Type D Personality and Chronic Pain: Construct and Concurrent Validity of the DS14

A body of research has demonstrated that the Type D personality is a risk factor among cardiac patients. Previous studies validating the Type D Scale (DS14) across other clinical groups have not included chronic pain patients in their samples. The purpose of this study was to investigate the construct and concurrent validity of the DS14 using the MMPI-2. The DS14 and its two component subscales demonstrated strong internal consistency among chronic pain patients. The two subscales of the DS14 were found to be related to similar clinical scales on the MMPI-2, and significant differences were found in the MMPI-2 profiles of individuals with and without the Type D personality. Considerations for clinical practice and research are discussed.     

Comparative validity of the MMPI-2 Wiener-Harmon subtle-obvious scales in male prison inmates

The Wiener-Harmon subtle-obvious MMPI subscales (Wiener, 1948; Wiener & Harmon, 1946) have been the subject of considerable debate. In this study, we examined the intercorrelations among full clinical scale T scores and their subtle and obvious subscales in an offender population. Low subtle to full-scale correlations were observed, suggesting that these items contribute little to full-scale scores. Further, we explored the criterion validity of the MMPI-2 subtle-obvious scales in this forensic sample. The results demonstrated that the obvious scales of the MMPI-2 had greater criterion validity than the subtle scales when compared to crime history data. Scores on the subtle subscales were unrelated to crime history. The Ma-O subscale demonstrated the strongest association to crime history data. The findings from this study add to a mounting body of evidence indicating that when respondents are in a position to understand item content, and can therefore provide a direct self-appraisal, responses are most predictive of clinical criteria.     

Personality and aging: a study of the MMPI-2 among older men

We examined whether separate norms for older men are necessary for the revised Minnesota Multiphasic Personality Inventory (MMPI-2). Scores from 1,459 men in the Normative Aging Study (NAS) (age: M = 61.27, SD = 8.37) were contrasted with those from 1,138 men from the MMPI Restandardization Study (age: M = 41.71, SD = 15.32). Results showed that scores on the MMPI-2 validity, clinical, and content scales for the NAS men were highly similar to those from the MMPI-2 Restandardization sample. There were also few differences between the two groups at the item level. Within-sample analyses revealed some differences between age groups. However, the magnitudes of these differences were small and may represent the single or combined effects of cohort factors and age-related changes in physical health status rather than age-related changes in psychopathology per se. We concluded that special, age-related norms for the MMPI-2 are not needed for older men.     

An examination of the MMPI-2 Wiener-Harmon Subtle subscales for D and Hy: implications for parent scale and neurotic triad interpretation

This research explores the scale development process for the MMPI-2 Wiener and Harmon (1946) Subtle subscales for Depression (D) and Hysteria (Hy) to provide insight into why certain items were included on these scales and were subsequently but inappropriately assumed to be subtle indicators of the same pathology that the Obvious items measure. In this research, I also explore what the Subtle scales on D and Hy measure and their potential utility for the interpretation of their parent scales and the "neurotic triad." It was hypothesized that the D and Hy Subtle subscales are related to denial, repression, or both and this hypothesis was supported. In a sample of 1,240 inpatient and outpatient psychiatric patients at a large Army medical center, it was found that these subscales had strong positive correlations with othe scales on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom. Graham, Tellegen, & Kaemmer, 1989) related to denial, repression, or both. It was also found that they had strong negative correlations with scales on the MMPI-2 and Millon Clinical Multiaxial Inventory (MCMI-II; Millon, 1987) that are related to symptom endorsement, which can be considered the opposite of denial or repression. In addition, ratings of the Subtle items on D and Hy by clinical psychology residents were consistent with the hypothesis that these items reflect a denial of psychological or physical dysfunction.     

Classification accuracy of MMPI-2 validity scales in the detection of pain-related malingering: a known-groups study

The purpose of this study was to determine the accuracy of Minnesota Multiphasic Personality Inventory 2nd edition (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity indicators in the detection of malingering in clinical patients with chronic pain using a hybrid clinical-known groups/simulator design. The sample consisted of patients without financial incentive (n = 23), nonmalingering patients with financial incentive (n = 34), patients definitively determined to be malingering based on published criteria ( n = 32), and college students asked to simulate pain-related disability (n = 26). The MMPI-2 validity scales differentiated malingerers from nonmalingerers with a high degree of accuracy. Hypochondriasis and Hysteria were also effective. For all variables except Scale L, more extreme scores were associated with higher specificity. This study demonstrates that the MMPI-2 is capable of differentiating intentional exaggeration from the effects on symptom report of chronic pain, genuine psychological disturbance, and concurrent stress associated with pursuing a claim in a medico-legal context.     

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.     

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.     

MMPI-2 characteristics in a chronic pain population

This study investigated the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) characteristics of 209 chronic pain patients in an inpatient pain treatment program. Patients completed the MMPI-2, Zung Self-Rating Depression Scale, and Oswestry Low Back Pain Disability Questionnaire. Participants in this sample were matched with comparison participants from the MMPI-2 normative sample on the demographic variables gender, age, and ethnicity. Chronic pain patients reported higher levels of general maladjustment and affective distress than did the normative control group, including more anxiety, depressive symptomatology, and somatic complaints. The MMPI-2 basic scales Hypochondriasis, Depression, and Hysteria were the most useful discriminating factors between chronic pain patients and normal controls, and the content scales Health Concerns and Depression showed significant elevations for the chronic pain group. The 1-3/3-1, 1-2/2-1, and 2-3/3-2 code types accounted for more than two thirds of all two-point classifications for the chronic pain group, and four cluster analysis types classified nearly half of all of these protocols.     

Repression predicts outcome following multidisciplinary treatment of chronic pain.

This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS x Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs.     

Detection of overreported psychopathology with the MMPI-2-RF [corrected] validity scales

We examined the utility of the validity scales on the recently released Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF; Ben-Porath & Tellegen, 2008) to detect overreported psychopathology. This set of validity scales includes a newly developed scale and revised versions of the original MMPI-2 validity scales. We used an analogue, experimental simulation in which MMPI-2 RF responses (derived from archived MMPI-2 protocols) of undergraduate students instructed to overreport psychopathology (in either a coached or noncoached condition) were compared with those of psychiatric inpatients who completed the MMPI-2 under standardized instructions. The MMPI-2 RF validity scale Infrequent Psychopathology Responses best differentiated the simulation groups from the sample of patients, regardless of experimental condition. No other validity scale added consistent incremental predictive utility to Infrequent Psychopathology Responses in distinguishing the simulation groups from the sample of patients. Classification accuracy statistics confirmed the recommended cut scores in the MMPI-2 RF manual (Ben-Porath & Tellegen, 2008).     

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.     

An ethnocultural study of posttraumatic stress disorder in African-American and white American Vietnam War veterans

This study examined the intensity of Posttraumatic Stress Disorder (PTSD) symptoms as measured by the Mississippi Scale, the Keane (PK), and the PTSD (PS) Scales of the MMPI-2 in a sample of 34 African-American and 34 White American Vietnam War Veterans who sought treatment in a Specialized Inpatient PTSD Unit. The scores of the two groups on the Beck Depression Inventory and the clinical scales of the MMPI-2 were also compared. The ethnoculturally different sample was matched on intensity of combat exposure, marital status, employment status, age, and education. No significant differences on the measures of PTSD symptoms were noted and no significant differences were found on the Beck scale or the MMPI-2 clinical scales.     

General Newsletter

Low scores often have been ignored in validity research on the MMPI, yet these statistically significant deviations from the norm may be valuable sources of information and occur frequently enough to merit further investigation. The meaning of low scores on the MMPI-2 was examined for 822 male-female partner pairs in the MMPI-2 restandardization sample. Subjects were divided by MMPI-2 scale scores into high-, medium-, and low-score groups. Analyses of variance were performed with score level as the independent variable and partner ratings as dependent variables. Significant differences were found between the low- and medium-score groups with low scorers rated as better adjusted than medium scorers. More significant differences were found between the high-score and medium-score groups than between the low-score and medium-score groups; this suggested that high scores on MMPI-2 clinical scales are associated with poorer adjustment.     

Utility of the Deceptive-Subtle Items in the Detection of Malingering

The aim of this study was to assess the capacity of a recently developed set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) subtle items-the Deceptive-Subtle scale (DS)-to detect fake-bad responding on the MMPI-2, relative to the capacity of the F scale and the sum of obvious items (Ob) and sum of subtle items (Su) scales. The MMPI-2 was administered to a sample of research participants asked to fake-bad (n = 74), and compared to psychiatric outpatients (n = 100) and nonclinical participants (n = 100) asked to respond honestly. Although the DS scale proved to be a better predictor of fake-bad response style than Su, and comparable to that of Ob, its predictive capacity was substantially less than that of F. Future research is needed to explore the potentially unique contribution of both DS and Ob to assess different strategies of faking-bad.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the screening instruments, the National Guard soldiers who produced a valid MMPI-2 RF were classified into four groups: 21 soldiers who screened positive for PTSD only, 33 soldiers who screened positive for mTBI only, 9 soldiers who screened positive for both conditions, and 166 soldiers who did not screen positive for either condition. Results showed that the MMPI-2 RF was able to differentiate across the groups with the MMPI-2 RF specific problem scale Anxiety adding incrementally to MMPI-2 Restructured Clinical scales in predicting PTSD. Both MMPI-2 RC1 (Somatic Complaints) and MMPI-2 RF head pain complaints predicted mTBI screen but did not add incrementally to each other. Of note, all of the MMPI-2 RF validity scales associated with overreporting, including Symptom Validity-Revised (FBS-r), were not significantly elevated in the mTBI group. These findings support the use of the MMPI-2 RF in assessing PTSD in non-treatment-seeking veterans. This further suggests that a positive screen for mTBI alone is not associated with significant emotional disturbance.     

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.     

Presurgical MMPI-2 Cluster Profiles Predict 1-Year Low-Back Surgery Outcomes

The primary purpose of this study was to examine whether empirically derived cluster profiles based on scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) predicted outcomes of surgery at 1 year for patients with low-back pain. On the basis of hierarchical cluster analysis of presurgery MMPI-2 scores for 60 patients, three interpretable and significant subgroups were formed. These consisted of a pathological/neurotic type, a double V-code type, and a normal type. The patents in the normal type were significantly more likely to report beneficial outcomes of surgery in terms of disability and pain than those in the other 2 types. These findings extend previous research and suggest (1) low-back surgery candidates are heterogeneous in their psychological profiles, and (2) MMPI-2 profiles are predictive of low-back surgery outcome. Future research should focus on identifying physiological substrates for these distinct profiles and investigating the effectiveness of presurgical psychological interventions based on profile type.     

MMPI-2 fake-bad scales: an attempted cross-validation of proposed cutting scores for outpatients

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) results were compared in 118 psychiatric outpatients given standard instructions, instructions to exaggerate their problems, instructions to feign a disorder they did not have, or instructions to feign global psychological disturbance. The groups were comparable on demographic, occupational and diagnostic characteristics as well as intake MMPI-2 results. Experimental MMPI-2 results showed that clinical scales were generally elevated in the feigning groups, with only modest differences across dissimulating instruction sets. The feigning groups had reliably higher scores than controls on all overreporting indexes examined, although no significant differences between feigning groups were present for overreporting indexes. Classification rates using previously proposed cutting scores for outpatients on individual feigning indexes showed near perfect specificity, but low to at best moderate sensitivity. Multiple regression analyses indicated that Gough's (1954) Dissimulation Scale (Ds2) was most strongly related to feigning status, and no other feigning scale contributed a significant increment in predictive power once Ds2 was entered.     

Racial identity and the MMPI in African American male college students

The relation of the Minnesota Multiphasic Personality Inventory (MMPI) to the Racial Identity Attitude Scale--Black, Short Form (RIAS-B) was examined among 50 African American male college students in a reanalysis of unpublished MMPI data described in R. H. Dana (1993). This permitted study of relationships between MMPI scores and specific psychological variables hypothesized to produce cultural differences among African Americans. Results indicated RIAS-B scale scores functioned as predictors of MMPI scale scores. Similar research with the MMPI-2 incorporating larger samples that more adequately represent African American heterogeneity is needed. Methodological implications of these findings for MMPI-2 research with ethnic and racial groups are discussed, emphasizing the importance of research to depathologize African American racial and cultural identity.