MMPI and Rorschach indices of schizophrenic and depressive diagnoses among adolescent inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

MMPI and Rorschach Indices of Schizophrenic and Depressive Diagnoses Among Adolescent Inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

Derivation and Implications of MMPI Cluster Groups in Clinically Depressed Inpatient Females

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

Validity and clinical scale comparisons between the MMPI and MMPI-2 with psychiatric inpatients.

This study was designed to investigate the comparability of the original MMPI (1950) and the MMPI-2 (1989) with a psychiatric patient population. 34 male and 3 female patients, shortly after admission to one of two acute psychiatry units, completed the old and revised versions of the MMPI. Paired t tests indicated but scant differences for raw scores, while many more differences were found among T scores for validity, clinical, and supplemental scales. Analyses, however, showed all scales on the two forms to be highly correlated. Analysis of the high-point and two-point codes across the two administrations also showed relative stability, although the proportion of Scales 2 (Depression) and 8 (Schizophrenia) decreased, while those for Scales 6 (Paranoia) and 7 (Psychasthenia) increased markedly in the MMPI-2 protocols. Examination of each version's discriminability among mood- and thought-disordered subsamples suggested that the MMPI provides slightly better delineation between diagnostic classes. Discriminant function analyses showed that there were essentially no differences between the two forms in the accurate classification of clinical and nonclinical groups. The findings reported here provide support for the MMPI-2; despite modification, the newer form retains the advantages of the original MMPI. Differences found here may be unique to psychiatric patients and their patterns of MMPI/MMPI-2 equivalence and may not generalize to other special populations.     

Differentiating between schizophrenic and manic inpatients by means of the MMPI

Forty-five psychiatric inpatients with DSM-III diagnoses of schizophrenia and 31 inpatients with DSM-III diagnoses of bipolar disorder (and currently manic) were compared on the MMPI. Results indicated that although the schizophrenic patients achieved significantly higher scores on several of the MMPI scales (F, Pt, Sc, Si), these findings were of questionable clinical significance. On the other hand, the schizophrenic group did produce a significantly greater percentage of MMPI high-point pairs containing Scale 8(Sc): that is, 64.4% versus 35.5%.     

MMPI predictors of mania among psychiatric inpatients

MMPI data from 64 patients with a diagnosis of manic-depressive illness, manic type, were compared with MMPI data from patients in two comparison groups--64 patients with a psychotic diagnosis other than manic-depressive illness, and 64 patients with a variety of psychiatric diagnoses. Manic patients had higher Ma scale scores for MMPI scales that assess personal distress and interpersonal difficulties (e.g., D and Si). Discriminant analysis, with the Ma, D, and Si scales as predictors, correctly classified as manic or not manic 82.5% of the patients in the derivation sample and 74.2% of the patients in the cross-validation sample. Two high-point pairs, Sc-Ma/Ma-Sc and Pa-Ma/Ma-Pa, occurred in the MMPI profiles of almost half of the manic patients but were rarely found among the profiles of other patients. The results of this study support the use of the MMPI in identifying manic patients, particularly when discriminating between mania and other types of psychosis.     

A Reevaluation of the Use of the MMPI in the Assessment of Combat-Related Posttraumatic Stress Disorder

This study attempts to validate previously developed, empirically based Minnesota Multiphasic Personality Inventory (MMPI) decision rules (Keane, Malloy, & Fairbank, 1984) to aid in the diagnosis of combat-related posttraumatic stress disorder (PTSD). Four groups of 21 subjects each were identified: PTSD, psychotic, depressed, and chronic pain. A decision rule based on the standard clinical scales resulted in a correct classification rate (PTSD vs. non-PTSD) of 81% across the four-group sample. An empirically derived MMPI PTSD scale resulted in a correct classification rate of 77%. However, 43% of the PTSD subjects were incorrectly classified as non-PTSD by these rules. Independent, blind sorting of the 84 MMPI profiles by two doctoral-level clinical psychologists resulted in "hit rates" similar to the MMPI decision rules. The present results suggest that the previously derived, empirically based MMPI decision rules for PTSD do scarcely better than chance on correct classification of individuals with PTSD. We suggest that the differential diagnosis of PTSD is difficult because of the wide variety of symptoms in common with other diagnostic groups, and hence the variability of PTSD subjects on psychometric measures. We also suggest that the MMPI decision rules of Keane et al. (1984) may have utility in identifying subgroup(s) of combat-related PTSDs.     

Relationships between the MAPI and the MMPI in the assessment of adolescent psychopathology.

Although the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Adolescent Personality Inventory (MAPI) are both widely used in the clinical assessment of adolescents, no research has examined the interrelationship between these two instruments. We investigated MMPI and MAPI responses from 199 adolescents assessed at entrance to inpatient or outpatient psychiatric programs in Florida and Virginia. Univariate correlation analyses identified areas of significant associations between these measures, with coefficients ranging widely from -.70 to .72. Substantial diagnostic differences were found between these instruments. The MAPI, for example, yielded no depression-related diagnoses, but produced many more adjustment disorder and personality disorder diagnoses than the MMPI. The rates of diagnostic assignment agreements between diagnoses produced by clinical judgment, MMPI findings, and MAPI interpretive reports were typically quite low.     

The MMPI, prototypal typology, and borderline personality disorder

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of variation in the number of borderline symptoms and overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.     

The Szondi Test in a Psychological Battery: Two Case Studies

This study investigated MMPI Characteristics of male and female adolescent inpatients with diagnoses of borderline personality disorder (n = 28) in contrast to adolescent inpatients receiving principal diagnoses of conduct disorder (n = 21), dysthymic disorder (n = 50), other personality disorders (n = 17), and other diagnoses (n = 30). The borderline group has significantly higher elevations than comparison groups on MMPI Scales F, Hs, D, Pd, Pa, Pt, Sc, and Ma. A stepwise discriminant analysis resulted in 82.1%. accuracy in correctly classifying borderline patients and 78.0% accuracy in identifying, nonborderline patients. Findings are discussed in terms of potential uses and limitations in identifying borderline personality disorder with the MMPI.     

The MMPI,Prototypal Typology,and Borderline Personality Disorder

This study demonstrates inherent features in the DSM-III diagnostic criteria for personality disorders (i.e., overlapping diagnoses and heterogeneous symptomatology) that limit efforts to identify a sensitive and specific MMPI profile for the borderline personality disorder. A sample of 71 inpatients was administered an MMPI and a semistructured interview that systematically evaluated each of 81 symptoms for the 11 DSM-III personality disorders. Interrater reliability was substantially higher than has been obtained with unstructured interviews. The effect on the borderline MMPI profile of (a) variation in the number of borderline symptoms and (b) overlap with the schizotypal, histrionic, and antisocial diagnoses was demonstrated. We discuss implications with respect to a prototypal model of classification.     

Low scores on California Psychological Inventory as predictors of psychopathology in alcoholic patients

This study concerned the use of generally low California Psychological Inventory (CPI) profiles to predict elevated MMPI scores. In a sample of 110 subjects, a CPI profile with T-scores of 25 or less reflects major psychopathology and there is a 79% chance of correct prediction of MMPI T-scores over 80. As a further validation, a Goldberg Individual Index was established with a cut-off score of 70 to classify profiles as psychotic or nonpsychotic. It appears that the California Psychological Inventory can be expanded in making dual diagnoses for alcoholic patients. Scores can be used in treatment planning for alcoholic patients and to identify those individuals who should complete an MMPI for additional treatment planning and diagnoses.     

Concordance of the MCMI-II, the MMPI, and Axis I discharge diagnosis in psychiatric inpatients.

Discriminant functions of the MMPI and the MCMI-II were compared in a sample of 166 hospitalized psychiatric patients with discharge diagnoses of affective disorder (63), schizophrenia (26), substance abuse (35), and other disorders (42). Of special interest was the comparative diagnostic utility of the two instruments in regards to DSM-III-R Axis I diagnoses. Both tests performed reasonably well in the discriminant function analyses; however, the MCMI-II achieved a somewhat superior overall hit rate with this sample of inpatients (79% to 68%). This difference was tied to greater accuracy of the MCMI-II for identifying the affective disorders group.     

Concordance of the MCMI-II,the MMPI,and Axis I Discharge Diagnosis in Psychiatric Inpatients

Discriminant functions of the MMPI and the MCMI-II were compared in a sample of 166 hospitalized psychiatric patients with discharge diagnoses of affective disorder (63), schizophrenia (26), substance abuse (35), and other disorders (42). Of special interest was the comparative diagnostic utility of the two instruments in regards to DSM-III-R Axis I diagnoses, Both tests performed reasonably well in the discriminant function analyses; however, the MCMI-II achieved a somewhat superior overall hit rate with this sample of inpatients (79% to 68%). This difference was tied to greater accuracy of the MCMI-II for identifying the affective disorders group.     

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.     

It only takes one psychologist to demonstrate the impact of psychological assessment

Evidence is needed in the field of psychological assessment of psychiatric patients to verify if test findings actually influence the clinical processes of diagnosis, treatment, case disposition, and outcome. Those who perform many assessments can conduct limited experiments to measure these effects. One such study is presented. It is a quasi-experiment in which the value of the psychologist's diagnostic recommendations to treating psychiatrists was measured. Diagnoses at admission, at subsequent psychological evaluation, and at discharge were compared among 70 patients referred to a clinical diplomate from the American Board of Professional Psychology (ABPP) for assessment. The psychiatrists who had referred the patient agreed with the psychologist's diagnosis in 94% of the cases. Agreement was high even when the psychologist had disagreed with the admitting psychiatrists' diagnoses. Despite imperfections in research design, the study demonstrates that solo practitioners can evaluate the impact of assessment. Other possibilities for study are presented, as are reasons for the significant findings of this study.     

Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.     

THE SEARCH FOR CONFIGURAL RELATIONSHIPS IN PERSONALITY ASSESSMENT: THE DIAGNOSIS OF PSYCHOSIS vs. NEUROSIS FROM THE MMPI

In 1956 Meehl predicted that the relationships between MMPI scores and the psychosis-neurosis diagnostic classification should be highly configural in character, and therefore that no linear combination of MMPI scores should be able to differentiate neurotic from psychotic patients as accurately as either experienced clinical psychologists or configural actuarial techniques. The present paper summarizes the findings from ten years of research on this question. While the search for configural actuarial procedures has led to a moderator variable, neither clinical experts, moderated regression analyses, profile typologies, the Perceptron algorithm, density estimation procedures, Bayesian techniques, nor sequential analyses-when cross-validated-have been-able to improve on a simple linear function. The implications of these negative findings for investigations of configural relationships with other problems are discussed.     

Construction and cross-validation of an MMPI Black-White scale

A robust set of MMPI items, sensitive to the effect of race (Blacks versus Whites), was constructed by compiling the results of six prior studies. Thirty-two items comprised the MMPI B-W scale. The scale was cross-validated on psychiatric patients and police cadets. Statistically significant mean differences were found between races in both groups, with 83% and 60% correct racial classification, respectively. These findings suggested that when used as a clinical instrument, the MMPI might pick up nonpathology-related racial variance contributing to scale devotion biased against the black respondent, but the degree of nonpathology-related racial scale score covariance has yet to be determined. For future research, the B-W scale was proposed as a set of standard queries in studies assessing connotative meaning for Black-White contrast groups, and to index "functional" as opposed to "objective" race membership.