Validity of the Substance Abuse Scales of the MMPI-2 in a College Student Sample

This study assessed the validity of three Minnesota Multiphasic Personality Inventory-2-based (MMPI-2: Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) substance abuse scales. The scales were the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., i989) and the recently developed Addiction Acknowledgment Scale and Addiction Potential Scale (AAS & APS; Weed, Butcher, McKenna, & Ben-Porath, 1992), Study participants were 308 male and female college students who completed the MMPI-2 and the substance use disorder modules of the Diagnostic Interview Schedule. The MAC-R and the APS had a nonsignificant-to-weak relationship with substance dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders' (3rd ed., rex. [DSM-III-R]; American Psychiatric Association, 1980). The AAS had a moderate ability to identify the 33 study participants who met DSM-HI-R criteria for a substance use disorder, primarily alcoholism, Broadening the definition of substance abuse to a continuum of alcohol/drug problems did not alter the character of findings, These results highlight the relative superiority of direct (AAS) versus subtle (APS, MAC-R) scales to detect substance dependence and support studies that question the overall utility of traditional MMPI scales to identify substance abuse.     

Diagnostic accuracy and factor structure of the AAS and APS scales of the MMPI-2

Receiver operating characteristics analysis and sensitivity analysis were used to compare the diagnostic accuracy of the Addiction Acknowledgement Scale (AAS; Weed, Butcher, McKenna, & Ben-Porath, 1992) and Addiction Potential Scale (APS; Weed et al., 1992) of the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to that of the MacAndrew Alcoholism Scale-Revised (Butcher et al, 1989), the CAGE (Mayfield, McLeod, & Hall, 1974), and Svanum's scale (Svanum & McGrew, 1995) in a sample of 338 university students. The AAS was the most accurate of these 5 scales at identifying current alcohol dependence (as measured by a structured diagnostic interview) and appears to offer considerable promise as an alcohol screening instrument. In contrast, the APS performed the most poorly of the 5 scales being evaluated, yielding results that would be of minimal clinical utility. Factor analysis yielded a 2-factor solution for the AAS (Acknowledgement of Alcohol/Drug Problems; Positive Alcohol Expectancies) and a 4-factor solution for the APS (Satisfaction with Self; Cynicism/Pessimism; Impulsivity; Risk-Taking).     

Accuracy of MMPI-A scales ACK,MAC-R,and PRO in detecting comorbid substance abuse among psychiatric inpatients

This study investigated the accuracy of various indices involving the MMPI-A scales, ACK, MAC-R, and PRO in diagnosing substance abuse in a sample of 79 psychiatric inpatients. In the full sample, 89.9% of the cases were accurately classified by at least one of the three scales. The overall accuracy of classification was similar among males, females, Caucasians, and African Americans, although there was a tendency for more false positive misclassifications among males. Profile code type moderated the accuracy of classification with greatest accuracy for code types including Scales 1, 2, 3, 5, or 0 and least accuracy for code types including Scales 4, 6, or 9. ACK, MAC-R, and PRO were better at screening out cases of substance abuse than in accurately identifying those adolescents who were using substances.     

Ability of substance abusers to escape detection on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) in a juvenile correctional facility

The ability of respondents to underreport successfully on substance abuse and validity scales of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was evaluated. Incarcerated teens (67 substance abusing, 59 non-substance abusing) completed the MMPI-A twice: once under standard instructions (SI) and once under instructions to fake good (FG). Under SI, substance scales correctly classified about 60% to 85% of adolescents. Under FG, substance- and non-substance-abusing juveniles produced lower scores on substance scales. However, the Lie Scale (L) was able to detect more than 75% of deceptive profiles and about 77% of honest profiles. When scale L and the best substance scale were used in combination, only about 18% of faking substance abusers were not identified as either substance abusers or as underreporting. For feigning substance abusers, only about 10% of substance abusers were detected, with about 72% being categorized as faking and needing further assessment.     

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.     

Incremental validity of selected MMPI-A content scales in an inpatient setting

To date, relatively few studies have been published evaluating the validity or incremental validity of the content scales from the adolescent version of the Minnesota Multiphasic Personality Inventory (MMPI-A; J. N. Butcher et al., 1992). A sample of 629 psychiatric inpatient adolescents who had completed the MMPI-A was used to evaluate the ability of selected clinical and content scales to predict conceptually related clinical variables. Criteria were based on clinician ratings, admission and discharge diagnoses, and chart reviews. Results from hierarchical multiple and logistic regression analyses indicated the content scales offered incremental validity over the clinical scales and supported the use of the content scales as an adjunct to the traditional clinical scales.     

Bridging the divide: comments on the Restructured Clinical Scales of the MMPI-2

In this comment, I discuss the target articles written by Nichols (2006/this issue) and Rogers, Sewell, Harrison, and Jordan (2006/this issue) regarding the Restructured Clinical (RC) Scales (Tellegen et al., 2003) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Both articles provide thoughtful discussion of the extent to which the RC Scales achieved the primary goals set forth by Tellegen et al., but they set different tones and come to somewhat different conclusions. I argue that the initial studies conducted on the RC Scales suggest a promising future for them. However, further studies are needed to explore the construct validity of the scales, assess their incremental validity with respect to other more established MMPI-2 scale sets, and determine their interpretive meaning in clinical contexts.     

Incremental validity of the MMPI-A content scales in the prediction of self-reported symptoms

The incremental contribution of the MMPI-A (Butcher et al., 1992) content scales to the prediction of scores on self-report measures of psychopathology was examined in a sample of 62 adolescents in inpatient treatment and 59 adolescents from the community. All participants completed the MMPI-A and a battery of criterion measures. A series of hierarchical regression analyses was conducted in which the MMPI-A clinical and content scales served as the independent variables and the criterion measures as the dependent variables. The content scales were found to have incremental validity beyond the clinical scales in predicting variance in the criterion measures. Similarly, the clinical scales also demonstrated incremental validity over the content scales in making these predictions. Both sets of scales made independent contributions to the prediction of sample membership (clinical vs. nonclinical). Findings suggest that both the clinical and content scales of the MMPI-A make significant contributions to the assessment of adolescents' psychological functioning.     

Psychometric properties of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) Clinical, Content, and Supplementary scales in a forensic sample

In this study, we evaluated the internal psychometric properties and external correlates of scores on the Clinical, Content, and Supplementary scales in a forensic sample of 496 adolescents (315 boys and 181 girls) who were court-ordered to receive psychological evaluations. We examined Cronbach's alpha coefficients, scale intercorrelation matrices, and frequencies of scale elevations. Further, we found varying degrees of support for the convergent and discriminant validity of scores on the MMPI-A (Butcher et al., 1992 ) Clinical, Content, and Supplementary scales. This study adds to the body of literature establishing the utility of the MMPI-A in forensic evaluations.     

The Personality Assessment Inventory Drug Problems Scale: a validity analysis

An analysis of the relationship among the Personality Assessment Inventory (PAI; Morey, 1991, 1996) Drug Problems (DRG) scale scores, the Addiction Severity Index (ASI; McLellan et al., 1992) scores, and urine toxicology reports revealed that the PAI Drug Problem scale scores of 100 substance-using and substance-abusing men and women were distributed in a manner that was in agreement with the guidelines suggested by Morey (1991, 1996) in the PAI manual. There were significant correlations among the PAI DRG scale and the ASI scales related to frequency of use, negative consequences of use, and need and desire for treatment. Overall, higher scores did reflect both more serious involvements with drug use and more serious problems as a consequence of their involvement.     

Changes in adolescent response patterns on the MMPI/MMPI--a across four decades

The purpose of this study was to explore changes in adolescent self-presentation on the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1940) and MMPI-A (Butcher et al., 1992) over a 40-year period. The primary samples used for comparison in this study include 1,235 adolescents, age 14 through 16, derived from the MMPI-A normative sample (Butcher et al., 1992) collected in 1989 and 10,514 adolescents, age 14 through 16, collected in 1948 and 1954 from Hathaway and Monachesi's (1963) study of adolescent personality and behavior. MMPI basic scale and item-level data were also included for 817 adolescents, age 14 through 16, collected by Colligan and Offord (1992) in 1985 as a further comparison. Between-sample analyses at the profile level revealed that adolescents from the MMPI-A normative sample scored significantly higher across basic clinical scales and lower on validity scales L and K than adolescents from the Hathaway and Monachesi (1963) sample, with mean data from the Colligan and Offord (1992) sample typically falling at a midpoint value. Analyses of Harris-Lingoes (Harris & Lingoes, 1955) subscale and item-level data were conducted to provide refined definitions of the contents of scale-level changes. Results were interpreted as reflecting moderate to large changes in response frequencies between eras of data collection, and emphasis was placed on the relatively high frequency of item endorsements by contemporary adolescents in the clinical direction in the MMPI-A normative sample. A series of cautions and limitations are also offered in interpreting these patterns.     

The Personality Psychopathology-Five (PSY-5): recent constructive replication and assessment literature review

The Personality Psychopathology-Five (PSY-5; Harkness & McNulty, 1994) is a model of individual differences relevant to adaptive functioning in both clinical and non-clinical populations. In this article, we review the development of the PSY-5 model (Harkness, 1992; Harkness & McNulty, 1994) and discuss the ways in which the PSY-5 model is related to and distinct from other 5-factor models. Using different methods and measures, the dimensions of the PSY-5 model have been constructively replicated (Lykken, 1968) by Tackett, Silberschmidt, Krueger, and Sponheim (2008) and by Watson, Clark, and Chmielewski (2008), and dimensions congruent with the PSY-5 have even been suggested for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; Krueger et al., 2011). PSY-5 Scales can be scored from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al., 2001), the MMPI-Adolescent version (MMPI-A; Butcher et al., 1992), and the Restructured Form of the MMPI-2 (MMPI-2-RF; Ben-Porath & Tellegen, 2008). Because the largest body of research exists for the MMPI-2-based scales, we focus our review of the literature on the MMPI-2-based PSY-5 scales (Harkness, McNulty, & Ben-Porath, 1995), but we briefly cover the small, but growing, body of MMPI-A and MMPI-2-RF PSY-5 scales research. We show that the PSY-5 research literature includes a wide variety of psychometric methodologies as well as diverse samples and clinical problems. An integrative summary reprises the theory behind each PSY-5 construct and links it to the reviewed literature. Advantages and limitations of MMPI-2-based PSY-5 scales are discussed.     

MMPI-2 at the crossroads: aging technology or radical retrofitting?

Paradigmatic shifts are uncommon in psychological assessment, which is often steeped more in tradition than innovative practices. The introduction of the Restructured Clinical (RC) Scales by Tellegen et al. (2003) represents a radical shift in the development and validation of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In broadening the debate over the merit of the RC Scales, in this article, we examine current challenges to MMPI-2 interpretation including issues with discriminant validity and imprecision (e.g., standard errors of measurement).We evaluate the RC alternative in the context of these interpretive challenges. Although we note several improvements, the incremental validity for MMPI-2 interpretative statements remains to be established. MMPI-2 researchers may wish to test several innovative models for their comparative strengths in establishing scale properties and providing empirically based interpretations.     

Development and validation of a Coping with Discrimination Scale: factor structure, reliability, and validity

Four studies were conducted to develop and validate the Coping With Discrimination Scale (CDS). In Study 1, an exploratory factor analysis (N = 328) identified 5 factors: Education/Advocacy, Internalization, Drug and Alcohol Use, Resistance, and Detachment, with internal consistency reliability estimates ranging from .72 to .90. In Study 2, a confirmatory factor analysis (N = 328) provided cross-validation of the 5-factor model as well as evidence for validity of the scale. The validity evidence was similar across racial groups and for males and females. In Study 3, the estimated 2-week test-retest reliabilities (N = 53) were between .48 and .85 for the 5 factors. Education/Advocacy, Internalization, Drug and Alcohol Use, and Detachment were positively associated with active coping, self-blame, substance use, and behavioral disengagement, respectively, providing further support for validity of the CDS. Finally, incremental validity evidence was obtained in Study 4 (N = 220), where it was shown that the CDS explained variance in outcome variables (i.e., depression, life satisfaction, self-esteem, and ethnic identity) that could not be explained by general coping strategies.     

Development of an Infrequency-Psychopathology scale for the MMPI-A: the Fp-A Scale

This article describes the development and initial validation of the Infrequency-Psychopathology scale, Fp-A, for the MMPI-A (Butcher et al., 1992). The scale parallels the Infrequency-Psychopathology scale, F(p), that has been developed for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Results demonstrated that the 40-item Fp-A scale is superior to the F scale at discriminating between faking-bad and accurate reports of psychopathology, although the improvement over F was modest, particularly when compared to the improvement found for the F(p) scale. The difference seemed to reflect the superiority of the MMPI-A F scale to the MMPI-2 F scale. Even so, the findings suggest that the identification of overreporting on the MMPI-A could potentially be enhanced by using Fp-A as an adjunct to the F scale.     

Why young people do not kill themselves: the reasons for living inventory for adolescents

Assessed the reliability, validity, and predictive power of a new measure, the Reasons for Living Inventory for Adolescents (RFL-A; Osman et al., 1998). A group of 206 (101 boys and 105 girls) adolescent psychiatric inpatients completed the RFL-A, Minnesota Multiphasic Personality Inventory for Adolescents (Butcher et al., 1992), and a packet of self-report measures. Additional information about the patients including diagnosis and suicide status were obtained from their medical records. It was determined that the RFL-A is a valid and reliable measure of adolescent suicide risk potential. Additionally, the RFL-A possesses better predictive power than the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). A discussion of the clinical and research utility of the RFL-A is included along with suggestions for future research.     

Detecting random, partially random, and nonrandom Minnesota Multiphasic Personality Inventory-Adolescent protocols

The ability of the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; J. N. Butcher et al., 1992) validity scales to detect random, partially random, and nonrandom MMPI-A protocols was investigated. Investigations included the Variable Response Inconsistency scale (VRIN), F, several potentially useful new F and VRIN subscales, and formulas F-sub-2 - F-sub-1 and F + F-sub-2 + |F - F-sub-2|. Protocols completed by 150 adolescents at a juvenile court setting, screened for randomness with a matched-pair Millon Adolescent Clinical Inventory (MACI) or Jesness Inventory, were compared with 100 computer-generated, all-random protocols, and with 5 levels of partially random protocols. VRIN was the most effective scale in detecting all-random protocols; however, the optimum cutoff of >or= 75 failed to identify 1/3 of them. Using the new scales, a decision algorithm was described that correctly classified 94%-95% of protocols as interpretable, partially interpretable, or uninterpretable.     

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.     

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.     

Addiction Severity Index Recent and Lifetime summary indexes based on nonparametric item response theory methods

Baseline Addiction Severity Index (5th ed.; ASI-5) data of 2,142 substance abuse patients were analyzed with two nonparametric item response theory (NIRT) methods: Mokken scaling and conditional covariance techniques. Nine reliable and dimensionally homogeneous Recent Problem indexes emerged in the ASI-5's seven areas, including two each in the Employment/Support and Family/Social Relationships areas. Lifetime Problem indexes were derived for five of the areas--Medical, Drug, Alcohol, Legal, and Psychiatric--but not for the Employment/Support and Family/Social Relationships areas. Correlational analyses conducted on a subsample of 586 patients revealed the indexes for the seven areas to be largely independent. At least moderate correlations were obtained between the Recent and Lifetime indexes within each area where both existed. Concurrent validity analyses conducted on this same subsample found meaningful relationships, except for the Employment/Support area. NIRT-based methods were able to add to findings produced previously by classical psychometric methods and appear to offer promise for the psychometric analysis of complex, mixed-format instruments such as the ASI-5.