Evolution of the Millon Clinical Multiaxial Inventory

Dr. Theodore Millon (1928–2014) was a primary architect for the personality disorders in the DSM–III, a structure that has endured into the DSM–5. His 1969 book, Modern Psychopathology, created an elegant framework into which the well-known personality prototypes could be fitted and understood. His theoretical work soon led into the creation of several psychological inventories, most notably the Millon Clinical Multiaxial Inventory (MCMI). The MCMI, now in preparation for its 4th major edition, has been a very popular instrument among clinicians. This article explores the history of the MCMI's development from its origins, through 2 distinct theoretical phases, and to its current status as the MCMI–IV is finalized.     

The Millon Clinical Multiaxial Inventory (MCMI): a review

This article reviews research conducted to date on the Millon Clinical Multiaxial Inventory (MCMI), a self-report test of psychopathology. The composition of the test and its theoretical basis are described. Data regarding its internal psychometric structure are reviewed. Finally, the article summarizes the research on the validity of the MCMI.     

Millon Clinical Multiaxial Inventory: I & II

The theoretical grounds for the Millon Clinical Multiaxial Inventory (MCMI) are noted, as are the purposes and features of the inventory. Specified also are the rationale and procedures for constructing the component scales. Both uses and limitations of the instrument are recorded. Steps to be followed in making configural interpretations are recommended. Also reported are results of evaluative research. These point to the general soundness of the MCMI as a clinical tool, as well to areas where ongoing studies may further strengthen its utility in the counseling context.     

Factor invariance of the Millon Clinical Multiaxial Inventory

Several factor analyses of the Millon Clinical Multiaxial Inventory (MCMI) have resulted in very similar solutions. Interpretation of this consistency is hampered by the fact that the 20 scales of the inventory share items. Overlapping items cause the scales to be linearly dependent and may create structure in the interscale correlation matrix which is separate from the subject response patterns. A factor analysis was performed on the matrix of item-overlap coefficients which describes the underlying artifactual structure of the instrument. Data from two new subject samples were factor analyzed and compared to previously published studies. Similarity coefficients among factors across studies were calculated.     

Retest reliability of the Millon Clinical Multiaxial Inventory

This article reports on two studies which examined the temporal stability of the personality disorder subscales from the Millon Clinical Multiaxial Inventory (MCMI). The scales demonstrated adequate stability in psychiatric inpatients (retested with an average of just over 1 year between testings). Furthermore, a separate sample of depressed inpatients assessed when depressed and 6 weeks later showed that the stability of MCMI personality scales was observed even after patients displayed an initial reduction in depression severity. Although stability is vital to the accurate assessment of personality disorders, both studies also found high retest correlations for the MCMI clinical syndrome subscales. In general, these results suggest that patients displayed similar symptom patterns over time, whether construed as personality traits or characteristic patterns of responding when symptomatic.     

The operating characteristics of the Millon Clinical Multiaxial Inventory

The operating characteristics of the 20 scales of the Millon Clinical Multiaxial Inventory (MCMI) were analyzed with respect to the construction sample data as presented in the test manual. Sensitivity, specificity, positive predictive power, negative predictive power, and overall diagnostic power of each scale were derived. Results indicated that eight scales show excellent characteristics, nine were classified as fair, and three were determined to have poor positive predictive power for identifying the presence of a syndrome in an individual patient. Five scales had good positive predictive power for identifying the most prominent syndrome in a patient's clinical picture, eleven scales were classified as fair, and four were seen as poor on this dimension. We suggest a method for determining the utility of individual scales for different clinical populations and discuss implications of this type of analysis of the MCMI for diagnosis of the individual case.     

The Operating Characteristics of the Millon Clinical Multiaxial Inventory

The operating characteristics of the 20 scales of the Millon Clinical Multiaxial Inventory (MCMI) were analyzed with respect to the construction sample data as presented in the test manual. Sensitivity, specificity, positive predictive power, negative predictive power, and overall diagnostic power of each scale were derived. Results indicated that eight scales show excellent characteristics, nine were classified as fair, and three were determined to have poor positive predictive power for identifying the presence of a syndrome in an individual patient. Five scales had good positive predictive power for identifying the most prominent syndrome in a patient's clinical picture, eleven scales were classified as fair, and four were seen as poor on this dimension. We suggest a method for determining the utility of individual scales for different clinical populations and discuss implications of this type of analysis of the MCMI for diagnosis of the individual case.     

Overview and Current Status of the Millon Clinical Multiaxial Inventory

The MCMI (Millon, 1983a, 1987, 1994, 1997a) was developed to operationalize Millon's (1969/1983b) model of psychopathology and has been revised 2 times over the past 20 years to keep pace with changes in theory as well as the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Since its introduction in 1977, it has become one of the most widely used and researched clinical assessment instruments in history, generating over 500 articles and 6 books. It has been translated into several languages and is being used in cross-cultural research. This article presents a historical overview of the measure and summarizes its current status in the literature. I highlight Millon's original vision for the test, changes that have been made, and its strengths and limitations. Future refinement of the MCMI is already in the planning stages and includes trait subscales for the personality disorders and linking codetypes to theory-derived interventions.     

Stability of the Millon Clinical Multiaxial Inventory among psychiatric inpatients

This study investigated the stability of the Millon Clinical Multiaxial Inventory (MCMI) in a sample of psychiatric inpatients over a longer time period and from different perspectives than previous reliability studies. Test-retest reliability was assessed from three perspectives: correlation/regression, equivalence of dimensional structures across testings upon different admissions, and stability of personality style across testings. Some stability from a correlational perspective was found, with higher stability estimates indicated for the basic personality scales in comparison with the clinical symptom scales which is consistent with Millon's theory. The internal structure of the MCMI was essentially identical across testings. Although source of reinforcement and instrumental or coping style were stable across testings beyond chance, the MCMI profiles of a considerable number of subjects were inconsistent across testings. Correspondingly, clinicians should be cautious in using the MCMI to make categorical decisions regarding personality style with inpatients who are tested at admission and who have had repeated hospitalizations.     

International Adaptations of the Millon Clinical Multiaxial Inventory: Construct Validity and Clinical Applications

This article examines the influence of the Millon Clinical Multiaxial Inventory (MCMI) as a clinical and research instrument beyond the borders of the United States. The MCMI's theoretical and empirical grounding, its alignment with the Diagnostic and Statistical Manual of Mental Disorders (DSM), and scales that can be interpreted both categorically and dimensionally, are the primary features that make the test attractive. We begin with studies that evaluated the construct equivalence of the different language adaptations. Data from the most widely researched non English-language forms (Danish, Dutch, and Spanish) show excellent comparability with Millon's original. Nevertheless, significant problems were noted in efforts to create clinical groups that would allow for equivalence of diagnostic accuracy when using the cutoff scores. Although dimensional aspects of the scale scores were not affected by this, the adapted measures might show attenuated diagnostic accuracy compared with Millon's original. Next, we present MCMI studies conducted in clinical settings to document where the adapted tests have made their greatest impact in the international literature. A wide variety of clinical applications demonstrated broad utility, and given the high number of issues addressed, we think Millon's influence will certainly stand the test of time in different domains and settings.     

The stability of the Millon Clinical Multiaxial Inventory for psychiatric inpatients

This study investigated the stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of psychiatric inpatients. Patients were administered the MCMI shortly following admission and shortly preceding discharge. As would be expected theoretically, results indicated that stability estimates were greater for the basic personality scales than for the symptom scales. These results were also compared with results from a previous study investigating the stability of MCMI scales. Overall, stability coefficients for the inpatient sample were lower than those reported for other samples. Possible explanations for this and other findings are discussed.     

Use of the Millon Clinical Multiaxial Inventory in the psychological assessment of domestic violence: A review

An Millon Clinical Multiaxial Inventory (MCMI)-based literature review found that the personality disorders of antisocial, aggressive–sadistic, passive–aggressive (negativistic), and, to some extent, narcissistic are more prevalent in the MCMI profile codes of male spouse abusers. There is a relative absence of Axis I syndromes, although substance abuse of moderate intensity was also extant in these profiles. Some patients produced a normal profile on the MCMI, and their domestic violence may not be a product of a personality disorder. We conclude that the MCMI may be a useful instrument to assess the personality of males in treatment for domestic violence. Elevations of these defined scales may be used as markers to evaluate personality styles at risk for domestic abuse.     

Personality characteristics of drug addicts and alcoholics on the Millon Clinical Multiaxial Inventory

The Million Clinical Multiaxial Inventory (MCMI) was administered to 106 alcoholics and 100 addicts in separate VA inpatient rehabilitation treatment programs. The alcoholics scored higher on the personality style scales of Avoidant, Passive-Aggressive, Schizotypal, Borderline and Paranoid, while the opiate addicts scored higher on the Narcissistic personality disorder scale. Separate cluster analyses for both groups further revealed common personality styles among both groups. Several MCMI scales showed significant correlations with age, but in no case were the effects attributed to age larger than 5% of the total variance. The MCMI may alert clinicians to subtle similarities and differences between and among alcoholics and opiate addicts.     

Stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administrations at intake into treatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

The detection of fake-bad and fake-good responding on the Millon Clinical Multiaxial Inventory III

The purpose of this study was to examine the effectiveness of the 3 Modifying Indices of the Millon Clinical Multiaxial Inventory III (MCMI-III) in the detection of fake-bad and fake-good responding. The sample consisted of 160 psychiatric outpatients. Paired t tests were performed to examine the effects of instructional set (faking vs. standard instructions). As hypothesized, instructional set produced significant differences on Scale X, Scale Y, and Scale Z in both fake-bad and fake-good analyses. Single-scale cutoff scores were as effective as multiple-scale cutoffs. The overall rates of successful classification indicated moderate effectiveness and utility of the MCMI-III Modifying Indices in the detection of dissimulated responding. When base rates were varied to more closely approximate a general clinical population, overall classification accuracy increased, but identification of faking (positive predictive power) gradually eroded with declining base-rate estimates. At lower base rates of faking, MCMI-III standard cutoff points yielded a high number of false positives.     

Stability of the Personality and Symptom Scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administration at intake into retreatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

Validity of the Millon Clinical Multiaxial Inventory in the assessment of affective disorders

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 270 adult outpatients with major affective disorders at the same time that a semistructured, diagnostic interview was conducted by a clinician. The mood of the patient was then rated, and the clinician completed the Hamilton Depression Rating Scale and the Mania Rating Scale. A consensual diagnosis was arrived at by the team of investigators using DSM-III criteria. Significant correlations were found between four MCMI affective scales and the global mood state of the patient. Analysis of covariance indicated that the MCMI affective scales are significantly related to DSM-III affective disorders even after the effect of the current mood of the patient is partialled out. The clinical usefulness of each of the scales is discussed.