Validation of a Theory-Driven Profile Interpretation of the Dutch Short Form of the MMPI Using the TAT Social Cognitions and Object Relations Scale (SCORS)

Sixty psychiatric inpatients were assigned to one of three groups on the basis of F and K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for help" validity profiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help"profiles were perceived as "acting out" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% of the seclusions in the patients sampled. Although the "plea for help"profile is considered invalid in some scoring systems, results suggest that this validity profile may be useful in treatment planning.     

Biofeedback, cognitive training and relaxation techniques as multimodal adjunct therapy for hospitalized adolescents: a pilot study

Modifications and adjuncts to traditional therapy techniques appear to be necessary for successfully treating hospitalized adolescents with impaired social and verbal skills, and a history of acting-out behavior. Modified therapy groups were combined with a structured biofeedback and cognitive training program to help these adolescents control anger and modify their behavior. Used in conjunction with training and practice in relaxation techniques, this multimodal treatment approach appeared to be helpful in both reducing incidents of acting out on residential units, and in reaching individualized therapeutic goals. The present paper describes use of this multimodal approach within selected residential settings, and outlines the structured materials developed by the authors.     

Personality organization as an aspect of back pain in a medical setting.

The MMPI profiles of 74 low back pain patients who had previously been classified as "functional,"organic," or "mixed" were sorted into six profile groups. The six profile groups were those used by Pichot, Perse, Lekous, Dureau, Perez, and Rychewaert (1972); denial, "conversion V" without defensiveness, "conversion V" with defensiveness, depressed/anxious, psychotic and normal. Results indicate that all six profile types are well represented in the low back pain group. Evidence is also presented which shows that each of the pathological MMPI profile types examined across "functional," "organic," and "mixed" classification is significantly more elevated than a normal profile group on two scales (Lb, DOR) designed to measure functional aspects of pain. Pathological MMPI profile groups did not differ significantly from each other on the "functional" pain scales. The data presented in this study point to the relationship of various forms of psychopathology with "functional pain." The findings of this study would not support a homogeneous "pain personality" for low back pain patients. However, combined "conversion V" profiles accounted for 58% of the "functional" group, 45% of the "mixed" group and 35% of the "organic" group.     

Development and Validation of a Dutch Translation of the Big Five Inventory (BFI)

The MMPI profiles of 74 low back pain patients who had previously been classified as "functional," "organic," or "mixed" were sorted into six profile groups. The six profile groups were those used by Pichot, Perse, Lekeous, Dureau, Perez, and Rychewaert (1972); denial, "conversion V" without defensiveness, "conversion V" with defensiveness, depressed/anxious, psychotic and normal. Results indicate that all six profile types are welt represented in the low back pain group. Evidence is also presented which shows that each of the pathological MMPI profile types examined across "functional," "organic," and "mixed" classification is significantly more elevated than a normal profile group on two scales (Lb, DOR) designed to measure functional aspects of pain. Pathological MMPI profile groups did not differ significantly from each other on the "functional," pain scales. The data presented in this study point to the relationship of various forms of psychopathology with "functional pain." The findings of this stud v would not support a homogeneous "pain personality" for low back pain patients. However, combined "conversion V" profiles accounted for 58% of the "functional" group, 45% of the "mixed" group and 35% of the "organic" group.     

Addictions and the Quest to Control the Object

Most patients come into psychoanalytic treatment engaged in some form of repetitive, destructive behavior that is an externalization or projection of their internal struggles. One form of this object relational acting-out is the addictions, be they to alcohol, gambling, drugs, sex, procrastination, or other variations. The patient's experience is a "must do-can't stop" one that leaves them both desperate and relieved. Patients come to us wanting help in refraining from these addictive patterns. Sometimes, they are attending a 12-step program or are in a day treatment recovery program but need additional assistance in remaining free from their addictive behaviors. Others seek out psychoanalytic treatment while still involved in their addiction, but wish to stop the behavior and build a more positive plan for their lives. This paper examines the deeper object relational issues that lie behind the addictive process. The transference is often colored by acting-out, by sadomasochistic dynamics, by projective identification, and by fantasies of persecution and loss. Case material is used to explore these specific problems as well as the patient's general difficulties with paranoid-schizoid and depressive functioning.     

Personality assessment in neuropsychology: the nonspecificity of MMPI-2 neurocorrection methods

Three established methods of neurocorrection claim to improve Minnesota Multiphasic Personality Inventory (MMPI)/MMPI-2 validity with closed-head injury (CHI) patients. These methods (which suggest removing "neurological" items from scoring) were employed here comparing 35 CHI patients with 35 psychiatric patients with elevated profiles. The 14-item correction changed 2-point codes for 41% of CHI and 31% of psychiatric profiles, the 30-item system changed 77% of CHI and 71% of psychiatric profiles, whereas the 37-item system changed 80% of CHI and 71% of psychiatric profiles. There were no significant differences between the two groups in number of profiles changed or number of neurocorrective items endorsed. Using each of the three correction systems, the following percentage of profiles remained elevated: 99%, 87%, and 89%, respectively.     

Reducing MMPI-2 defensiveness: the effect of specialized instructions on retest validity in a job applicant sample

The MMPI-2 is often used for screening job applicants when public safety or security are at risk. Inherent in such applications is concern for profile validity and test defensiveness. In this study, we examine the impact of revised instructions on profile validity for a group of job applicants who initially produced invalid profiles. Participants were 271 male applicants for airline pilot positions. Of these, 72 produced invalid defensive MMPI-2 profiles during preemployment screening. The MMPI-2 was readministered to these applicants with instructions informing them of validity scales and instructing them to respond in a more open, honest manner. Comparisons were made between valid and invalid profiles for initial administrations and between valid and invalid profiles at readministration. Some clinical scales were more elevated for valid, nondefensive profiles. Most content scales showed more elevation for valid profiles, and 12% of the applicants who were retested produced significant elevations (T>or=65) on the content scales. Profiles were similar to those produced by employed pilots of a previous study.     

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.     

Normal range MMPI-A profiles among psychiatric inpatients

The present study examined the base rates of normal range Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) profiles in an inpatient sample and examined the differences between adolescents with apparently valid normal range profiles (all clinical scale T-scores < 60) and those with elevated profiles on prior interventions, reported internalizing and externalizing symptoms, and MMPI-A validity scale scores and other indexes of underreporting. Normal range profiles cannot be adequately explained by a less pathological history prior to hospitalization or by defensiveness. Thirty percent of male and 25% of female adolescents produced valid MMPI-A profiles in which none of the clinical scales were elevated. Both male and female adolescents with normal range profiles were generally less likely to report internalizing symptoms than those with elevated profiles, but both groups report externalizing symptoms. Neither the standard MMPI-A validity scales nor additional validity scales discriminated between profile groups. Clinicians should not assume that normal range profiles indicate an absence of problems.     

Bender-Gestalt emotional indicators and acting-out behavior in young children.

This study was designed to investigate the relationship between 15 emotional indicators on the Bender-Gestalt Test and acting-out behavior in young children. The subjects were 93 children ranging in age from five to 12 years. Each was administered the Bender. A measure of each subject's overt acting-out behavior was then obtained by having teachers rate each student on a Behavioral Rating Scale. Subjects' records were then divided into groups on the basis of both sex and age. Results indicated that neither the total number of Bender indicators nor any of the individual Bender indicators were correlated significantly with total scores on the rating scale. Use of the Bender as a projective device to measure acting-out behavior was seriously questioned.     

Reducing MMPI-2 Defensiveness: The Effect of Specialized Instructions on Retest Validity in a Job Applicant Sample

The MMPI-2 is often used for screening job applicants when public safety or security are at risk. Inherent in such applications is concern for profile validity and test defensiveness. In this study, we examine the impact of revised instructions on profile validity for a group of job applicants who initially produced invalid profiles. Participants were 271 male applicants for airline pilot positions. Of these, 72 produced invalid defensive MMPI-2 profiles during preemployment screening. The MMPI-2 was readministered to these applicants with instructions informing them of validity scales and instructing them to respond in a more open, honest manner. Comparisons were made between valid and invalid profiles for initial administrations and between valid and invalid profiles at readministration. Some clinical scales were more elevated for valid, nondefensive profiles. Most content scales showed more elevation for valid profiles, and 12% of the applicants who were retested produced significant elevations on the content scales. Profiles were similar to those produced by employed pilots of a previous study.     

An approach to families of acting-out adolescents--a case study.

Certain types of acting-out in the adolescent express the feelings of deprivation of the parental pair in a maladaptive aggressive way. Family therapists have attempted to convert the acting-out behavioral disorders into an effective state, i.e., make the family aware of their feelings of deprivation by focusing on the aggressive component. In many instances, the family becomes depressed and then interrupts or terminates treatment. The authors feel that this is due to the therapist's interpretations which bring about the depressive state via guilt provocation. The family understands the interpretations as meaning "You are bad to have your adolescent offspring behave in such a way". The therapist is thus seen as the family's collective super-ego. In order to prevent premature termination, the therapist should instead help the members of the family to become more conscious of their loving, "welfare" feelings for one another. In this way the self-esteem of the family is increased, which then permits more verbal action of aggressive feelings--thus a decrease in the acting-out, and ultimately an increase in the capacity to mourn. It should be pointed out, however, that in certain families, the technique described is not applicable. In these cases, although there is acting-out, the families are unable to draw on sufficient good experiences together which are necessary to elicit positive feeling for one another. The absence of readily available "welfare" feelings is of diagnostic and prognostic significance and differentiates the disorganized, sociopathic or schizophrenic family from the acting-out of parental deprivation as illustrated in this paper.     

Long-term, non-specific spinal pain: reliable and valid subgroups of patients

The aim of this study was to identify reliable and valid subgroups of spinal pain patients, using data from the Swedish version of the Multidimensional Pain Inventory (MPI-S). A second aim was to test the generalisability of the three patient profiles described in earlier studies on the MPI ("adaptive coper", "dysfunctional" and "interpersonally distressed" patients). The study base consisted of two samples of individuals suffering from long-term, non-specific spinal pain and the results were validated across these samples. Cluster analysis was used to detect distinct groups of patients and the validity of these subgroups was evaluated on variables not used to generate the cluster solution. One subgroup was characterised by lower pain severity, lower interference with everyday activities, lower affective distress and higher life control than the other two subgroups. This patient profile was similar to the MPI adaptive coper patients. A second subgroup resembled the dysfunctional patient profile, thus displaying a worse adjustment to chronic pain than the AC patients. The third patient group reported significantly lower levels of social support from "significant others" than the other subgroups. This patient profile was similar to that of the interpersonally distressed patient group. Taken together, the results support the reliability, validity and generalisability of three subgroups of chronic pain patients derived from the MPI-S.     

Failed back surgeries and minnesota multiphasic personality inventory (MMPI) profiles

MMPI profiles were evaluated for 105 prospective surgical patients who had previously undergone surgery or other procedures for treatment of back pain. Patients were classified into groups having undergone zero, one, two, three, or four or more previous surgeries. While all groups demonstrated a characteristicsomatogenic profile, none of the MMPI validity or clinical scales significantly differentiated the groups and there was no relationship between increased number of surgeries and MMPI scale characteristics. These results support the nonoptimistic prognostication of thesomatogenic MMPI profile for surgical intervention for back pain but show no clear relationship of MMPI profile characteristics to degree of experience of previously failed surgery.     

Foreseeability and self-interest as moral judgment factors with normal and acting-out adolescent boys

Thirty-two male adolescents participated in a study of moral judgment and its relationship to social functioning. Half of the subjects were selected for frequent acting-out, aggressive behavior, and half were selected from regular eighth-grade classes and matched for intelligence. The moral stories featured good intentions with bad outcomes and varied as to whether or not the outcome was foreseeable and in the actor's self-interest. Subjects judged the actor, attributed judgments to adults, and casually explained the outcome. The difference in judgments between foreseeable and nonforeseeable actions was greater for “normal” subjects. Furthermore, although normal subjects judged foreseeable actions more harshly than acting-out subjects, the reverse was true for nonforeseeable actions. Judgments attributed to adults were harsher than subjects' own judgments, and this difference was greater for acting-out subjects. Causal attributions (personal vs. situational) and other reasoning related strongly to the foreseeability and self-interest factors but not to subject group.     

Exploratory behavior and developmental skill acquisition in infants with Down syndrome

Infants learn about objects by exploring them. Typically developing infants actively explore objects through visual, manual, and oral modalities. Attenuated exploratory behavior has been observed in various neurodevelopmental disorders, including Down syndrome (DS), presumably limiting learning options. However, a direct link between exploration and overall developmental functioning has not been characterized. This study used a Latent Profile Analysis framework to examine within-syndrome variability in exploratory behavior in infants with DS and the developmental correlates of different exploratory behavior profiles. Participants were 45 infants with DS (CA = 9.58 months; SD = 3.62) who completed an object exploration activity and the Bayley Scales of Infant Development-III (BSID-III; Bayley, 2006). Exploration behavior was coded for the percentage of time engaged in visual, manual, and oral exploration. Results indicated that a 2-profile solution provided the best model fit for exploratory behavior, yielding profiles that represented either an Active (57.78% of the sample) or a Passive Exploratory (42.22% of the sample) profile. The Active Exploratory profile was associated with significantly higher age equivalent scores on the BSID-III Cognitive, Communication, and Motor domains than the Passive Exploratory profile. Other factors, such as sex and biomedical risk factors, were not associated with exploratory profiles. These findings offer a more nuanced understanding of early within-syndrome heterogeneity in DS, and demonstrate that impoverished early exploratory behavior may serve as an important indicator of increased risk for more pronounced developmental delays in DS.     

Comparing three new MMPI-2 randomness indices in a novel procedure for random profile derivation

This study compared three new validity indices; /F-Fb/, VRIN+/F-Fb/, and F+Fb+/F-Fb/; to the F, back-F, and VRIN according to their effectiveness in detecting degrees of profile randomness. Participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer, 1989) according to standardized instructions. All profiles starting at Items 142, 284, or 426 were substituted with computer-generated random responses to produce 75%, 50%, and 25% random profiles, respectively. Twenty-five profiles were derived using 100% computer-generated items. Finally, one unaltered set of profiles was designated as 0% random. This generated five groups of MMPI-2 profiles, differing according to the degree of profile randomness (i.e., 0%, 25%, 50%, 75%, and 100%). Results showed that the F and /F-Fb/ indices were unable to distinguish authentic from all degrees of randomness, whereas the F+Fb+F-Fb scale could reliably distinguish all levels of randomness. The actuarial analysis found back-F and F+Fb+/F-Fb/ misclassified the least number of profiles, suggesting the latter index should be included in the evaluation of MMPI-2 profile randomness.     

Comparing Three New MMPI-2 Randomness Indices in a Novel Procedure for Random Profile Derivation

This study compared three new validity indices; |F-Fb|, VRIN+|F-Fb|, and F+Fb+|F-Fb|; to the F, back-F, and VRIN according to their effectiveness in detecting degrees of profile randomness. Participants completed the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer, 1989) according to standardized instructions. All profiles starting at Items 142, 284, or 426 were substituted with computer-generated random responses to produce 75%, 50%, and 25% random profiles, respectively. Twenty-five profiles were derived using 100% computer-generated items. Finally, one unaltered set of profiles was designated as 0% random. This generated five groups of MMPI-2 profiles, differing according to the degree of profile randomness (i.e., 0%, 25%, 50%, 75%, and 100%). Results showed that the F and |F-Fb| indices were unable to distinguish authentic from all degrees of randomness, whereas the F+Fb+F-Fb scale could reliably distinguish all levels of randomness. The actuarial analysis found back-F and F+Fb+|F-Fb| misclassified the least number of profiles, suggesting the latter index should be included in the evaluation of MMPI-2 profile randomness.     

Acting-out: its functions within analytic group psychotherapy and its transformation into dreams

In group processes, acting-out has diverse functions, all of them equally important. It has an intrapsychic, interpersonal, and group dynamic function. Not only may it be understood as a form of resistance, but also in its communicative and reparative potential. The authors investigate the thesis that acting-out also contains the seed for change, thus helping patients divest themselves of pathological behavior. Using a group process as an example, this article shows how boundaries can be drawn between past and present experiences while using the communicative and reparative functions of acting-out. Unconscious psychodynamics can then be transformed from acting-out into dreams.