An exploration of the impact of invalid MMPI-2 protocols on collateral self-report measure scores

Although a number of studies have examined the impact of invalid MMPI-2 (Butcher et al., 2001) response styles on MMPI-2 scale scores, limited research has specifically explored the effects that such response styles might have on conjointly administered collateral self-report measures. This study explored the potential impact of 2 invalidating response styles detected by the Validity scales of the MMPI-2, overreporting and underreporting, on scores of collateral self-report measures administered conjointly with the MMPI-2. The final group of participants included in analyses was 1,112 college students from a Midwestern university who completed all measures as part of a larger study. Results of t-test analyses suggested that if either over- or underreporting was indicated by the MMPI-2 Validity scales, the scores of most conjointly administered collateral measures were also significantly impacted. Overall, it appeared that test-takers who were identified as either over- or underreporting relied on such a response style across measures. Limitations and suggestions for future study are 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.     

The effect of personality pathology on treatment outcome for Axis I disorders in dysfunctional clergy

The relationship between Narcissistic, Compulsive, Dependent, and Antisocial personality traits, as measured by the MCMI-III, and the clinical presentation and the treatment outcome for Axis I disorders, as measured by the MMPI-II was investigated. The subjects were 86 Roman Catholic priests and nuns who participated in 6 to 8 months of residential treatment. Pretreatment evaluation of the patients included the MCMI-III and the MMPI-2. Clinical presentation of Axis I disorders was measured by pretreatment scores on MMPI scales 2 (Depression), 7 (Psychasthenia), content scale DEP (Depression), and content scale ANX (Anxiety). Treatment outcome was measured by posttreatment MMPI-2 scores on these four variables. The results of this study suggest that the level of personality traits a patient possesses can significantly impact the clinical presentation of an Axis I disorder. Although the 48 patients with MCMI-III base rate scores above 74 had significantly higher pretreatment MMPI-2 scores than the patients with lower MCMI-III scores, both groups obtained posttreatment MMPI scores well within normal limits. The intensive individual and group therapy, extended length of stay, and emphasis on community living that the residential program provides may account for these results.     

Graphomotor Interpretation of the MMPI-2?

Although clinicians may attribute various personality features to patients who complete paper-and-pencil instruments (e.g., the MMPI-2) with notable neatness (compulsivity?) or sloppiness (oppositionalism?), such inferences have not been empirically examined. In our investigation, MMPI-2 protocols of 154 psychiatric inpatients (74 female and 80 male, M age = 36.7) were examined. A scoring system was developed to categorize the degree of neatness with which each patient had filled in the MMPI-2 response sheet (interrater Cohen Kappa = 0.86). Degree of neatness was not found to be correlated with clinical or content scales on the MMPI-2, with any Millon Clinical Multiaxial Inventory-II (MCMI-II) scales, or with various Rorschach (Comprehensive System) variables. These results imply that, clinical lore notwithstanding, clinicians should refrain from drawing unwarranted inferences about patients' personality features on the basis of the apparent neatness or sloppiness of patients' protocols.     

Graphomotor interpretation of the MMPI-2?

Although clinicians may attribute various personality features to patients who complete paper-and-pencil instruments (e.g., the MMPI-2) with notable neatness (compulsivity?) or sloppiness (oppositionalism?), such inferences have not been empirically examined. In our investigation, MMPI-2 protocols of 154 psychiatric inpatients (74 female and 80 male, M age = 36.7) were examined. A scoring system was developed to categorize the degree of neatness with which each patient had filled in the MMPI-2 response sheet (interrater Cohen Kappa = 0.86). Degree of neatness was not found to be correlated with clinical or content scales on the MMPI-2, with any Millon Clinical Multiaxial Inventory-II (MCMI-II) scales, or with various Rorschach (Comprehensive System) variables. These results imply that, clinical lore notwithstanding, clinicians should refrain from drawing unwarranted inferences about patients' personality features on the basis of the apparent neatness or sloppiness of patients' protocols.     

MMPI-2 profiles of women with eating disorders in a Dutch day treatment sample

In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.     

The MMPI-2: A Contemporary Normative Study of Midwestern Family Medicine Outpatients

For more than 60 years it has been known that profiles from the Minnesota Multiphasic Personality Inventory (MMPI), obtained from medical patients, are elevated when scores are plotted using general population norms. These elevations have been most apparent on the neurotic triad (NTd), the first 3 clinical scales on the MMPI profile. More than 45 years have passed since a nonreferred, normative sample of MMPIs was established from 50,000 consecutive medical outpatients. We present comparable but contemporary normative data for the revised MMPI (MMPI-2) based on a nonreferred sample of 1,243 family medicine outpatients (590 women; 653 men). As true for the original MMPI, contemporary medical outpatients have profiles that are significantly different, clinically and statistically, from the general population norms for the MMPI-2. This is particularly evident in elevations on the NTd. New normative tables of uniform medical T (UMT) scores were developed following the procedures used to create the uniform T scores for the MMPI-2. Measures of internal consistency are reported; test-retest reliability was established over a mean of 3.7 weeks, and results characterizing the stability of the validity and clinical scales are presented.     

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.     

Four-Month Test-Retest Reliability of the MMPI-2 With Normal Male Clergy

This investigation examined the test-retest coefficients and absolute score changes with the Basic, Supplementary, and Content scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Participants were 111 active male clergy who were not receiving mental health services at the time of their participation and who completed the MMPI-2 on two occasions separated by 4 months. A repeated measures multivariate analysis of variance for the three groups of scales revealed nonsignificant changes in mean T scores. In general, the test-retest coefficients obtained were similar to those reported in the MMPI-2 manual by Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer (1989) and by Spiro, Butcher, Levenson, Aldwin, and Bosse (1993). Increases or decreases of 3 to 6 T-score points were observed for the majority of the scales, and instances in which T-score changes exceeded 10 points were observed on every scale. In sum, the test-retest reliability of the majority of MMPI-2 scales, as represented in this nonclinical sample, appears acceptable and compares favorably with the original MMPI.     

Use of the MMPI-2 in American Indians: I. Comparability of the MMPI-2 between two tribes and with the MMPI-2 normative group

The comparability of the MMPI-2 in American Indians with the MMPI-2 normative group was investigated in a sample of 535 Southwestern and 297 Plains American Indian tribal members with contrasting sociocultural and historical origins. Both American Indian tribal groups had clinically significant higher T scores (> 5 T points) on 5 validity and clinical scales, 6 content scales, and 2 supplementary scales than did the MMPI-2 normative group. There were no significant differences between the 2 tribal groups on any of the MMPI-2 clinical, content, or supplementary scales. Matching members of both tribes with persons in the MMPI-2 normative group on the basis of age, gender, and education reduced the magnitude of the differences between the 2 groups on all of these scales, although the differences in T scores still exceeded 5 T points. It appears likely that the MMPI-2 differences of these 2 American Indian groups from the normative group may reflect their adverse historical, social, and economic conditions.     

Diagnosis of posttraumatic stress disorder with the MMPI: PK scale scores in somatization disorder

Clinic patients with diagnoses of either major depression or somatization disorder were given the MMPI. Women with somatization disorder had high scores on Keane's MMPI scale (PK) for posttraumatic stress disorder. Following the procedure for the MMPI-2 (46 of the 49 PK items and MMPI-2 norms), 59% of the women with somatization disorder and 21% of the women with major depression would have T scores > or = 65 on the MMPI-2 scale although none of them were known to have developed psychiatric disorder after exposure to a life threatening event. The PK scale has little use in the differential diagnosis of women patients with somatization disorder.     

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.     

Detection of a Cry for Help on the MMPI-2: an analog investigation

We compared Minnesota Multiphasic Personality Inventory (MMPI-2) results from 2 groups of mildly to moderately disturbed psychiatric outpatients (N=60) answering under either Standard or Cry for Help instructions. Results from previously completed intake MMPI-2 protocols were obtained for each participant. The two groups were comparable on intake MMPI-2 variables and demographic characteristics. Analysis of feedback data from the second, experimental observation indicated that the two groups had equivalent self-estimates of understanding of their role and success in simulating their role. Significant differences were found between the two groups on their experimental MMPI-2 protocols. The Cry for Help group had significantly higher scores on F, F-K, Fb, Ds2, and Fp scales as well as significantly lower scorns on the K scale. The Cry for Help group also had significantly higher scores on all clinical scales with the exception of 5, which was not tested. Cutting scores derived by Rogers, Sewell, and Ustad (1995) for the detection of a Cry for Help in outpatients were cross-validated with fairly positive results. Although these results are promising, particularly in light of the shrinkage expected on cross-validation, further research is needed in this area.     

The MMPI-2 With College Students

MMPI-2 responses of 515 male and 797 female college students from four universities were examined. College students were compared with the new MMPI-2 normative sample on the clinical and validity scales. The reliability of MMPI-2 scores of college students were compared with reliabilities of the MMPI-2 normative sample. The results indicated that college students respond to the MMPI-2 in a highly similar manner to the MMPI-2 normative sample. Mean score differences on the validity and clinical scales were within 1 to 3 T-score points on most scales, and the frequency distributions of the college students were highly similar to those of the MMPI-2 normative samples, Slight differences obtained on the Pt, Sc, and Ma scales may reflect the younger age of the college groups compared to the MMPI-2 normative groups. The MMPI-2 norms were shown to be appropriate for use with college subjects. Test-retest correlation coefficients obtained from college students who were administered the MMPI-2 on two occasions showed reliabilities comparable to those found for the MMPI-2 normative sample.     

Psychological well-being of patients with insomnia and its relationship with anxiety and depression

The aims of the present study are to evaluate the impact of insomnia on psychological well-being and to examine the associations of insomnia and psychological well-being with anxiety and depression. Forty-one patients attending our hospital-based Centre for sleep medicine were administered scales for the evaluation of insomnia (ISI), anxiety (STAI-Y), depression (BDI-II) and psychological well-being (PWB). The scores were compared to those of a control group of 68 subjects attending the hospital for routine examinations or as accompanying persons. Significant differences between patients and controls were detected for anxiety and depression, as well as for psychological well-being. Even if subclinical on average, anxiety and depression symptoms were significantly related to poor psychological well-being, whereas insomnia per se was not. These findings suggest that patients with insomnia report a relevant impact on their psychological well-being, and that such an impact seems to be strongly associated with concomitant subthreshold symptoms of anxiety and depression. The implications for diagnosis and treatment are discussed.     

Another look at paradoxical severity effects in head injury with the Personality Assessment Inventory

Previous investigations of psychiatric symptomatology after head injury using the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) have consistently revealed greater Basic scale elevations in mild injuries versus more severe injuries. In this study, we tested this pattern of paradoxical severity effects using the Personality Assessment Inventory (PAI; Morey, 1991). We gathered PAI and MMPI-2 data from 34 patients with moderate-to-severe head injuries and from 52 patients with mild head injuries. MMPI-2 Basic scale profiles were consistent with the paradoxical severity effect; mild injury patients had significantly more elevated scores on four Basic scales (Scales 1, 2, 3, and 7). PAI Clinical scale profiles showed significantly more elevated scores among mild injury patients on 2 scales, Somatization and Depression, and more elevated scores among moderate-to-severe patients on 2 scales, Antisocial Features and Alcohol Problems. We consider unique contributions of the PAI for the psychological assessment of head injury.     

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.     

The Consistency Between Scores of the Harris-Lingoes Subscales of the MMPI and MMPI-2

This study investigates the consistency between scores of the Harris-Lingoes subscales of the Minnesota Multiphasic Personality Inventory (MMPI) and the MMPI-2. College students (200 men and 200 women) were randomly assigned to either the original to original condition, where they took the MMPI twice, or the original to revised condition, where they took the MMPI and MMPI-2. Results indicate relative consistency in the item and normative changes between the Harris-Lingoes subscales of the MMPI and MMPI-2. These results suggest that the recommendation of a clinical significance score of T > 65 for the MMPI-2 scales should not be applied to the Harris-Lingoes subscales.     

MMPI-2 validity scales in child custody evaluations: clinical versus statistical significance

The MMPI-2 is commonly used in the psychological assessment of parents within child custody evaluations. Due to the interface of mental health practitioners with non-mental-health professionals in the context of child custody cases, careful attention must be paid to the potential misunderstanding or misuse of data from psychological testing. While traditional clinical lore has maintained an expectation of clinically significant defensiveness on the MMPI-2 with this population, the research data does not support this view. Despite empirical findings that identify patterns of elevations on the MMPI-2 validity scales with parents involved in child custody disputes, these patterns have been demonstrated to reach statistical but not clinical significance. That is, MMPI-2 profiles that contain elevations on scales L or K that either invalidate or notably suppress clinical scales are not to be expected in the child custody population. False causal attributions contributing to the potential mischaracterization or loss of important data related to personality functioning within this population are identified and discussed. Potential dangers associated with such false causal attributions are reviewed.