of the MMPI-2 Restructured Clinical (RC) Scales: Addressing questions raised by Rogers et al. and Nichols. Journal of Personality Assessment, 87, 148-171.
35. ^ Rogers, R., Sewell, K. W., Harrison, K. S., & Jordan, M. J. (2006). The MMPI-2 Restructured Clinical Scales: A paradigmatic shift in scale development. Journal of Personality Assessment, 87, 139-147.
36. ^ Archer, R. P. (2006). A perspective on the Restructured Clinical (RC) Scale project. Journal of Personality Assessment, 87, 179-185.
37. ^ ^{a b} Ben-Porath, Yossef S.; Greve, Kevin W.; Bianchini, Kevin J.; Kaufmann, Paul M. (2009). "The MMPI-2 Symptom Validity Scale (FBS) is an Empirically Validated Measure of Overreporting in Personal Injury Litigants and Claimants: Reply to Butcher et al. (2008)". Psychological Injury and Law 2 (1): 62–85. doi:10.1007/s12207-009-9037-4.  edit
38. ^ Greiffenstein M.F., Fox D., Lees-Haley P. (2007) MMPI-2 in Detection of Non-credible Brain Injury Claims. In K.B. Boone (Ed.) Assessment of Feigned Cognitive Impairment: A Neuropsychological Perspective (pp. 210-235) New York: Guilford Press.
39. ^ Press Release:http://www.pearsonassessments.com/pai/ai/about/news/NewsItem/2006/newsrelease0806ca.htm
40. ^ Larrabee G.J. (2005) Assessment of Malingering. Forensic Neuropsychology: A Scientific Approach. (pp 115-158). New York: Oxford University Press
41. ^ Greiffenstein M.L., Baker W.J., Axelrod B., Peck E. & Gervais R. (2004) The Fake Bad Scale and the MMPI-2 F-family in detection of implausible trauma claims. The Clinical Neuropsychologist, 18, 573-590.
42. ^ Henry G.K., Heilbronner H.L., Mittenberg W., Enders C., & Stanczak S.R. (2008) Comparison of the Lees-Haley Fake Bad Scale, Henry-Heilbronner Index, and Restructured Clinical Scale 1 in identifying noncredible symptom reporting. The Clinical Neuropsychologist, 22, 919-929.
43. ^ Downing S.K., Denney R.L., Spray B.L., Houston C.M., Halfaker D.A. Examining the relationship between the Reconstructed Scales and the Fake Bad Scale of the MMPI-2. (2008) The Clinical Neuropsychologist, 22, 680-688.
44. ^ Butcher, James N.; Gass, Carlton S.; Cumella, Edward; Kally, Zina; Williams, Carolyn L. (2008). "Potential for Bias in MMPI-2 Assessments Using the Fake Bad Scale (FBS)". Psychological Injury and Law 1 (3): 191–209. doi:10.1007/s12207-007-9002-z.  edit
45. ^ Williams, Carolyn L.; Butcher, James N.; Gass, Carlton S.; Cumella, Edward; Kally, Zina (2009). "Inaccuracies About the MMPI-2 Fake Bad Scale in the Reply by Ben-Porath, Greve, Bianchini, and Kaufman (2009)". Psychological Injury and Law 2 (2): 182–197. doi:10.1007/s12207-009-9046-3.  edit

See also

• Employment testing#Personality tests
• Big five personality traits
• 16PF Questionnaire
• Meyers-Briggs Type Indicator (MBTI)
• Neuroticism Extraversion Openness Personality Inventory (NEO-PI)
• Diagnostic classification and rating scales used in psychiatry

External links

• MMPI-2, Pearson Website
• MMPI-A (Minnesota Multiphasic Personality Inventory-Adolescent)
• MMPI Research Project