Behavioral correlates of selected MMPI-2 clinical, content, and restructured clinical scales

In this study, we evaluated the validity of the Restructured Clinical (RC; Tellegen et al., 2003) scales by identifying and comparing behavioral correlates of selected RC scales (RCd, RC2, RC4), their original Clinical scale counterparts (Scale 2, Scale 4), and conceptually related Content scales (DEP, ASP, CYN) in an outpatient clinical sample (N = 150). The results of this study indicate that RC4 is a stronger predictor of several antisocial behaviors than Clinical Scale 4 or the Content Scales ASP and CYN. In contrast, RC2 demonstrated significantly lower correlations with several behaviors conceptually related to depression than its Clinical scale counterpart or DEP. DEP was highly correlated with RCd (r = .91, p < .0001), suggesting that the 2 scales may be measuring similar constructs. Overall, the results of this study demonstrate relatively few differences among the scales selected in their ability to predict extratest behaviors.     

A comparison of the correlational structures and elevation patterns of the MMPI-2 restructured clinical (RC) and clinical scales

The relationship between the MMPI-2 restructured clinical scales and the original clinical scales was evaluated using an outpatient clinical sample (N = 150). Similar patterns of correlations to those reported by Tellegen et al. in 2003, such as high correlations between the restructured scales and their original scale counterparts and lower intercorrelations among the restructured scales than among the original scales, were found in the outpatient sample. The former provided evidence of convergence between the two sets of scales, whereas the latter increases the potential for discriminant validity in the restructured scale profiles. Mean T-scores of the restructured scales were significantly lower than their original scale counterparts for every clinical scale except Scale 1 (hypochondriasis). Individual profiles exhibited fewer scale elevations using the restructured clinical scales (M = 2.15, Mdn = 2.0) than the original clinical scales (M = 3.29, Mdn = 3.0). The majority of client profiles (56%) had fewer scale elevations when plotted using the restructured scales versus the original clinical scales.     

Psychometric evaluation of the restructured clinical scales of the MMPI-2

Conceptual overlap and heterogeneity have long been noted as weaknesses of the Minnesota Multiphasic Personality Inventory's clinical scales. Restructured clinical (RC) scales recently were developed to address these concerns (A. Tellegen et al., 2003). The authors evaluated the psychometric properties of the RC scales in psychology clinic clients (N=285) and military veterans (N=567). The RC scales were as internally consistent as the clinical scales and correlated strongly with their original counterparts (except for RC3/Hysteria). They also were less intercorrelated, produced conceptually clearer relations with measures of personality and psychopathology, and yielded somewhat greater incremental utility than the clinical scales. Thus, the RC scales demonstrated several psychometric strengths while utilizing 60% fewer items, but the 2 sets of scales cannot be used interchangeably. Interpretive considerations are discussed.     

Examination of racial differences on the MMPI-2 clinical and restructured clinical scales in an outpatient sample

The current study examined the possibility of differential predictive accuracy of selected Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) clinical and Restructured Clinical (RC) scales in a group of Black and White mental health center clients. Results indicate that Black clients scored higher than White clients on one non-K-corrected clinical scale and 4 RC scales. All these differences produced medium effect sizes and were clinically significant according to Greene's (1987) criterion. These differences, however, were not accompanied by differential predictive accuracy of the scales in Black versus White clients. Although additional research is needed, especially on the RC scales, this study indicates that the MMPI-2 is not a biased predictor of symptomatology for Black versus White test takers.     

The factor structure of the MMPI-2 Restructured Clinical (RC) scales

We investigated the MMPI-2 Restructured Clinical (RC) scales (Tellegen et al., 2003) to determine if they had a more differentiated factor structure than the MMPI-2 Clinical scales. When factored alone, the RC scales had a 5-dimensional structure; the Clinical scales had 3 dimensions. When factored in combination with the Content scales, both sets of scales produced 5 dimensions. However, the RC and Content factors generally provided more efficient and logical markers of psychopathology than the Clinical and Content factors. We discuss interpretive considerations.     

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.     

Validation of selected MMPI-2 basic and content scales

To investigate whether some of the MMPI-2 basic and/or content scales measure the factor structure represented by the Big-Five, 288 undergraduates (178 women and 110 men), between the ages of 18 and 34 years, were administered MMPI-2 and MARS (Michill Adjective Rating Scale) which measures four factors that are conceptually similar to the first four of the Big-Five. It was hypothesized that (a) three MMPI-2 scales (basicDepression or D, contentAnxiety or ANX, and contentDepression or DEP) would be correlated with MARSUnhappiness; (b) two MMPI-2 scales (basicSocial Introversion or Si and contentSocial Discomfort or SOD) would be correlated with MARSExtraversion; (c) two MMPI-2 scales (contentAnger or ANG and contentType A Behavior or TPA) would be correlated with MARSAssertiveness; and (d) two MMPI-2 scales (contentWork Interference or WRK and supplementaryDominance or DOM) would be correlated with MARSProductive Persistence. Results corroborated the hypothesized relationships between the components of the aforementioned four dyads.     

Incremental validity of the MMPI-2 Restructured Clinical (RC) scales in a private practice sample

Building on results reported in Sellbom, Graham, and Schenk (2005), in this study, we examined the incremental validity of the newly introduced MMPI-2 (Butcher et al., 2001) Restructured Clinical (RC) scales (Tellegen et al., 2003) over both the Clinical and Content scales. Participants were 647 clients in private practice who were administered the MMPI-2 and the Multiaxial Diagnostic Inventory (Doverspike, 1990) early in therapy. The results indicate that the RC scales had acceptable internal consistency, reduced intercorrelations (compared to the Clinical scales), and promising convergent and discriminant validity. Hierarchical regression analyses revealed that the RC scales added incrementally to both the Clinical and Content scales in predicting self reported clinical symptoms. These findings suggest that the RC scales are relatively homogenous measures of core clinical constructs that can add unique information to the understanding of private practice clients above and beyond the Clinical and Content scales.     

External correlates of the MMPI-2 content component scales in mental health inpatients

External correlates of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Content Component Scales were identified using an inpatient sample of 544 adults. The Brief Psychiatric Rating Scale (BPRS) and Symptom Checklist 90-Revised (SCL-90-R) produced correlates of the Content Component Scales, demonstrating external validity with clinician-rated and self-report scales. Relationships between MMPI-2 Content Component Scales and patient hospital chart variables were also examined. Results demonstrated cross-criterion validity in that most MMPI-2 Content Component Scales correlated with appropriate BPRS dimensions, SCL-90-R items, and other patient variables. Discriminant validity of the Content Component Scales was also demonstrated. In addition, the finding that similar patterns of correlates are produced when the component scales are correlated with a self-report measure, as well as clinician ratings and medical chart variables, provides converging lines of evidence supporting the construct validity of the Content Component Scales.     

An investigation of the psychometric properties of the MMPI-2 Restructured Clinical (RC) scales with mental health inpatients

In this study, we compared the internal psychometric properties and external correlates of the MMPI-2 (Butcher et al., 2001; Tellegen et al., 2003) Restructured Clinical (RC) scales and corresponding MMPI-2 non-K-corrected Clinical scales in a sample of 280 men and 264 women admitted to inpatient psychiatric units. We evaluated the internal psychometric properties of the RC and Clinical scales by intercorrelation analyses and alpha coefficients. We investigated external correlates of scores from the RC and Clinical scales using selected chart variables, selected Symptom Checklist 90-Revised (Derogatis, 1983, 1994) items, and clinician ratings on the Brief Psychiatric Rating Scale (Overall & Gorham, 1988). Results showed psychometric support for the RC scales in terms of improved intercorrelation patterns and comparable or greater alpha coefficients. Further, external correlational analyses revealed varying degrees of evidence of improvement in convergent and discriminant validity.     

Adherence to substance abuse treatment: clinical utility of two MMPI-2 scales.

In this study, we examined the ability of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Addiction Acknowledgment scale (AAS; Weed, Butcher, McKenna, & Ben-Porath, 1992) and Negative Treatment Indicators scale (TRT; Butcher, Graham, Williams, & Ben-Porath, 1990) to predict adherence to and outcomes from substance abuse treatment. There was no evidence that the AAS was related to treatment adherence or outcome in our sample. However, results did reveal a significant positive relation between scores on the TRT scale and readmission to the hospital. Further analyses identified an optimal score for use in similar clinical populations and settings, and characteristics of high and low scorers. Compared to low scorers, high TRT scorers were more likely to not return for treatment after an initial screening interview. If they did return for treatment, high TRT scorers were more likely to experience fewer treatment days and to be rated as having lower motivation, poorer participation, and poorer comprehension of program materials. These findings provide promising initial evidence of the utility of the TRT scale for identifying patients who may be at a high risk for unsuccessful substance abuse treatment.     

Convergent validity of the MCMI-III personality disorder scales and the MMPI-2 scales

The MCMI-III personality disorder scales (Millon, 1994) were empirically validated in a sample of prisoners, psychiatric inpatients, and outpatients (N = 477). The scale intercorrelations were congruent with those obtained by Millon, Davis, and Millon (1997). We conclude that our Flemish/Dutch version shows no significant differences with the original version of the MCMI-III as far as intercorrelations are concerned. Convergent validity of the MCMI-III personality disorder scales was evaluated by the correlational data between the MCMI-III personality disorder scales and the MMPI-2 clinical (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and personality disorder (Somwaru & Ben-Porath, 1995) scales. Improved convergence was obtained compared with previous versions of the MCMI-I. Only the compulsive MCMI-III personality disorder scale remains problematic. The scale even showed negative correlations with some of the related clinical scales and with the corresponding personality disorder scales of the MMPI-2.     

A taxometric analysis of the MMPI-2 Depression scales

The MMPI (Hathaway & McKinley, 1943) and MMPI-2 (Butcher et al., 2001) have long been used as measures of psychopathology. Both clinicians and researchers have noted the widespread existence of negative affectivity on the MMPI and MMPI-2 that may elevate scale scores and eclipse the tests' ability to differentiate depression from other clinical disorders. Using taxometric analyses, in this study we sought to test directly whether the MMPI-2 depression scales could differentiate patients with depressive symptoms from patients with other disorders. A large psychiatric sample (N = 2,000) was utilized and analyses were run separately for men and women. Taxometric analyses did not find a MMPI-2 Depression scale cut point that categorizes patients with depressive symptoms from other patients. Rather, these findings support previous studies finding an underlying dimensionality of depression. We discuss implications for MMPI-2 scale use and depression nosology in light of these findings.     

Comparability of MMPI-2 scales and profiles over time

This study investigated Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) scale and profile comparablilty for MMPI-2 profiles completed on 2 separate occasions by mental health patients receiving treatment at a Veterans Affairs Medical Center (n = 114). Patients were predominantly men (96.5%), with an average age of 44.08 and an average of 12.39 years of education at the time of initial testing. MMPI-2 tests were completed on 2 separate occasions as a routine part of treatment with a mean interval between test administrations of 688 days. Findings were analyzed for the complete sample and for 3 subsamples with different test-retest intervals. MMPI-2 scale test-retest correlation coefficients for the entire sample ranged from .48 to .69 for the Basic scales, .49 to .80 for the Supplementary scales, and .56 to .78 for the Content scales with scale high-point agreement = 38.60%, high 2-point agreement = 16.67%, and high 3-point agreement = 19.30%. High-point agreement for subsets of participants with well-defined high points, 2-points and 3-points was 41.07%, 27.50%, and 25.93% respectively. Pearson r correlation coefficients for T scores across the Basic scales for pairs of profiles averaged .78, suggesting similarity of profile shape across testing occasions. MMPI-2 profiles were also examined in relation to Skinner and Jackson's 3 modal MMPI profile types.     

Genetic variation and covariation in the original and restructured clinical scales of the MMPI

The authors investigated genetic variation and covariation among the original Minnesota Multiphasic Personality Inventory clinical and validity scales and the restructured clinical scales. Variation in most of these scales was best explained by a combination of moderate genetic influences and environmental influences not shared by cotwins. Genetic correlations among the standard clinical scales were generally substantial and positive (M = .48), whereas genetic correlations between the clinical scales and the K scale were strong and negative. The restructured clinical scales were strongly correlated with the general Demoralization scale (M = .55), with lower genetic correlations among the remaining scales (M = .39).     

A taxometric analysis of MMPI-2 Infrequency scales [F and F(p)] in clinical settings

The typology of overreporting, which is a deliberate attempt to amplify symptoms, simulate psychopathology, or understate coping capacities, was examined using taxometric procedures with Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency scales [F and F(p)] in psychiatric inpatient and Veterans Affairs (VA) medical center treatment settings. Overreporting was identified as a taxon using several taxometric procedures, and the multiple estimates of the taxon base rate were consistent within each sample. Mean base-rate estimates were .27 and .19 for the psychiatric inpatient and VA medical center settings, respectively. Overall classification rates ranged from .80 to .97 across the 2 settings, which supports the use of F and F(p) in the identification of overreporting on the MMPI-2 in psychiatric inpatient and VA medical center settings.     

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.