Factor Structure of the MCMI Basic Personality Scales and Common-Item Artifact

The eight basic personality scales of the Millon Clinical Multiaxial inventory (MCMI) were derived from Millon's theory of personality, but the adequacy of the MCMI for measuring Millon's personality constructs has never been assessed. One major problem with using factor analysis to illuminate the structure of the MCMI personality scales is that artifactual structure may result from item overlap among the scales. To analyze this, item-overlap coefficients were factored and compared to the factor structures of five subject samples. For the eight basic personality scales, three factors emerged for the overlap matrix and each of the five sample matrices: Aloof-Social, Aggressive-Submissive, and Lability-Restraint. It was concluded that these three factors are inconsistent with Millon's theory and that they will be found artifactually across a wide variety of populations due to overlapping items.     

The Bender Visual Motor Gestalt Test as an Index of Emotional Disturbance in Children

Millon (1985) presented eight criticisms of the article by Widiger, Williams, Spitzer, and Frances (1985) on the MCMI as a measure of DSM-III. This article is a brief rejoinder. The major point we wish to make is that one should be cautious in interpreting the MCMI as a measure of DSM-III disorders because there has not yet been any research published on the relationship between the MCMI and DSM-III. We believe this position has not been refuted by Millon's critique.     

International Adaptations of the Millon Clinical Multiaxial Inventory: Construct Validity and Clinical Applications

This article examines the influence of the Millon Clinical Multiaxial Inventory (MCMI) as a clinical and research instrument beyond the borders of the United States. The MCMI's theoretical and empirical grounding, its alignment with the Diagnostic and Statistical Manual of Mental Disorders (DSM), and scales that can be interpreted both categorically and dimensionally, are the primary features that make the test attractive. We begin with studies that evaluated the construct equivalence of the different language adaptations. Data from the most widely researched non English-language forms (Danish, Dutch, and Spanish) show excellent comparability with Millon's original. Nevertheless, significant problems were noted in efforts to create clinical groups that would allow for equivalence of diagnostic accuracy when using the cutoff scores. Although dimensional aspects of the scale scores were not affected by this, the adapted measures might show attenuated diagnostic accuracy compared with Millon's original. Next, we present MCMI studies conducted in clinical settings to document where the adapted tests have made their greatest impact in the international literature. A wide variety of clinical applications demonstrated broad utility, and given the high number of issues addressed, we think Millon's influence will certainly stand the test of time in different domains and settings.     

Contributions of Discriminant Analysis to Differential Diagnosis by Self-Report

We used discriminant function analyses of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1983), Millon Clinical Multiaxial inventory (MCMI; Milton, 1983), MCMI-II (Millon, 1987), and Symptom Checklist Ninety-Revised (SCL-90-R; Derogatis, 1983) profiles from a heterogenous group of 272 psychiatric inpatients to classify patients as depressed, manic, and/or psychotic, Most functions generated from these tests significantly discriminated depressed, manic (not MCMI-II), and psychotic (not MCMI) subjects from psychiatric controls. However. there was little improvement in diagnostic efficiency over the use of single scale elevations at specified cut scores. Functions derived from the MCMI for mania and the MCMI-II for psychosis show the most promise but require replication. The difficulty of using group profile differences for the diagnosis of individual psychiatric patients is discussed.     

The Relationship Between MCMI Subtlety and Severity

Wierzbicki (Wierzbicki & Daleiden, 1993; Wierzbicki & Howard, 1992) has suggested that the Subtle-Obvious distinction may be useful for detecting faking on the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). This study examined Schretlen's (1990) criticism that, on the MMPI, subtlety is confounded with severity. Nine clinical psychology graduate students rated MCMI items for severity. Severity was significantly correlated (r = -.48) with item subtlety. However, this association was lower than that reported by Schretlen on the MMPI.     

Evolution of the Millon Clinical Multiaxial Inventory

Dr. Theodore Millon (1928–2014) was a primary architect for the personality disorders in the DSM–III, a structure that has endured into the DSM–5. His 1969 book, Modern Psychopathology, created an elegant framework into which the well-known personality prototypes could be fitted and understood. His theoretical work soon led into the creation of several psychological inventories, most notably the Millon Clinical Multiaxial Inventory (MCMI). The MCMI, now in preparation for its 4th major edition, has been a very popular instrument among clinicians. This article explores the history of the MCMI's development from its origins, through 2 distinct theoretical phases, and to its current status as the MCMI–IV is finalized.     

Development and Validation of an Adjective Check List to Assess the Millon Personality Types in a Normal Population

A 405-item experimental Personality Adjective Check List (PACL) was refined into a 153-item form to assess the personality types outlined by Millon (1969, 1981) in a normal population. Scale construction and validation followed a method outlined by Loevinger (1957, 1972). Nine scales were developed based on the responses of 459 men and women, one for each of Milton's eight basic personalities plus an Experimental scale measuring aspects of his three more severe types. Extensive reliability and validity analyses were conducted involving over 2,200 men and women from across the United States, including a factor analysis of scales. These revealed good internal consistency for each scale, good test-retest reliability over a 3-month period, adequate factor structure, and good convergent and discriminant validity based on self-report data. Results indicated that Millon's basic types exist in normal form much as they are postulated to exist as disorders. Research efforts focusing on Millon's theory as it applies to normals may bring a more complete understanding of the entire spectrum of personality.     

The MCMI-III: present and future directions

Both the original Millon Clinical Multiaxial Inventory (MCMI-I; Millon, 1977) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) were refined and strengthened on a regular basis by both theoretic logic and research data. This aspiration has continued. The new Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) has been further coordinated with the most recent official diagnostic schema, the Diagnostic and Statistical Manual of Mental Disorders (4th ed., [DSM-IV]; American Psychiatric Association [APA], 1994) in an even more explicit way than before. Although the publication of the first version of the MCMI preceded the publication of the DSM-IV, its author played a major role in formulating the official manual's personality disorders, contributing thereby to their conceptual correspondence. The DSM-III-R (APA, 1987) was subsequently published in the same year as the MCMI-II; the inventory was modified in its final stages to make it as consonant as possible with the conceptual changes introduced in the then forthcoming official classification. The present version of the MCMI, the MCMI-III, strengthens these correspondences further by drawing on many of the diagnostic criteria of the DSM-IV to serve as the basis for drafting the inventory's items. This article reports on a select set of theoretical and empirical developments that are being carefully weighed for possible inclusion in future MCMIs, or as a guide in the refinement process of future MCMIs.     

Exploring the psychometric properties and construct validity of the MCMI-III anxiety and avoidant personality scales

The Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983) is a commonly used self-report instrument designed to aid in the assessment of Axis I and Axis II disorders. Concerns have been expressed regarding the procedures used in the normative research for the current version of the MCMI (MCMI-III; Millon, 1994) leading to a call for additional validity research on the MCMI-III (Retzlaff, 1996). In this study, we investigated the psychometric properties of the MCMI-III's Anxiety and Avoidant personality scales in a sample of patients diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) anxiety disorders. Our results suggest that the MCMI-III Avoidant scale is reliable (r =.89) and it was found to demonstrate appropriate convergent and divergent validity with other self-report measures. The MCMI-III Anxiety scale also showed adequate reliability (r =.78); however, our findings raise some concerns about the discriminant validity of this scale. A scale composed of the MCMI-III core anxiety items was found to have better discriminant validity. These findings are consistent with those reported by other researchers regarding the relationship between self-report measures of anxiety, avoidance, and depression. We conclude that the MCMI-III measures of anxiety and avoidance are consistent with other measures of these constructs and may provide valuable clinical information in this regard.     

Effects of Theodore Millon's Teaching,Mentorship, Theory,and Scientific Contributions on Health Psychology and Behavioral Medicine Research and Practice

This article summarizes the impact of Theodore Millon's work on the disciplines of health psychology and behavioral medicine over the past 5 decades spanning from the late 1960s to present. The article is written from my perspectives as a graduate student mentored by Millon on through my faculty career as a collaborator in test construction and empirical validation research. Several of the most recent entries in this summary reflect projects that were ongoing at the time of his passing, revealing the innovation and visionary spirit that he demonstrated up until the end of his life. Considering that this summary is restricted to Millon's contributions to the disciplines of health psychology and behavioral medicine, this work comprises only a small portion of his larger contribution to the field of psychology and the areas of personality theory and psychological assessment more broadly.     

Theodore Millon's Contributions to Conceptualizing Personality Disorders

We review Theodore Millon's contributions to conceptualizing personality disorders in contemporary clinical science and practice. Millon worked tirelessly across professional domains and theoretical orientations, developing a rich integrative theory of personality and its pathology, directly and indirectly impacting the evolving iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III through DSM–5), and advocating for the personality disorders through his contributions to cofounding the International Society for the Study of Personality Disorders and the Journal of Personality Disorders. We conclude with a closer look at Millon's final major contributions to conceptualizing personality disorders as well as the strengths and limitations of his approach.     

The MCMI as a measure of DSM-III

The Millon Clinical Multiaxial Inventory (MCMI) has been interpreted as a measure of DSM-III disorders. However, the MCMI was constructed and validated primarily as a measure of Millon's (1969, 1981) taxonomy, not DSM-III. Comparison of the two taxonomies and examination of the MCMI's content validity for two of the MCMI scales indicate only a partial congruence between the Millon and DSM-III taxonomies. There has been no published empirical research concerning the relationship between the MCMI and DSM-III, and the derivation and cross-validation research for the MCMI scales employed Millon's taxonomy and not DSM-III. It is suggested that until such data have been presented one should be cautious in one's interpretation of the MCMI as a measure of DSM-III disorders.     

The relationship between MCMI subtlety and severity

Wierzbicki (Wierzbicki & Daleiden, 1993; Wierzbicki & Howard, 1992) has suggested that the Subtle-Obvious distinction may be useful for detecting faking on the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). This study examined Schretlen's (1990) criticism that, on the MMPI, subtlety is confounded with severity. Nine clinical psychology graduate students rated MCMI items for severity. Severity was significantly correlated (r = -.48) with item subtlety. However, this association was lower than that reported by Schretlen on the MMPI.     

The Validity of the PAT in the Selection of Tabulating Machine Operators: An Analysis of Predictive Power

For the past 4 decades Theodore Millon has provided the field with a series of articles and books that illustrate his unprecedented effort to build a unified science of personology and psychopathology. Especially significant is the nonreductionist synthesis of personology with universal principles grounded in the concept of evolution. His theoretically derived personality disorder prototypes are most unusual in that they correspond in almost all regards to the official Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axis II classification schema. In this article, I summarize major elements of Millon's model, past and present, including the personality disorder types and stages of personality development. Perhaps best known to the readers of Journal of Personality Assessment is his publication of several objective diagnostic instruments (e.g., Millon Clinical Multiaxial Inventory-III; Millon, Millon, &; Davis, 1994; Millon Adolescent Clinical Inventory; Millon, Millon, &; Davis, 1993). Most recent is the construction of a clinician-rated checklist (Millon Personality Disorder Checklist; Millon, 1997) of structural and functional forms of psychic pathology. I touch on these measures as well as his very recent framework of personality-guided, synergistic treatment for both Axis I syndromes and Axis II disorders.     

Three Approaches to Interpersonal Behavior and Their Common Factors

This study examined the factor dimensions common to three different approaches to interpersonal behavior- the interpersonal circle, Millon's theory of personality, and a factor analytic (FA) approach. These were compared with the Norman (1963) "Big Five" factors. Measures employed were the revised Wiggins (1979) Interpersonal Adjective Scales, Strack's Personality Adjective Check List (1990), and the short form of the Lorr (1986) Interpersonal Style Inventory. Subjects were 146 college students (83 men and 63 women). A principal components analysis with varimax rotation revealed four distinct factors, based on a scree test, that accounted for 55.4% of the variance: Dominance-Submission, Extraversion-Introversion, Conscientiousness, and Agreeable-Disagreeable. Each of the models measured the circumplex axes of dominance and affiliation, but only the Millon (1969/1983) and FA approaches measured more than these elements, with the FA paradigm most sufficiently addressing all four. Dominance-Submission, the largest factor, was not explicit in the Big Five. Results suggest that earlier studies isolating five factors of personality may not have adequately represented this dimension.     

Accepting Fallibility: A Model for Personal Responsibility for Nonegregious Ethics Infractions

The profession's ethics standards require counselors to self‐monitor their professional actions and take responsibility for misconduct. However, the professional literature has focused on preventing misconduct and on response to serious violations and has offered little guidance regarding the minor infractions that all professionals are vulnerable to committing during their careers. The author presents a 4‐element model to guide counselors in ethically repairing damage when they recognize they have violated ethics codes or ethical principles in minor ways. The model uses the ethical principles that underlie the American Counseling Association's (1995) Code of Ethics and Standards of Practice and J. R. Rest's (1983, 1994) model of moral behavior as a foundation.     

Effects of client presenting syndromes on client and therapist dominance and affiliation during early sessions of Rational-Emotive psychotherapy

This is a study of effects of presenting clinical status on interpersonal presentation during early Rational-Emotive therapy (RET). Independent variables were intake scores for clients from the axis I scales of the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983). Dependent variables, from audiotapes of sessions at the Institute for RET (IRET), were Revised Interpersonal Adjective Scale (IAS-R; Wiggins, Trapnell and Phillips, 1988) ratings of clients and therapists. MCMI scales associated with stimulation seeking (N, hypomania; T, drug abuse) were significantly positively correlated with client dominance. Therapist affiliation was negatively correlated with all client MCMI scales, and these were significant for scales that assessed the most severe intake presenting problems (A, anxiety, D, dysthymia).     

MCMI Characteristics of DSM-II-R Bulimics

The literature on bulimia has suggested that bulimic women exhibit a number of pathological personality characteristics. However, the Millon Clinical Multiaxial Inventory (MCMI), an objective measure of personality functioning, has not previously been utilized to assess the personality characteristics of a bulimic population. The MCMI was administered to 37 female bulimics, 32 female general psychiatric outpatients, and 30 normal female controls in order to assess the relationship between bulimia and pathological personality traits. Bulimic women were found to score higher than the other groups on MCMI Scales 1 (Schizoid), 2 (Avoidant), and 3 (Dependent). They also scored lower than the other two groups on Scale 6 (Antisocial). Results are discussed within the framework of parallels between the MCMI profiles of bulimics and the existing literature on bulimics' personality characteristics.