A Review of “The reviewer's guide to quantitative methods in the social sciences”

The Millon Clinical Multiaxial Inventory-II (MCMI-II) profiles of 26, psychiatric inpatients diagnosed as having borderline personality disorders were compared with profiles of 42 patients with no personality disorders. The borderline group scored significantly higher on the following scales: Disclosure (X), Debasement (Z), Passive-Aggressive (8A), Self-Defeating (8B), Borderline (C), and Major Depression (CC). Differences approaching significance were also found on substance abuse measures: the Alcohol Dependence (B) scale and Drug Dependence (T) scale. These findings are consistent with criteria established in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R] American Psychiatric Association, 1987) and the results of other studies utilizing the MCMI-II. In addition, diagnostic efficiency of Scale C was assessed at various cutoff points defined by either base rate (BR) scores or the number of prototypic items endorsed. The greatest efficiency was found when a cutoff seven or more prototypic items was utilized, with nearly 80% of the patients correctly classified. Results are discussed in terms of their relevance for further research.     

MCMI-II borderline personality disorder in anorexia and bulimia nervosa

The aim of the present study is to explore the MCMI-II personality style and MCMI-II possible disorder of borderline personality (BPD) in various groups of women. 93 patients-31 anorexia nervosa restricting subtype (ANr), 31 anorexia nervosa binge-eating/purging subtype (ANp), and 31 bulimia nervosa purging subtype (BNp); 31 women at high risk for eating disorder or symptomatic control group (S-CG) and 31 without known pathology or not symptomatic control group (NS-CG)-completed the Spanish version of the MCMI-II. The results revealed: (1) clinically significant borderline personality traits [74>Base Rate (BR) <85]: 16.1% ANr, 12.9% ANp, and 45.2% BNp versus 3.2% of the S-CG and none of the NS-CG; (2) possible disorder (BR>84): 29% ANr, 41.9% ANp and 29% BNp. According to the MCM-II, women with BNp displayed more BPD traits than possible disorder (though these were more severe). However, the probability of a possible disorder was higher in ANp (more disorders than traits).     

An MCMI-II item-level component analysis: personality and clinical factors

The Millon Clinical Multiaxial Inventory, Version 2 (MCMI-II) was released to replace the MCMI-I. Research into the factor structure of the items of the MCMI-I showed components consistent with the underlying construction theory. No such work has been done with the new MCMI-II. For this study, we analyzed the personality disorder and clinical syndrome items across two subject samples. For 579 Veterans Administration patients and 492 normal college students, six personality factors were identified. The samples shared Hostility, Histrionic/Schizoid, Dependent, Compulsive, and a Sadistic variant. For the clinical syndrome items, eight factors were isolated for veterans and seven for normals. Depression, Alcohol Abuse, Drug Abuse, Crying, and Mania were shared factors. Most of the factors were found to be highly consistent with MCMI-II scale keyings.     

An MCMI-II Item-Level Component Analysis: Personality and Clinical Factors

The Milton Clinical Multiaxial Inventory, Version 2 (MCMI-II) was released to replace the MCMI-I. Research into the factor structure Of the items of the MCMI-I showed components consistent with the underlying construction theory. No such work has been done with the new MCMI-II. For this study, we analyzed the personality disorder and clinical syndrome items across two subject samples. For 579 Veterans Administration patients and 492 normal college students, six personality factors were identified. The samples shared Hostility, Histrionic/ Schizoid, Dependent, Compulsive, and a Sadistic variant. For the clinical syndrome items, eight factors were isolated for veterans and seven for normals. Depression, Alcohol Abuse, Drug Abuses Crying, and Mania were shared factors. Most of the factors were found to be highly consistent with MCMI-II scale keyings.     

MCMI-II profiles of women with eating disorders: a cluster analytic investigation

A three-factor model of personality pathology was investigated in a clinical sample of 183 female patients in an outpatient eating disorders treatment program. Cluster analysis of MCMI-II personality scales (Millon, 1987) yielded three distinct personality profiles, which were consistent with previous studies. First, 16.9% of the sample comprised a High Functioning cluster, which manifested no clinical elevations on the MCMI-II and had significantly lower scores on the Eating Disorder Inventory (EDI; Garner; 1991) scales than the other two clusters. Second, 49.1% of the sample comprised an Undercontrolled/Dysregulated cluster. Finally, the remaining 34% of the sample comprised an Overcontrolled/Avoidant cluster. This final cluster had significantly higher EDI Ineffectiveness scale scores than the Undercontrolled/Dysregulated cluster group. Cluster membership was not associated with eating disorder subtype, suggesting that there is considerable variance in personality pathology within eating disorder diagnostic categories.     

Assessment of dysfunctional beliefs in borderline personality disorder

This study had two aims: to test the hypothesis that borderline personality disorder (BPD) patients hold numerous dysfunctional beliefs associated with a variety of Axis II disorders, and to construct a BPD belief scale which captures these beliefs. Beliefs were measured using the Personality Belief Questionnaire (PBQ) which is designed to assess beliefs associated with various personality disorders, although not specifically BPD. Eighty-four BPD patients and 204 patients with other personality disorders (OPD) were randomly split into two study samples. Fourteen PBQ items were found to discriminate BPD from OPD patients in both samples. These items came from the PBQ Dependent, Paranoid, Avoidant, and Histrionic scales and reflect themes of dependency, helplessness, distrust, fears of rejection/abandonment/losing emotional control, and extreme attention-seeking behavior. A BPD beliefs scale constructed from these items showed good internal consistency and diagnostic validity among the 288 study patients. The scale may be used to assist in diagnosis and cognitive therapy of BPD.     

The MCMI-II depression scales: do they assist in the differential prediction of depressive disorders?

This study examined the diagnostic efficiency of the Millon Clinical Multiaxial Inventory-II (MCMI-II) Major Depression (CC) and Dysthymia (D) scales for the differential prediction of unipolar depressive disorders. The MCMI-II was administered to 109 inpatients at a large private psychiatric hospital in the Midwest. All patients had a primary Axis I diagnosis of a depressive disorder, given at discharge by the attending psychiatrists. When CC scores were compared to clinician diagnoses, results indicated that the sensitivity of the CC scale was improved over what had previously been reported for studies involving the MCMI-I CC scale. However, overall, the D scale functioned slightly better as a predictor of major depression than did the CC scale. One likely factor in explaining this finding is that the CC scale contains very few items assessing vegetative/somatic symptomatology, which are the critical factors in distinguishing major depression from other unipolar depressive disorders.     

Borderline personality disorder from the perspective of general personality functioning

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits.     

Factor analysis of MCMI-II and PACL basic personality scales in a college sample

This study examined factor dimensions common to the eight basic personality scales of the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) and Personality Adjective Check List (PACL; Strack, 1987, 1990). Subjects were 140 college students (65 men and 75 women). MCMI-II weighted raw scores (WRS) and WRS corrected for number of items endorsed true by regression were employed for analysis along with PACL T-scores. Principal components analyses with varimax and direct oblimin rotations were carried out separately on the two sets of MCMI-II and PACL scores. MCMI-II and PACL scales measuring the same personalities were usually correlated most highly with each other, although some divergences were noted. WRS yielded three bipolar dimensions and a fourth unipolar method factor that loaded only the five MCMI-II scales that were strongly correlated with number of items endorsed true. Residual scores yielded a more meaningful set of three bipolar dimensions labeled Social Introversion-Extraversion, Emotionality-Restraint, and Social Dominance-Submissiveness, without the method factor, that were very similar to personality dimensions found separately in the two tests. More research is needed to clarify the response bias issue in the MCMI-II and to further explicate similarities and differences between the MCMI-II and the PACL.     

Factor Analysis of MCMI-II and PACL Basic Personality Scales in a College Sample

This study examined factor dimensions common to the eight basic personality scales of the Millon Clinical Multiaxiat Inventory-II (MCMI-II; Millon, 1987) and Personality Adjective Check List (PACL; Strack, 1987, 1990). Subjects were 140 college students (65 men and 75 women). MCMI-II weighted raw scores (WRS) and WRS corrected for number of items endorsed true by regression were employed for analysis along with PACL T-scores. Principal components analyses with varimax and direct oblimin rotations were carried out separately on the two sets of MCMI-II and PACL scores. MCMI-II and PACL scales measuring the same personalities were usually correlated most highly with each other, although some divergences were noted. WRS yielded three bipolar dimensions and a fourth unipolar method factor that loaded only the five MCMI-II scales that were strongly correlated with number of items endorsed true. Residual scores yielded a more meaningful set of three bipolar dimensions labeled Social IntroversionExtraversion, Emotionality-Restraint, and Social Dominance-Submissiveness, without the method factor, that were very similar to personality dimensions found separately in the two tests. More research is needed to clarify the response bias issue in the MCMI-II and to further explicate similarities and differences between the MCMI-II and the PACL.     

Contributions of Discriminant Analysis to Differential Diagnosis by Self-Report

We used discriminant function analyses of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1983), Millon Clinical Multiaxial inventory (MCMI; Milton, 1983), MCMI-II (Millon, 1987), and Symptom Checklist Ninety-Revised (SCL-90-R; Derogatis, 1983) profiles from a heterogenous group of 272 psychiatric inpatients to classify patients as depressed, manic, and/or psychotic, Most functions generated from these tests significantly discriminated depressed, manic (not MCMI-II), and psychotic (not MCMI) subjects from psychiatric controls. However. there was little improvement in diagnostic efficiency over the use of single scale elevations at specified cut scores. Functions derived from the MCMI for mania and the MCMI-II for psychosis show the most promise but require replication. The difficulty of using group profile differences for the diagnosis of individual psychiatric patients is discussed.     

Overreport on the MCMI-III: concurrent validation with the MMPI-2 using a psychiatric inpatient sample

The MCMI-III (Millon, Davis, & Millon, 1997) is a widely used measure of personality often used in inpatient psychiatric settings. Although patients in such settings often overreport or exaggerate their symptoms, relatively little is known about how such a response set presents on the validity indexes of the MCMI-II. In this study, we used a sample of 191 psychiatric inpatients and compared MCMI-III modifier indices (Disclosure, Desirability, and Debasement) with the validity measures (L, F, Fb, F(p), K, and F - K) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In addition, the MCMI-III Disclosure Index (Scale X, which imposes a set cutoff score for invalidity due to overreport) was compared to several cutoff scores on the validity scales of the MMPI-2. Although the MCMI-III indexes generally performed as expected, the MCMI-III had a very high tolerance for overreport. When contrasted with MMPI-2 F scale, the MCMI-II Disclosure Index (which gauges overreport) remained valid until scores on MMPI-2 F scale approached a T score of 120. In addition, the Disclosure Index was at the upper end or slightly exceeded the highest recommended cutoff scores on all other MMPI-2 validity scales except F - K. Clinicians using the MCMI-III alone are cautioned to consider the high tolerance the MCMI-III has for overreport.     

Empirically derived personality subtypes of public psychiatric patients: effect on self-reported symptoms, coping inclinations, and evaluation of expressed emotion in caregivers.

Personality scales on the Millon Clinical Multiaxial Inventory-II (MCMI-II) for 195 psychiatric inpatients (93 men and 102 women) in a public facility were cluster analyzed to develop an empirical subtyping according to personality traits. Subjects also completed the Brief Symptom Inventory (BSI), Methods of Coping Scale (MOC), and the Level of Expressed Emotion Scale (LEE). The five personality subtypes that emerged were consistent across two clustering methods (K-means and complete linkage). Subtypes members differed on subscales of the BSI, MOC, and LEE. Results support the relevance of personality traits and disorders in assessing psychopathology in psychiatric patients. Results also support the relevance of subtyping these patients according to MCMI-II results.     

Borderline and schizotypal personality disorders: mutually exclusive or overlapping?

This article is concerned with one aspect of the validity of DSM-III Axis II diagnoses, namely, the discriminability of borderline and schizotypal disorders. Forty-nine patients diagnosed by DSM-III criteria as borderline, schizotypal, or "mixed" personality disorders completed the Borderline Syndrome Index (BSI), an independent self-report 52-item instrument that has been shown to be reliable and to have discriminative validity. A one-way analysis of variance and a discriminant function analysis were conducted. Our major finding was that there were no significant differences among the groups on the BSI self-report test, although there were differences on clinical grounds. We discuss this in terms of "fuzzy set" theory and prototypic systems of classification.     

Empathic Insights From the Rorschach: Paul Lerner's Legacy

This article is concerned with one aspect of the validity of DSM-III Axis II diagnoses, namely, the discriminability of borderline and schizotypal disorders. Forty-nine patients diagnosed by DSM-III criteria as borderline, schizotypal, or "mixed" personality disorders completed the Borderline Syndrome Index (BSI), an independent self-report 52-item instrument that has been shown to be reliable and to have discriminative validity. A one-way analysis of variance and a discriminant function analysis were conducted. Our major finding was that there were no significant differences among the groups on the BSI self-report test, although there were differences on clinical grounds. We discuss this in terms of "fuzzy set" theory and prototypic systems of classification.     

Borderline and schizophrenic patients: A comparison using the MCMI-II

In the present study we examined the Millon Clinical Multiaxial Inventory-II scores of psychiatric patients with a diagnosis of either borderline personality disorder (BPD;n=13) or schizophrenia (n=13). The analyses revealed that the BPD patients were significantly elevated on a number of scales in addition to the Borderline scale. The second goal of this study was to assess the discriminative validity of the Borderline and Thought Disorder Scales with both base rate (BR) cutoffs and the number of endorsed prototypic items. The Borderline scale demonstrated the most diagnostic power when using BR cutoffs, whereas the Thought Disorder scale performed poorly, no better than chance levels, with all cutoffs.This research was supported by Social Sciences and Humanities Research Council of Canada Grant 410-89-0335 and by a grant from the Department of Research and Programme Evaluation, Brockville Psychiatric Hospital. The authors thank Renate Simmons for her assistance.     

Diagnosing personality disorders: an examination of the MMPI-2 and MCMI-II

Personality disorders are highly prevalent in clinical populations and affect outcomes across all forms of intervention. This investigation examined the diagnostic efficiency of two widely used, self-report measures of personality disorder (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; MCMI-II; Millon, 1987), as compared to a structured interview (SCID-II; Spitzer et al., 1987) diagnosis. The measures were administered to 150 residential and outpatient volunteer subjects. Persons with primary organic or psychotic-spectrum disorders were excluded from participation. Results were variable across disorders measured, with low to moderate levels of diagnostic agreement observed. The MCMI-II appears to be a more sensitive measure, whereas the MMPI-2 is more specific. The two self-report measures demonstrated greater convergence with each other than with the interview measure. Both the MMPI-2 and MCMI-II were more accurate at identifying the absence of a given disorder. Although overall diagnostic powers exist at acceptable levels. the results suggest that diagnoses generated by self-report versus interview are not interchangeable.     

Bias and Millon clinical multiaxial inventory (MCMI-II) diagnosis

In the current study, the degree of bias is calculated for each of the personality disorder and clinical syndrome scales of the MCMI-II. In general, most of the MCMI-II scales are prone to only mild or moderate biases. However, the paranoid personality disorder, somatoform, bipolar: manic, thought disorder, and delusional disorder scales are prone to severe biases. When the MCMI-II is utilized to make diagnostic decisions, bipolar and schizophrenic disorders are apt to be grossly underestimated. The implications of bias in diagnostic prevalence rates are discussed and an equation is offered which provides for adjustments to be made when the percentage of positive MCMI-II test results are used to determine prevalence rates for clinical or research populations. The observation is made that imperfect sensitivity and specificity for the MCMI-II scales will result in inaccurate estimates of personality disorders and clinical syndromes when the MCMI-II is used to survey various populations.     

An all‐or‐nothing thinking turns into darkness: Relations between dichotomous thinking and personality disorders1

Dichotomous thinking is an individual's propensity to think in terms of binary opposition. While this thinking style may be useful for quick decision‐making, some clinical psychologists have indicated that such a style is related to personality disorders. Oshio (2009 ) revealed that the Dichotomous Thinking Inventory (DTI) has significant positive correlations with borderline personality and narcissism. This study examines whether dichotomous thinking is associated with cluster A, B, and C personality disorders. The participants comprised 152 Japanese undergraduates (84 male and 68 female). They completed the DTI and Ten Personality Styles scale (10 PesT; Nakazawa (2006 )), developed from the definitions of personality disorders in the DSM‐IV. Structural equation modeling supported the hierarchical factor structure of personality disorders. The dichotomous thinking effects “cluster” level of disorders more than other levels. The results indicated that thinking dichotomously may lead to wide‐ranging personality disorders.     

A biometrical study of schizotypy in a normal population

A recently devised two-scale questionnaire (STQ) for measuring ‘borderline’ personality traits, together with the EPQ, was administered to 108 monozygotic and 102 dizygotic adult twin pairs. Initial item and scale analyses of the STQ indicated good internal consistency and acceptably high endorsement frequencies for individual items, as well as an absense of any marked skew in the scale distributions. The pattern of correlations with the EPQ closely resembled that seen in earlier, smaller-sized studies, the most notable feature being a positive correlation between the borderline scales and the N-scale. Biometrical analysis of the data suggested that, for the main STQ scale (‘schizotypal personality’), the best-fitting model was one assuming additive genetic variation combined with within-family environmental effects: results for the other (‘borderline personality’) scale were less clear cut. A number of sex differences were also observed: males had lower schizotypy scores than females, while the biometrical analysis suggested that schizotypy may be under greater genetic control in males than in females. The data are presented and discussed in the context of the dimensional/biological theory of disposition to psychosis.