Discriminating malingered from genuine civilian posttraumatic stress disorder: a validation of three MMPI-2 Infrequency scales (F, Fp, and Fptsd)

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2's F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd's incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.     

An ethnocultural study of posttraumatic stress disorder in African-American and white American Vietnam War veterans

This study examined the intensity of Posttraumatic Stress Disorder (PTSD) symptoms as measured by the Mississippi Scale, the Keane (PK), and the PTSD (PS) Scales of the MMPI-2 in a sample of 34 African-American and 34 White American Vietnam War Veterans who sought treatment in a Specialized Inpatient PTSD Unit. The scores of the two groups on the Beck Depression Inventory and the clinical scales of the MMPI-2 were also compared. The ethnoculturally different sample was matched on intensity of combat exposure, marital status, employment status, age, and education. No significant differences on the measures of PTSD symptoms were noted and no significant differences were found on the Beck scale or the MMPI-2 clinical scales.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

The incremental validity and clinical utility of the MMPI-2 infrequency posttraumatic stress disorder scale

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F(B), and F(P), F, F(B), and F(P) added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales.     

Differentiating overreporting and extreme distress: MMPI-2 use with compensation-seeking veterans with PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

Detection of Feigned Posttraumatic Stress Disorder: A Comparison of the MMPI-2 and PAI

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) were compared for detecting feigned posttraumatic stress disorder (PTSD) in a simulation research design. Participants were 85 undergraduates in one of three groups: PTSDs (n = 23), Fakers (n = 31), and Controls (n = 31). As expected, both the MMPI-2 and PAI discriminated PTSDs and Controls, with PTSDs scoring significantly higher on fake-bad validity scales and PTSD-relevant clinical scales. However, only the MMPI-2 discriminated Fakers and PTSDs, with Fakers scoring significantly higher on all MMPI-2 scales considered, but on only one PAI scale. Further, in logistic regression analyses the MMPI-2 demonstrated higher overall correct classification of PTSDs and Fakers than did the PAI. Although the MMPI-2 outperformed the PAI in detecting feigned PTSD, a substantial proportion of Fakers avoided detection by MMPI-2 fake-bad validity scales, suggesting that both tests are vulnerable to feigning of PTSD by motivated respondents with relatively limited coaching.     

Differentiating Overreporting and Extreme Distress: MMPI-2 Use With Compensation-Seeking Veterans With PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

MMPI-2 Assessment of Varying Levels of Posttraumatic Stress in Vietnam Combat Veterans

The effectiveness of the MMPI-2 in the detection of posttraumatic stress (PTS) symptomatology was investigated. Forty-nine veterans at a VA posttraumatic stress clinic were evaluated for PTS symptomatology according to DSM-III-R criteria. The ability of the MMPI-2 to differentiate between Vietnam combat veterans (VCV) who met DSM-III-R criteria for posttraumatic stress disorder (PTSD; N = 36) and those who reported varying levels of posttraumatic stress symptoms (PTSS; N = 13) was examined. Overall, the MMPI-2 was effective in differentiating between the two groups of veterans. Of the 15 MMPI-2 scales used to evaluate PTS symptomatology, 12 significantly differentiated veterans with PTSD from those with PTSS. Diagnostic efficiency statistics for the MMPI-2 PTSD scales (PS and PK) were calculated at four cutoff points (T 65, 70, 75, and 80). The PS Scale was the most robust and effective index in differentiating between veterans with PTSD and those with PTSS. Implications for the assessment of varying degrees of PTS are discussed.     

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the screening instruments, the National Guard soldiers who produced a valid MMPI-2 RF were classified into four groups: 21 soldiers who screened positive for PTSD only, 33 soldiers who screened positive for mTBI only, 9 soldiers who screened positive for both conditions, and 166 soldiers who did not screen positive for either condition. Results showed that the MMPI-2 RF was able to differentiate across the groups with the MMPI-2 RF specific problem scale Anxiety adding incrementally to MMPI-2 Restructured Clinical scales in predicting PTSD. Both MMPI-2 RC1 (Somatic Complaints) and MMPI-2 RF head pain complaints predicted mTBI screen but did not add incrementally to each other. Of note, all of the MMPI-2 RF validity scales associated with overreporting, including Symptom Validity-Revised (FBS-r), were not significantly elevated in the mTBI group. These findings support the use of the MMPI-2 RF in assessing PTSD in non-treatment-seeking veterans. This further suggests that a positive screen for mTBI alone is not associated with significant emotional disturbance.     

The utility of the PAI and the MMPI-2 for discriminating PTSD, depression, and social phobia in trauma-exposed college students

This study investigated the Minnesota Multiphasic Personality Inventory-Revised (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and the Personality Assessment Inventory (PAI; Morey, 1991) with regard to each instrument's utility for discriminating post-traumatic stress disorder (PTSD) from depression and social phobia in a sample of college students with mixed civilian trauma exposure. Participants were 90 trauma-exposed undergraduates (16 male, 74 female) classified into one of four groups: PTSD, depressive disorders, social phobia, and well-adjusted. For both the PAI and the MMPI-2, profile analysis revealed that the groups differed in the elevation and shape of their profiles. The PAI Traumatic Stress subscale demonstrated good discriminant validity.     

The detection of feigned uncoached and coached posttraumatic stress disorder with the MMPI-2 in a sample of workplace accident victims

In this study research participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) under standard instructions and then were asked to fake posttraumatic stress disorder (PTSD) when completing the MMPI-2 for a 2nd time in 1 of 4 conditions with different instructions on how to fake PTSD: (a) uncoached, (b) coached about PTSD symptom information, (c) coached about MMPI-2 validity scales, or (d) coached about both symptoms and validity scales. These MMPI-2 protocols were then compared with protocols of claimants with workplace accident-related PTSD. Participants given information about the validity scales were the most successful in avoiding detection as faking. The family of F scales (i.e., F, FB, FP), particularly FP, produced consistently high rates of positive and negative predictive power.     

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd) for the MMPI-2: development and initial validation with veterans presenting with combat-related PTSD

Researchers have identified difficulties associated with the use of traditional Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity scales with survivors of traumatic events. A new scale, the Infrequency-Posttraumatic Stress Disorder scale (Fptsd), was created from MMPI-2 items that were infrequently endorsed by 940 male combat veterans presenting for treatment at the posttraumatic stress disorder (PTSD) clinics of 2 Veterans Affairs Medical Centers. A variety of statistical methods were implemented that preliminarily established Fptsd's validity with a validation sample of 323 additional PTSD-diagnosed combat veterans. Results indicate that, relative to previously established validity and overreporting scales (F, Fb, and Fp), Fptsd was significantly less related to psychopathology and distress and better at discriminating simulated from genuinely reported PTSD. Clinical implications are discussed concerning the use of Fptsd to assess disability-seeking veterans suspected of overreporting PTSD symptoms.     

A comparison of the MCMI-III personality disorder and modifier indices with the MMPI-2 clinical and validity scales

In this study, we examined the relationship of the MCMI-III (Millon, Davis, & Millon, 1997; Millon, Millon, & Davis, 1994) modifier indices and personality disorder scales to the validity and basic clinical scales of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MCMI-III modifier indices highly correlated with all of the MMPI-2 validity scales except for the F(p) scale. Similarly, the MCMI-III personality disorder scales strongly covaried with the MMPI-2 validity and clinical scales except for the F(p) and 5 (Mf) scales. A factor analysis with Promax rotation revealed substantial relationships between the MMPI-2 and MCMI-III. However, the MMPI-2 F(p) scale did not tend to correlate with MMPI-2 or MCMI-III scales, indicating that F(p) scale variance was largely independent of other scales. The results suggest that clinicians should consider the interrelationship between personality characteristics and dissimulation.     

Assessing depression with the MMPI and MMPI-2

The usefulness of the MMPI (Hathaway & McKinley, 1951 ) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) for diagnosing and assessing symptomatic depression has been the subject of considerable debate for a number of years. In this article, we review the relative contributions of the MMPI and MMPI-2 clinical and content scales in predicting depression. Positive predictive power, negative predictive power, and overall classification rate were computed for Scale 2 (D) of the MMPI and MMPI-2 and the Depression content scale (DEP) of the MMPI-2. Scale 2 (D) of both the MMPI and MMPI-2 appears to be moderately accurate in predicting depression. Although some studies suggest that the content scale DEP provides incremental validity over Scale 2 (D) of the MMPI-2, the results of this review indicate that the content scale DEP of the MMPI-2 does not exceed the diagnostic efficiency of Scale 2 in predicting depression.     

The Use of the MMPI-2 Infrequency–Psychopathology Scale in the Assessment of Posttraumatic Stress Disorder in Male Veterans

This study evaluated the use of the F_P (Infrequency–Psychopathology) scale of the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) as a measure of symptom overreporting among 423 service-seeking male veterans with and without PTSD. Results were consistent with several predictions based on the logic of the F_P scale. F_P produced lower scores for PTSD and non-PTSD patients than the other two MMPI-2 measures of infrequent responding; F and F_B. F_P also resulted in fewer invalid protocols than did F or F_B. Finally, F_P yielded lower correlations with MMPI-2 and other measures of psychopathology than did F or F_B. Consistent with previous studies, compensation-seeking status was associated with extreme elevations across clinical and validity scales. Contrary to previous findings, however, compensation-seeking veterans were also more likely to receive a PTSD diagnosis. Implications for the relationship between compensation seeking and symptom overreporting are discussed.     

An evaluation of the usefulness of the MMPI-2 F(p) scale

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) F(p) scale was developed by Arbisi and Ben-Porath (1995) by identification of 27 items endorsed by fewer than 20% of individuals in both normal and psychiatric samples. The F(p) scale was designed for applications in settings characterized by high base rates of serious psychopathology, such as psychiatric inpatient units, and is proposed as a useful scale in discriminating overreported protocols from those produced by patients with serious psychopathology. In this study we investigated the characteristics of this scale in a sample of 617 psychiatric inpatients who responded to the MMPI-2 under standard conditions, and 203 overreported protocols derived in research studies conducted with normal adult participants instructed to simulate various forms of serious psychopathology. Results of this study are consistent with prior reports of a relatively low frequency of item endorsement for F(p) scale items in psychiatric samples, and intercorrelations between the F(p) scale and the MMPI-2 basic clinical scales in clinical samples that are generally lower than those produced between either F or Fb and the basic clinical scales. However, this intercorrelational pattern between F(p) and the MMPI-2 basic scales was not as consistent for the overreported sample. Additionally, the F(p) scale appears to be effective in discriminating overreported from accurate MMPI-2 protocols, with some evidence that the optimal cutting scores for this and other MMPI-2 infrequency scales may differ as a function of gender. Finally, these findings do not show clear evidence of improved group prediction derived from the use of the F(p) scale in contrast to results obtainable through the use of the MMPI-2 F scale.     

Couples in marital distress: a study of personality factors as measured by the MMPI-2

This study examines the relationship between Minnesota Multiphasic Personality Inventory-2 (MMPI-2) measured personality characteristics and marital distress and provides empirical validation for using the MMPI-2 with a marital therapy population. Studied were 150 couples in marital therapy and 841 normal couples who participated in the MMPI-2 restandardization study. The MMPI-2, a biographical form, a partner rating form, and the Dyadic Adjustment Scale (DAS) were administered to all couples. The marital counseling group resembled previous marital counseling samples studied with the MMPI and scored significantly higher than the normative sample on several MMPI-2 scales. Relationships between the DAS and MMPI-2 clinical and content scale scores are reported. The Psychopathic Deviate (Pd) clinical scale and Family Problems (FAM) content scale were the most powerful group discriminators and strongest correlates of the DAS; their use as indices of marital distress is tested. The meaning of Pd as an index in assessing personality factors in marital distress is explored.     

Developmental Changes in Content of Movement Responses

This study examines the relationship between Minnesota Multiphasic Personality Inventory-2 (MMPI-2) measured personality characteristics and marital distress and provides empirical validation for using the MMPI-2 with a marital therapy population. Studied were 150 couples in marital therapy and 841 normal couples who participated in the MMPI-2 restandardization study. The MMPI-2, a biographical form, a partner rating form, and the Dyadic Adjustment Scale (DAS) were administered to all couples. The marital counseling group resembled previous marital counseling samples studied with the MMPI and scored significantly higher than the normative sample on several MMPI-2 scales. Relationships between the DAS and MMPI-2 clinical and content scale scores are reported. The Psychopathic Deviate (Pd) clinical scale and Family Problems (FAM) content scale were the most powerful group discriminators and strongest correlates of the DAS; their use as indices of marital distress is tested. The meaning of Pd as an index in assessing personality factors in marital distress is explored.     

Distinguishing bipolar depression, major depression, and schizophrenia with the MMPI-2 clinical and content scales

Clinical and content scales from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) were used to examine the capacity of these scales to assist in the differential diagnosis of a sample of 212 psychiatric patients-137 with major depression; 43 with schizophrenia; and 32 with bipolar disorder, depressed state. Consistent with the previous literature, the clinical scales Depression (D), and Schizophrenia (Sc), and the content scales Depression (DEP), and Low Self-Esteem (LSE) best distinguished major depression from schizophrenia; the content scale DEP proved to be the most powerful predictor in distinguishing bipolar depression from schizophrenia. No clinical or content scale proved to be effective in distinguishing patients with bipolar depression from patients with major depression. In general, the content scales outperformed the clinical scales.