Correspondence between MMPI PTSD measures and clinical diagnosis

Correspondence of the Minnesota Multiphasic Personality Inventory (MMPI) posttraumatic stress disorder (PTSD) subscale and the clinical scale decision rules reported by Keane, Malloy, and Fairbank (1984) with clinical diagnoses of PTSD was measured on a sample of 595 veterans. The measures demonstrated good sensitivity and selectivity, but the false-positive rate was high. It is suggested the MMPI measures be used to rule out, but not to establish, the diagnosis of PTSD. The construct validity of the PTSD subscale was supported by the finding of a higher mean score in combat than noncombat veterans.     

Correspondence Between MMPI PTSD Measures and Clinical Diagnosis

Correspondence of the Minnesota Multiphasic Personality Inventory (MMPI) posttraumatic stress disorder (PTSD) subscale and the clinical scale decision rules reported by Keane, Malloy, and Fairbank (1984) with clinical diagnoses of PTSD was measured on a sample of 595 veterans. The measures demonstrated good sensitivity and selectivity, but the false-positive rate was high. It is suggested the MMPI measures be used to rule out, but not to establish, the diagnosis of PTSD. The construct validity of the PTSD subscale was supported by the finding of a higher mean score in combat than noncombat veterans.     

MMPI Response-Set Characteristics Among Adolescents

This study examined the Minnesota Multiphasic Personality Inventory (MPPI) profile characteristics for five different response sets in adolescent populations employing adolescent MMPI norms. In general, findings for "all-true" and "all-false" adolescent profiles were highly similar in shape and elevation to those reported in the adult literature (Graham, 1977; Lachar, 1974), whereas random profiles on adolescent norms differed substantially from adult-norm random profiles in shape but not elevation. The characteristics of "fake good" or "fake bad" response sets were investigated by the use of adolescent subjects in two settings. Ninety-four public high-school students were administered the MMPI with standard and "fake bad" instructions, and 24 adolescents in inpatient psychiatric treatment were administered the MMPI under standard and "fake good" instructions. The MMPI profiles generated by special instructional sets were analyzed in relation to the subject's age, sex, race, and actual MMPI profile features. Findings indicated that although sex and race effects were evident in normal adolescents' attempts to simulate psychopathology on the MMPI, teenagers generally produce profiles containing grossly exaggerated symptom patterns that are relatively easy to detect as invalid. In contrast, it was found that a substantial number of psychiatrically disturbed adolescents may effectively simulate normal profiles and that effectiveness in these attempts was related to greater age and lower actual MMPI T-score values on the Hs and Hy scales.     

MMPI response-set characteristics among adolescents

This study examined the Minnesota Multiphasic Personality Inventory (MPPI) profile characteristics for five different response sets in adolescent populations employing adolescent MMPI norms. In general, findings for "all-true" and "all-false" adolescent profiles were highly similar in shape and elevation to those reported in the adult literature (Graham, 1977; Lachar, 1974), whereas random profiles on adolescent norms differed substantially from adult-norm random profiles in shape but not elevation. The characteristics of "fake good" or "fake bad" response sets were investigated by the use of adolescent subjects in two settings. Ninety-four public high-school students were administered the MMPI with standard and "fake bad" instructions, and 24 adolescents in inpatient psychiatric treatment were administered the MMPI under standard and "fake good" instructions. The MMPI profiles generated by special instructional sets were analyzed in relation to the subject's age, sex, race, and actual MMPI profile features. Findings indicated that although sex and race effects were evident in normal adolescents' attempts to simulate psychopathology on the MMPI, teenagers generally produce profiles containing grossly exaggerated symptom patterns that are relatively easy to detect as invalid. In contrast, it was found that a substantial number of psychiatrically disturbed adolescents may effectively simulate normal profiles and that effectiveness in these attempts was related to greater age and lower actual MMPI T-score values on the Hs and Hy scales.     

Parent and child MMPI responses: Characteristics among families with adolescents in inpatient and outpatient settings

The relationship of parent personality to child psychopathology has been investigated in numerous MMPI studies over the past three decades. Very few of these studies, however, have directly analyzed MMPI response patterns of both parents and offspring. The current study included the MMPI responses of 199 families with adolescents entering inpatient and outpatient psychiatric setting (N = 542). Inpatient parents and adolescents had significantly higher mean scores across a variety of MMPI scales than did their outpatient counterparts. The linear combination of adolescent and maternal MMPI scale data, in a stepwise discriminative function analysis, resulted in accurate classification of 75% of all children in inpatient treatment and 74% of all children assigned to outpatient treatment. Findings were discussed in terms of salient MMPI differences between inpatient and outpatient families and shared psychopathological characteristics among family members with offspring in psychiatric treatment settings.     

MMPI configural interpretation as applied to posttraumatic stress disorder in Vietnam veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

Subtle-obvious scales of the MMPI: indicators of profile validity in a psychiatric population.

This study explored the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI) Subtle-Obvious scales as profile validity indicators with a inpatient psychiatric population. Some 292 MMPI profiles were utilized and divided into overreporters, underreporters, and standard reporters, based on their Subtle-Obvious scale scores. Reporting style was shown to be unrelated to actual patient pathology because of the lack of relationship between reporting style and diagnostic categorization according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) Axis I and II. Comparisons of MMPI profiles of the three groups revealed that overreporters endorsed more pathology on the MMPI clinical scales than did either underreporters or standard reporters. The same pattern of response style was demonstrated by subjects on another objective measure, the Beck Depression Inventory, whereas on a projective measure, the Rorschach Inkblot Test, there were no differences between groups. These findings suggest that clinicians may want to utilize the Subtle-Obvious scales to gain information about MMPI profile validity. Specifically, profiles of patients identified as overreporters should be interpreted with caution so as to not overstate their level of pathology.     

Subtle-Obvious Scales of the MMPI: Indicators of Profile Validity in a Psychiatric Population

This study explored the usefulness of the Minnesota Multiphasic Personality Inventory (MMPI) Subtle-Obvious scales as profile validity indicators with a inpatient psychiatric population. Some 292 MMPI profiles were utilized and divided into overreporters, underreporters, and standard reporters, based on their Subtle-Obvious scale scores. Reporting style was shown to be unrelated to actual patient pathology because of the lack of relationship between reporting style and diagnostic categorization according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, I987) Axis I and II. Comparisons of MMPI profiles of the three groups revealed that overreporters endorsed more pathology on the MMPI clinical scales than did either underreporters or standard reporters. The same pattern of response style was demonstrated by subjects on another objective measure, the Beck Depression Inventory, whereas on a projective measure, the Rorschach Inkblot Test, there were no differences between groups. These findings suggest that clinicians may want to utilize the Subtle-Obvious scales to gain information about MMPI profile validity. Specifically, profiles of patients identified as overreporters should be interpreted with caution so as to not overstate their level of pathology.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

MMPI Configural Interpretation as Applied to Posttraumatic Stress Disorder in Vietnam Veterans

This study investigated the systems of Minnesota Multiphasic Personality Inventory (MMPI) configural interpretation of Skinner and Jackson (1978) and Kunce (1979) with Vietnam veterans with posttraumatic stress disorder (PTSD). MMPI profiles of four groups differing in combat exposure were compared on four MMPI configural variables from Kunce (1979) and Skinner and Jackson (1978). The four groups were (a) PTSD sufferers, (b) Vietnam combat veterans without PTSD, (c) Vietnam noncombat veterans, and (d) Vietnam era veterans. All groups were further divided into hospitalized versus nonhospitalized subgroups. Dependent variables were Skinner and Jackson's (a) sociopathic modal profile, (b) neurotic profile, (c) psychotic profile, and (d) Kunce's emotional expression (enthusiastic-reserved) dimension. Results indicated that hospitalized PTSD subjects had significantly higher scores on Skinner and Jackson's neurotic profile; both hospitalized and nonhospitalized PTSD subjects had higher scores on the psychotic profile and were more "reserved" on Kunce's emotional expression dimension. Results were interpreted in terms of configural MMPI interpretation systems and the adjustment of Vietnam veterans with PTSD. PTSD was viewed as exhibiting cognitive, somatic, and affective features.     

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.     

A Review of MMPI and Rorschach interrelationships in adult samples

The MMPI and Rorschach are consistently ranked among the most widely used psychological assessment instruments across adolescent and adult clinical settings. Although there is an extensive research literature available on each instrument individually, relatively little research attention has been focused on the interrelationships between these measures. This article reviews the literature derived from 37 studies that have reported interrelationships between MMPI and Rorschach variables in adult populations. The results of these studies generally indicate limited or minimal relationships between the MMPI and Rorschach. A number of methodological issues, however, prevent drawing firm conclusions from the literature at this time. Directions for future research are discussed, including consideration of issues related to sources of alpha and beta error and the need for studies examining the incremental validity of combinations of Rorschach and MMPI data in prediction to relevant external criteria.     

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.     

Pain-related correlates of MMPI profile subgroups among back pain patients

The MMPI profiles of 96 male and 218 female patients attending a back pain clinic in a private university-affiliated, orthopedic hospital were analyzed by a hierarchical clustering procedure. The clustering procedure produced four male and four female profile subgroups. The subgroups were compared with one another on the basis of patients' responses to the Cornell Medical Index and revised McGill Pain Assessment Questionnaire. Within the male and female patient cohorts it was found that profile subgroups featuring elevated clinical scales showed greater disruptions of daily activities than did subgroups with relatively unelevated profiles. However, profile subgroups with elevations primarily on the neurotic triad scales reported greater affective disturbance and disruption of daily activities than did subgroups with elevations on both the neurotic triad and relatively psychotic scales. In addition, profile subgroups with subclinical elevations on the neurotic triad scales appeared to have adjusted to their pain experience more poorly than did subgroups that featured scores on nearly all clinical scales that were within one standard deviation of the mean. Suggestions are provided for the use of the MMPI in assessing chronic pain patients and future research regarding cluster analyses of patients' MMPI profiles.     

Adapting Cognitive Processing Therapy for PTSD for People With Disabilities: A Case Study With a U.S. Veteran

Many veterans receiving treatment for PTSD in the VA health care system are also living with a disability and utilize assistive technologies for communication and/or mobility. While evidence-based treatments for PTSD have been disseminated in VA hospitals nationwide, clinicians may have concerns about implementing these treatments with people with disabilities or question how to adapt evidence-based protocols to facilitate successful outcomes. This clinical case study details the treatment of a 48-year-old male U.S. veteran with a diagnosis of military-related PTSD and significant functional and communicative complexities characteristic of locked-in syndrome. The study implemented an adapted protocol of Cognitive Processing Therapy (CPT), a first-line evidence-based psychotherapy for PTSD with unknown application to people with disabilities. CPT protocol structure, length, and delivery was adapted to accommodate the veteran’s assistive devices and functional abilities. The veteran experienced a clinically significant reduction in PTSD symptoms over the course of treatment, suggesting successful application of the adapted protocol. In addition to symptom reduction, the veteran reported advances in his ability to tolerate emotional distress while engaged in goal-directed behavior and improved interpersonal functioning. Results suggest that CPT can be adapted and effective in instances where the presence of disability and multiple assistive technologies impact standard treatment implementation. This information is valuable in its potential ability to make evidence-based psychotherapies more accessible and disability-sensitive. Clinical recommendations for using and adapting CPT for people with disabilities are provided.     

Intensive,Multi-Couple Group Therapy for PTSD: A Nonrandomized Pilot Study With Military and Veteran Dyads

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder (CBCT for PTSD; Monson & Fredman, 2012) is efficacious in improving PTSD symptoms and relationship adjustment among couples with PTSD. However, there is a need for more efficient delivery formats to maximize engagement and retention and to achieve faster outcomes in multiple domains. This nonrandomized trial was designed to pilot an abbreviated, intensive, multi-couple group version of CBCT for PTSD (AIM-CBCT for PTSD) delivered over a single weekend for 24 couples that included an active-duty service member or veteran with PTSD who had deployed in support of combat operations following September 11, 2001. All couples completed treatment. Assessments conducted by clinical evaluators 1 and 3 months after the intervention revealed significant reductions in clinician-rated PTSD symptoms (ds = -0.77 and -0.98, respectively) and in patients’ self-reported symptoms of PTSD (ds = -0.73 and -1.17, respectively), depression (ds = -0.60 and -0.75, respectively), anxiety (ds = -0.63 and -0.73, respectively), and anger (ds = -0.45 and -0.60, respectively), relative to baseline. By 3-month follow-up, partners reported significant reductions in patients’ PTSD symptoms (d = -0.56), as well as significant improvements in their own depressive symptoms (d = -0.47), anxiety (d = -0.60), and relationship satisfaction (d = 0.53), relative to baseline. Delivering CBCT for PTSD through an abbreviated, intensive multi-couple group format may be an efficient strategy for improving patient, partner, and relational well-being in military and veteran couples with PTSD.     

Correspondence of the MMPI and MMPI-168 among incarcerated female felons

This study was designed to assess the correspondence between the MMPI and MMPI-168 for a sample of adult incarcerated female felons. The results indicated a high degree of agreement, median correlation of .79, between corresponding validity and clinical scales of the MMPI-168 and the full MMPI. The MMPI-168 significantly overestimated scales L, F, and D, while it underestimated scales K, Hy, Pd, and Mf. Configural correspondence between the two instruments in terms of profile high points was somewhat less than has been reported for psychiatric populations. However, the MMPI-168 appeared to be a useful short screening instrument for incarcerated female felons with respect to accurate assessment of profile validity, configural correspondence to the full MMPI, and correlations between corresponding scales. Its utility in these respects far exceeds prior attempts to employ the Mini-Mult with a similar sample of incarcerated females.