Differentiating Overreporting and Extreme Distress: MMPI-2 Use With Compensation-Seeking Veterans With PTSD

This purpose of this study was to examine overreporting on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) in compensation-seeking veterans with posttraumatic stress disorder (PTSD). A sample of veterans tested during a V.A. hospital compensation and pension exam were given the MMPI-2 and measures of PTSD, depression, and combat exposure. Veteran's MMPI-2s were only included in the analyses if their profile was extremely exaggerated, as measured by an F scale T score above 80, did not elevate the MMPI-2 VRIN and TRIN scales, and had a primary diagnosis of PTSD (n = 127). Using the Infrequency-Psychopathology, F(p), scale to distinguish overreporting from distress, it was found that 98 veterans elevated profiles due to distress, whereas 29 elevated due to overreporting, F(p) below and above 7, respectively. Differences between groups on MMPI-2 clinical scales and the other measures were assessed. Implications of these findings for assessing veteran response style and using the MMPI-2 with a PTSD population are discussed.     

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd) for the MMPI-2: development and initial validation with veterans presenting with combat-related PTSD

Researchers have identified difficulties associated with the use of traditional Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity scales with survivors of traumatic events. A new scale, the Infrequency-Posttraumatic Stress Disorder scale (Fptsd), was created from MMPI-2 items that were infrequently endorsed by 940 male combat veterans presenting for treatment at the posttraumatic stress disorder (PTSD) clinics of 2 Veterans Affairs Medical Centers. A variety of statistical methods were implemented that preliminarily established Fptsd's validity with a validation sample of 323 additional PTSD-diagnosed combat veterans. Results indicate that, relative to previously established validity and overreporting scales (F, Fb, and Fp), Fptsd was significantly less related to psychopathology and distress and better at discriminating simulated from genuinely reported PTSD. Clinical implications are discussed concerning the use of Fptsd to assess disability-seeking veterans suspected of overreporting PTSD symptoms.     

Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach

The goal of this study was to examine the incremental validity and the clinical utility of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and Rorschach (Rorschach, 1942) with regard to differential diagnosis in a sample of adult inpatients with a primary psychotic disorder or a primary mood disorder without psychotic features. Diagnostic efficiency statistics have suggested that the Rorschach Perceptual Thinking Index (PTI; Exner, 2000a, 2000b) was better than MMPI-2 scales in discriminating psychotic patients from nonpsychotic patients. We compared the 84% overall correct classification rate (OCC) for the PTI to an OCC of 70% for the MMPI-2 scales. Adding the MMPI-2 scales to the PTI resulted in a decrease in OCC of 1%, whereas adding the PTI to the MMPI-2 resulted in an increase in OCC of 14%. Sensitivity, specificity, positive predictive power, negative predictive power, and kappa were equal or higher with only the PTI in the model.     

The relationship between spiritual distress, PTSD and depression in Vietnam combat veterans

Presents empirical data showing the relationship between combat-related posttraumatic stress disorder (PTSD), depression and spiritual distress. Uses spiritual injury scale to measure distress; scale measures guilt, anger or resentment, sadness/grief, lack of meaning, feeling God/life has treated one unfairly, religious doubt, and fear of death. Shows high association between spiritual injuries and both PTSD and depression. Also finds inverse relationship between intrinsic religious faith and these two diagnostic categories. An inverse relationship also exists between religious faith as measured by regular worship with a faith community and both depression and PTSD.     

Comparison of MMPI-2 profiles of Gulf War veterans with epileptic and nonepileptic seizure patients

As part of a larger study of illnesses related to service in the Gulf War, MMPI-2 profiles of epileptic seizure (ES) patients; nonepileptic seizure (NES) patients; Gulf War veterans with unexplained cognitive, psychological, musculoskeletal, fatigue, or dermatologic symptoms; and asymptomatic Gulf War veterans (Controls) were analyzed. There were 70 people in each group. Seizure diagnosis was based upon intensive EEG monitoring. Gulf War cases were mildly abnormal on MMPI-2 Scales Hs and D and significantly higher than controls on 8 of 10 MMPI-2 clinical scales, but they were significantly lower than NES patients on several scales including Hs and Hy.     

Susceptibility of the MMPI-2 clinical, restructured clinical (RC), and content scales to overreporting and underreporting

The authors examined and compared the susceptibility of three Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scale sets (Clinical, Restructured Clinical [RC], and Content) to over- and underreporting using five analog samples. Two samples of 85 and 191 undergraduate students, respectively, took the MMPI-2 under underreporting versus standard instructions. Three samples consisting of 42 undergraduates, 73 psychiatric inpatients, and 84 medical patients took the MMPI-2 under overreporting versus standard instructions. A comparison of the effect sizes across the three sets of scales indicated that Clinical Scale scores are not less susceptible to distortion than the Content or RC Scales. An apparent lesser susceptibility to underreporting for the Clinical Scales was an artifact of the subtle items' effect on these scales.     

Anhedonia and emotional numbing in combat veterans with PTSD

We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyper-arousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing insight into the nature of PTSD.     

Civilian PTSD scales: relationships with trait characteristics and everyday distress

Strong associations between civilian posttraumatic stress disorder (PTSD) scales and measures of general psychological distress suggest that the scales are nonspecific to PTSD. Three common PTSD scales were administered to 122 undergraduates who had experienced an emotionally salient, nontraumatic event: a college examination. Results indicated that normal levels of anxiety associated with the examination were positively correlated with scores on the Impact of Event Scale-Revised, Revised Civilian Mississippi Scale, and PTSD Checklist-Civilian Version. Multiple regression analyses indicated that substantial variance in the PTSD scales was accounted for by trait characteristics such as negative and positive affectivity and affect intensity (R2 .29 to .53). Negative affectivity correlated as highly with PTSD measures (r = .46 to .71) as those measures correlated with each other (r = .48 to .65). A high proportion of participants exceeded clinical cutoffs on these measures. The findings suggest that these PTSD scales may be overly sensitive to nontraumatic stressors such as everyday distress and trait characteristics.     

Interrelationship Between MMPI-2 and Rorschach Variables in a Sample of Vietnam Veterans With PTSD

We examined interrelationships between theoretically related MMPI-2 and Rorschach variables in a sample of Veterans Affairs outpatients with Posttraumatic Stress Disorder (PTSD). Subjects were 20 White Vietnam combat veterans diagnosed with PTSD who completed the Rorschach and MMPI-2 as part of a comprehensive evaluation. Correlations were calculated for variables in three groups: validity, depression and anxiety, and thought disturbance. Results showed strong relationships between m, MOR, and t he Dramatic special score of the Rorschach and MMPI-2 indices of distress. Positive relationships were also found for some indicators of thought disturbance, whereas correlations for other depressive indicators were not significant. Findings are discussed with regard to implications for the clinical assessment of combat-related PTSD and future directions for assessment research.     

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.     

Detecting symptom exaggeration in combat veterans using the MMPI-2 symptom validity scales: a mixed group validation

Although validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) have proven useful in the detection of symptom exaggeration in criterion-group validation (CGV) studies, usually comparing instructed feigners with known patient groups, the application of these scales has been problematic when assessing combat veterans undergoing posttraumatic stress disorder (PTSD) examinations. Mixed group validation (MGV) was employed to determine the efficacy of MMPI-2 exaggeration scales in compensation-seeking (CS) and noncompensation-seeking (NCS) veterans. Unlike CGV, MGV allows for a mix of exaggerating and nonexaggerating individuals in each group, does not require that the exaggeration versus nonexaggerating status of any individual be known, and can be adjusted for different base-rate estimates. MMPI-2 responses of 377 male veterans were examined according to CS versus NCS status. MGV was calculated using 4 sets of base-rate estimates drawn from the literature. The validity scales generally performed well (adequate sensitivity, specificity, and efficiency) under most base-rate estimations, and most produced cutoff scores that showed adequate detection of symptom exaggeration, regardless of base-rate assumptions. These results support the use of MMPI-2 validity scales for PTSD evaluations in veteran populations, even under varying base rates of symptom exaggeration.     

Couples in marital distress: a study of personality factors as measured by the MMPI-2

This study examines the relationship between Minnesota Multiphasic Personality Inventory-2 (MMPI-2) measured personality characteristics and marital distress and provides empirical validation for using the MMPI-2 with a marital therapy population. Studied were 150 couples in marital therapy and 841 normal couples who participated in the MMPI-2 restandardization study. The MMPI-2, a biographical form, a partner rating form, and the Dyadic Adjustment Scale (DAS) were administered to all couples. The marital counseling group resembled previous marital counseling samples studied with the MMPI and scored significantly higher than the normative sample on several MMPI-2 scales. Relationships between the DAS and MMPI-2 clinical and content scale scores are reported. The Psychopathic Deviate (Pd) clinical scale and Family Problems (FAM) content scale were the most powerful group discriminators and strongest correlates of the DAS; their use as indices of marital distress is tested. The meaning of Pd as an index in assessing personality factors in marital distress is explored.     

Detection of faking on the MMPI-2: differentiation among faking-bad, denial, and claiming extreme virtue

The purpose of this study was (a) to evaluate the ability of the existing validity indices of the Minnesota Multiphasic Personality Inventory (MMPI-2) in detecting faking. bad and faking-good profiles, (b) to differentiate between two strategies for faking-good (denial and claiming extreme virtue), (c) to determine the effectiveness of the new MMPI-2 validity scale, the S scale, in detecting people's tendency to present themselves in a superlative manner, and (d) to explore the response strategy under conditions in which individuals we known to be distorting their responses to the MMPI-2 Participants were 167 undergraduate, college students who were administered the test under different conditions, and 50 hospitalized, psychiatric patients. Mean profile configurations and optimal cutoff scores obtained in this study were similar to those reported in previous studies. Accurate identification of faked profiles was achieved. The new S scale and its subscales, especially S2 (Serenity), S3 (Contentment With Life), and S5 (Denial of Moral Flaws), showed particular promise in detecting faking-good (denial and claiming extreme virtue) profiles, Participant's debriefing provided valuable information about the participants' understanding of the instructions and their deception strategies. The attempts to differentiate between two strategies for faking-good, denial and claiming extreme virtue, were not successful, However, these results should not be taken to indicate that the particular strategies assessed in this study cannot be differentiated. Methodological issues reviewed suggest that further research might yield more understanding of the nature of any deception efforts made by respondents. In addition, future, research is needed to discover if the findings from this study generalize to other clinical settings and populations.     

MMPI-2 assessment of malingered emotional distress related to a workplace injury: a mixed group validation

In this study, we examined the capacity of MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 2001) validity indexes to identify malingered depression associated with a workplace injury. We compared 27 graduate students simulating depression with archival records of 33 inpatients diagnosed with major depressive disorder. We employed a mixed-group validation design to generate true positive rates (TPR) and false positive rates (FPR) for the various MMPI-2 validity scales [F, FB, F(p), FBS, F - K, Ds2] while we accounted for base rates of malingering in each sample. The Fake Bad scale (FBS) was the only validity measure that produced acceptable TPR and FPR or a significant correlation with malingering status.     

Assessing depression with the MMPI and MMPI-2

The usefulness of the MMPI (Hathaway & McKinley, 1951 ) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) for diagnosing and assessing symptomatic depression has been the subject of considerable debate for a number of years. In this article, we review the relative contributions of the MMPI and MMPI-2 clinical and content scales in predicting depression. Positive predictive power, negative predictive power, and overall classification rate were computed for Scale 2 (D) of the MMPI and MMPI-2 and the Depression content scale (DEP) of the MMPI-2. Scale 2 (D) of both the MMPI and MMPI-2 appears to be moderately accurate in predicting depression. Although some studies suggest that the content scale DEP provides incremental validity over Scale 2 (D) of the MMPI-2, the results of this review indicate that the content scale DEP of the MMPI-2 does not exceed the diagnostic efficiency of Scale 2 in predicting depression.     

Reliving,emotions, and fragmentation in the autobiographical memories of veterans diagnosed with PTSD

Fifty veterans diagnosed with posttraumatic stress disorder (PTSD) each recalled four autobiographical memories: one from the 2 years before service, one non‐combat memory from the time in service, one from combat, and one from service that had often come as an intrusive memory. For each memory, they provided 21 ratings about reliving, belief, sensory properties, reexperiencing emotions, visceral emotional responses, fragmentation, and narrative coherence. We used these ratings to examine three claims about traumatic memories: a separation of cognitive and visceral aspects of emotion, an increased sense of reliving, and increased fragmentation. There was evidence for a partial separation of cognitive judgments of reexperiencing an emotion and reports of visceral symptoms of the emotion, with visceral symptoms correlating more consistently with scores on PTSD tests. Reliving, but not fragmentation of the memories, increased with increases in the trauma relatedness of the event and with increases in scores on standardized tests of PTSD severity. Copyright © 2004 John Wiley & Sons, Ltd.     

Assessing general maladjustment with the MMPI-2

The validities of 7 MMPI-2 (Butcher, Graham, Ben-Porath, Tellegen, & Kaemmer, 2001) measures of general maladjustment were compared using a composite criterion measure based on self-reported symptom severity and clinicians' ratings of symptom severity and level of functioning. Participants were 274 male and 425 female clients at a community mental health center and 105 male and 247 female clients at a university psychological clinic. All MMPI-2 measures were significantly related to the composite criterion measure for both male and female clients in both settings. The mean score on 8 clinical scales (M8) consistently was the best indicator of maladjustment. Although other MMPI-2 measures sometimes added significantly to the variance accounted for in the criterion measure, increments were small and probably not clinically meaningful. However, M8 added significantly and meaningfully to each of the other MMPI-2 measures in predicting maladjustment. Implications for using the MMPI-2 to assess general maladjustment in outpatient mental health settings are discussed.