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.     

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.     

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.     

MMPI-2 profile code types and measurement error

We studied simulated MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) code type stability and change expected with measurement error for 12 MMPI-2 well-defined mean code type profiles. Profile scores for the 2 scales defining the code type were systematically varied to represent target code type profiles at 9 different levels of T-score profile definition. We randomly generated samples of 50 simulated, estimated true score profiles at each level of profile definition for each code type around the estimated true scores for each scale at each level of profile definition. Two sets of simulated profiles were developed. The first simulation was based on the reported means, test-retest reliabilities, and the standard errors of measurement for the MMPI-2 normative group. The second simulation was based on the means, standard deviations, and estimated retest stability for a clinical group of psychiatric patients. We calculated frequencies and percentages of simulated profiles with the highest estimated true scores on the same 2 scales as the original code type profile. Percentages of simulated profiles with the same 2 highest scales as the original code type profiles increased from 27% to 37% for the 3-point level of definition, 37% to 49% for the 5-point definition, 46% to 61% for 7-point definition, 63% to 78% for 10-point definition, 78% to 89% for 13-point definition, 83% to 93% for 15-point definition, and greater than 90% for profile definition greater than 15 points.     

A resolution to the interpretive dilemmas created by the Minnesota Multiphasic Personality Inventory 2 (MMPI-2)? A reply to Ben-Porath and Graham

In my original article (Strassberg, 1991) I described (1)some of the changes introduced by the MMPI-2, (2) possible interpretive dilemmas created by these changes, and (3) strategies for dealing with these dilemmas. In their reply to my paper, Ben-Porath and Graham (preceding paper) suggest that the differences between the MMPI-2 and the MMPI (1) are to be expected, (2) are less important than I imply, and (3) when they do occur, will almost always reveal the superiority of the MMPI-2. In this reply to Ben-Porath and Graham, I explain why, despite their reassurances, I continue to contend that interpretive dilemmas can exist when using the MMPI-2, but these should not deter us from using this instrument.     

Psychometric evaluation of the MMPI-2 Restructured Clinical scales in two Dutch samples

In this article, we evaluate internal validity, internal consistency, and test-retest reliability of the MMPI-2 Restructured Clinical (RC) scales in the Dutch MMPI-2 normative sample (N = 1,244) and a Dutch outpatient psychiatric sample (N = 1,066). We pay special attention to a critique regarding construct drift of RC3 and the redundancy of the RC scales with existing MMPI-2 scales. The results indicate that the RC scales in both samples show comparable or better internal consistencies than the Clinical scales. Also, in both samples, the RC scales demonstrate lower scale-level intercorrelations than the Clinical scales. As to the structural characteristics, principal component analysis of the RC scales provided a clearer pattern than an analysis of the Clinical scales. Furthermore, mean raw scores on the RC scales for men in the Dutch normative sample corresponded highly with those in the U.S. normative sample except for RC2 and RC4. Less correspondence was found for women. Overall, we conclude that the RC scales show satisfactory reliability and promising internal validity in our Dutch samples. We suggest that U.S. validation studies on the RC scales may be generalized to the Dutch-language version of the MMPI-2 RC scales.     

Detection of Feigned Posttraumatic Stress Disorder: A Comparison of the MMPI-2 and PAI

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) were compared for detecting feigned posttraumatic stress disorder (PTSD) in a simulation research design. Participants were 85 undergraduates in one of three groups: PTSDs (n = 23), Fakers (n = 31), and Controls (n = 31). As expected, both the MMPI-2 and PAI discriminated PTSDs and Controls, with PTSDs scoring significantly higher on fake-bad validity scales and PTSD-relevant clinical scales. However, only the MMPI-2 discriminated Fakers and PTSDs, with Fakers scoring significantly higher on all MMPI-2 scales considered, but on only one PAI scale. Further, in logistic regression analyses the MMPI-2 demonstrated higher overall correct classification of PTSDs and Fakers than did the PAI. Although the MMPI-2 outperformed the PAI in detecting feigned PTSD, a substantial proportion of Fakers avoided detection by MMPI-2 fake-bad validity scales, suggesting that both tests are vulnerable to feigning of PTSD by motivated respondents with relatively limited coaching.     

Type A Personality,Self-Control,and Vulnerability to Stress

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was released in 1992 and has rapidly become the most widely used objective personality assessment instrument with adolescents. Although the MMPI-A reduced or eliminated several problems associated with the use of the original MMPI (Hathaway &; McKinley, 1943) with adolescents, the MMPI-A does produce a high frequency of within normal limits basic scale profiles for individuals with substantial psychopathology including adolescents in inpatient psychiatric settings. To better understand the reasons for this phenomenon, we compared the item endorsement frequencies for the MMPI-A normative sample with results from two adolescent clinical samples, and these results were contrasted to the item endorsement frequencies for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, &; Kaemmer, 1989) normative sample and a clinical sample of adult psychiatric inpatients. Results showed that the MMPI-A contains a substantial number of items that do not show a significant difference in item endorsement frequency between normative and clinical samples. Furthermore, MMPI-A basic and content scales generally show a much lower percentage of effective items than do the corresponding scales for the MMPI-2. We discuss the findings in relation to the frequent occurrence of low range MMPI-A profiles in clinical samples and the potential usefulness of these results in future efforts to develop viable short forms for the MMPI-A.     

MMPI-2 scores of patients with insomnia

Although the MMPI-2 has been employed since 1989, to date no study has been reported on its use with patients with insomnia. The MMPI-2 was administered to 104 insomnia patients. The T scores of all the MMPI-2 scales fell below the cut-off score of T = 65. Although the group profile was within the normal range, the percentages of patients who had MMPI-2 scores above T = 65 for each scale indicated that a substantial portion of the insomnia patients obtained elevated scores, particularly in the Hs, D, Hy, and Pt scales. Thus, the results suggest that many of the insomnia patients exhibit psychological distress and would benefit from brief psychological interventions, such as sleep hygiene education and relaxation training. In view of the large number of insomnia patients who obtained abnormal MMPI-2 scores, a psychological measure such as the MMPI-2 remains an important assessment tool in identifying insomnia patients who may need extensive psychotherapeutic intervention.     

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-RF characteristics of custody evaluation litigants

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a 338-item objective self-report measure drawn from the 567 items of the MMPI-2. Although there is a substantial MMPI-2 literature regarding child custody litigants, there has been only one previously published study using MMPI-2-RF data in this population that focused on Validity scales L-r and K-r. The current study evaluated the MMPI-2-RF results of 344 child custody litigants and showed substantial consistency between T-score elevations typically found on MMPI-2 Validity scales L and K, and comparable elevations for MMPI-2-RF validity scales L-r and K-r. Mean T-scores well within normal limits characterized results for clinical scales on both instruments. The RC scale intercorrelation patterns, and alpha coefficient values found for MMPI-2-RF scales in a custody population, were also found to be very similar to those reported for other populations. Directions for future research are presented.     

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.     

Current status of MMPI-2 research: a methodologic overview

MMPI-2 research since 1990 has been reviewed to assess whether Butcher and Tellegen's (1978) concerns and suggestions about MMPI research were being followed. Guidelines are provided for when the MMPI-2 is appropriate to administer, how to describe the sample used, assessing validity of the profile, what scores to analyze, and how to report the results. Suggestions also are presented for research within several current areas of debate in the MMPI-2: codetype comparability between the MMPI and MMPI-2, incremental validity of new or existing scales, obvious and subtle subscales, emphasis on item content, development of new scales, and correcting profiles for specific medical and physical conditions.     

An evaluation of the MMPI-2 and MMPI-a true response inconsistency (TRIN) scales

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) True Response Inconsistency (TRIN) scales are measures of acquiescence and non-acquiescence included among the standard validity scales on these instruments. The goals of this study were to evaluate the effectiveness of these scales in detecting varying degrees of acquiescence and non-acquiescence and to evaluate cutoff scores for clinical use. After the removal of invalid protocols from the MMPI-2 and MMPI-A normative samples, each normative sample was randomly divided in half. For each measure, one half of the normative sample served as a comparison group and the other half was modified with increasing degrees (10%, 20%, 30%, 40%, and 50%) of randomly inserted true or false responses. The results for a 9.1% base rate of acquiescence or non-acquiescence provide support for TRIN cutoff scores at or near those presented in the MMPI-A and MMPI-2 manuals.     

A cultural-contextual perspective on the validity of the MMPI-2 with American Indians

This study investigated the normative validity of the MMPI-2 with two distinct American Indian tribes. Differences occurred on 8 of the 13 basic validity and clinical scales (F, 1, 4, 5, 6, 7, 8, 9) between the MMPI-2 norms and both tribal samples. Elevated MMPI-2 scores of American Indians may not only reflect the possibility of psychological distress spurred by historical oppression and present adversity, but also an expression of a divergent worldview. Considering the context of the historical and social production of knowledge about American Indians, it is argued that researchers and practitioners, when interpreting MMPI-2 results for American Indians, should seriously consider their interpretive points of reference, which may be impacted by dominant cultural belief systems.     

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 effectiveness of MMPI-A items in discriminating between normative and clinical samples.

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was released in 1992 and has rapidly become the most widely used objective personality assessment instrument with adolescents. Although the MMPI-A reduced or eliminated several problems associated with the use of the original MMPI (Hathaway & McKinley, 1943) with adolescents, the MMPI-A does produce a high frequency of within normal limits basic scale profiles for individuals with substantial psychopathology including adolescents in inpatient psychiatric settings. To better understand the reasons for this phenomenon, we compared the item endorsement frequencies for the MMPI-A normative sample with results from two adolescent clinical samples, and these results were contrasted to the item endorsement frequencies for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) normative sample and a clinical sample of adult psychiatric inpatients. Results showed that the MMPI-A contains a substantial number of items that do not show a significant difference in item endorsement frequency between normative and clinical samples. Furthermore, MMPI-A basic and content scales generally show a much lower percentage of effective items than do the corresponding scales for the MMPI-2. We discuss the findings in relation to the frequent occurrence of low range MMPI-A profiles in clinical samples and the potential usefulness of these results in future efforts to develop viable short forms for the MMPI-A.     

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 MMPI-2 in Perú: a normative study

In this study, we compared a Peruvian normative group to the standard Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989b) U.S. normative sample. The MMPI-2 Hispanic Version was administered under standardized conditions to participants with a wide range of age, educational, occupational, and socioeconomic levels. Between the 2 samples, there was a high degree of similarity across most basic and supplementary scales. Elevations (Ts = 60-65) were found on Scale F for men and women and Scales Mf and MDS for women only. For both men and women, small elevations (Ts = 55-60) were found on several other scales. The differences were consistent with those found in other Latin American populations. The results of this study suggest that the adaptation of the MMPI-2 with the U.S. norms is appropriate for use in Perú.     

Validation of selected MMPI-2 basic and content scales

To investigate whether some of the MMPI-2 basic and/or content scales measure the factor structure represented by the Big-Five, 288 undergraduates (178 women and 110 men), between the ages of 18 and 34 years, were administered MMPI-2 and MARS (Michill Adjective Rating Scale) which measures four factors that are conceptually similar to the first four of the Big-Five. It was hypothesized that (a) three MMPI-2 scales (basicDepression or D, contentAnxiety or ANX, and contentDepression or DEP) would be correlated with MARSUnhappiness; (b) two MMPI-2 scales (basicSocial Introversion or Si and contentSocial Discomfort or SOD) would be correlated with MARSExtraversion; (c) two MMPI-2 scales (contentAnger or ANG and contentType A Behavior or TPA) would be correlated with MARSAssertiveness; and (d) two MMPI-2 scales (contentWork Interference or WRK and supplementaryDominance or DOM) would be correlated with MARSProductive Persistence. Results corroborated the hypothesized relationships between the components of the aforementioned four dyads.