MMPI-2 and MCMI-III scores among dutch inpatient substance abusers: Assessing correspondence and cross-cultural equivalence

The Millon Clinical Multiaxial Inventory (MCMI-II and MCMI-III) and the Minnesota Multiphasic Personality Inventory (MMPI-2) were applied to 263 Dutch inpatient substance abusers with multiple psychiatric diagnoses, and the results compared with those of 306 North-American substance abusers studied by Ward (1995). We looked for structural similarity both across groups (per instrument) and across the two instruments (per sample), using principal components analysis and congruence analysis. The component structure found by Ward was partly replicated in the Dutch group, thus cross-validating the use of the two instruments with these patients. Moreover, as found by Ward, the MMPI-2 content and supplementary scales of the Dutch sample proved to be important determinants of the first three MMPI-2 components, adding to convergent validity. Questions remained about the influence of the (dis)continuity of MCMI-II and MCMI-III on the replicability of the MCMI components.     

Overreport on the MCMI-III: concurrent validation with the MMPI-2 using a psychiatric inpatient sample

The MCMI-III (Millon, Davis, & Millon, 1997) is a widely used measure of personality often used in inpatient psychiatric settings. Although patients in such settings often overreport or exaggerate their symptoms, relatively little is known about how such a response set presents on the validity indexes of the MCMI-II. In this study, we used a sample of 191 psychiatric inpatients and compared MCMI-III modifier indices (Disclosure, Desirability, and Debasement) with the validity measures (L, F, Fb, F(p), K, and F - K) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In addition, the MCMI-III Disclosure Index (Scale X, which imposes a set cutoff score for invalidity due to overreport) was compared to several cutoff scores on the validity scales of the MMPI-2. Although the MCMI-III indexes generally performed as expected, the MCMI-III had a very high tolerance for overreport. When contrasted with MMPI-2 F scale, the MCMI-II Disclosure Index (which gauges overreport) remained valid until scores on MMPI-2 F scale approached a T score of 120. In addition, the Disclosure Index was at the upper end or slightly exceeded the highest recommended cutoff scores on all other MMPI-2 validity scales except F - K. Clinicians using the MCMI-III alone are cautioned to consider the high tolerance the MCMI-III has for overreport.     

Assessment of substance abusers on the MCMI-III and the Rorschach

We examined 60 substance abusers (SA) on the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) and on eight Rorschach variables from the Comprehensive System (CS; Exner, 2003). On the MCMI-III, SA scored above the cutoff for clinical significance (M > or = BR 70) on Drug Dependence (94.77), Antisocial (82.95), Depressive (74.33), Self-Defeating (71.48), and Alcohol Dependence (70.70). On seven of the CS variables (M+,o,u, XA%, X-%, WSum6Lv2%, M-%, SumT%, and Pure H%) the scores of the SAs suggested significant more psychopathology compared to the scores of 60 university students, whereas the SA's scores on six of these variables (M+,o,u, XA%, X-%, WSum6Lv2%, SumT%, and Pure H%) suggested significantly less psychopathology compared to the scores of 36 schizophrenics. The effect sizes for the significant differences were in the small, medium and large range (d= 0.31 to d= 1.87).     

MMPI-2 and MCMI-III characteristics of parental competency examinees

The MMPI-2 (Butcher et al., 2001) and the MCMI-III (Millon, Davis, & Millon, 1997) may contribute to understanding psychological functioning in parental competency examinees. In this study, we sought to identify MMPI-2 and MCMI-III characteristics of this population. We collected data regarding 127 individuals who underwent court-ordered parental competency evaluations. Although test results were generally consistent with findings from the child custody literature, MMPI-2 results indicated the highest Validity scale elevation on the L scale in contrast to the K scale elevations that have often been reported in the custody literature.     

Subtypes of substance abusers: personality differences associated with MacAndrew scores

Several earlier studies have reported clinically relevant personality correlates of high vs low scores on the MacAndrew Scale (Mac) of the MMPI. Unfortunately, these projects have not adjusted for age or nature of abuse. Also, most have assumed that the personality correlates are the same for female patients as for male patients. This study attempts to address these deficiencies. Even after correcting for age and diagnosis, high Mac patients differ from low Mac patients on major scales of the MMPI. The pattern of such differences varies considerably between men and women. Substance abuse treatment implications of these differences are discussed.     

Convergent validity of the MCMI-III personality disorder scales and the MMPI-2 scales

The MCMI-III personality disorder scales (Millon, 1994) were empirically validated in a sample of prisoners, psychiatric inpatients, and outpatients (N = 477). The scale intercorrelations were congruent with those obtained by Millon, Davis, and Millon (1997). We conclude that our Flemish/Dutch version shows no significant differences with the original version of the MCMI-III as far as intercorrelations are concerned. Convergent validity of the MCMI-III personality disorder scales was evaluated by the correlational data between the MCMI-III personality disorder scales and the MMPI-2 clinical (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and personality disorder (Somwaru & Ben-Porath, 1995) scales. Improved convergence was obtained compared with previous versions of the MCMI-I. Only the compulsive MCMI-III personality disorder scale remains problematic. The scale even showed negative correlations with some of the related clinical scales and with the corresponding personality disorder scales of the MMPI-2.     

Assessing depression with the MMPI and MMPI-2

The usefulness of the MMPI (Hathaway & McKinley, 1951 ) and MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) for diagnosing and assessing symptomatic depression has been the subject of considerable debate for a number of years. In this article, we review the relative contributions of the MMPI and MMPI-2 clinical and content scales in predicting depression. Positive predictive power, negative predictive power, and overall classification rate were computed for Scale 2 (D) of the MMPI and MMPI-2 and the Depression content scale (DEP) of the MMPI-2. Scale 2 (D) of both the MMPI and MMPI-2 appears to be moderately accurate in predicting depression. Although some studies suggest that the content scale DEP provides incremental validity over Scale 2 (D) of the MMPI-2, the results of this review indicate that the content scale DEP of the MMPI-2 does not exceed the diagnostic efficiency of Scale 2 in predicting depression.     

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.     

A comparison of the MCMI-III personality disorder and modifier indices with the MMPI-2 clinical and validity scales

In this study, we examined the relationship of the MCMI-III (Millon, Davis, & Millon, 1997; Millon, Millon, & Davis, 1994) modifier indices and personality disorder scales to the validity and basic clinical scales of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). The MCMI-III modifier indices highly correlated with all of the MMPI-2 validity scales except for the F(p) scale. Similarly, the MCMI-III personality disorder scales strongly covaried with the MMPI-2 validity and clinical scales except for the F(p) and 5 (Mf) scales. A factor analysis with Promax rotation revealed substantial relationships between the MMPI-2 and MCMI-III. However, the MMPI-2 F(p) scale did not tend to correlate with MMPI-2 or MCMI-III scales, indicating that F(p) scale variance was largely independent of other scales. The results suggest that clinicians should consider the interrelationship between personality characteristics and dissimulation.     

Bias and equivalence in cross-cultural assessment: an overview

In every cross-cultural study, the question as to whether test scores obtained in different cultural populations can be interpreted in the same way across these populations has to be dealt with. Bias and equivalence have become the common terms to refer to the issue. Taxonomy of both bias and equivalence is presented. Bias can be engendered by the theoretical construct (construct bias), the method such as the form of test administration (method bias), and the item content (item bias). Equivalence refers to the measurement level at which scores can be compared across cultures. Three levels of equivalence are possible: the same construct is measured in each cultural group but the functional form of the relationship between scores obtained in various groups is unknown (structural equivalence), scores have the same measurement unit across populations but have different origins (measurement unit equivalence), and scores have the same measurement unit and origin in all populations (full scale equivalence). The most frequently encountered sources of bias and their remedies are described.     

The Lazarus Project: a longitudinal study of spiritual transformation among substance abusers

This is a longitudinal study of spiritual transformation at the Lazarus Project (LP), a 12-month Pentecostal-Charismatic residency program for substance abuse. In 2006, we began administering to residents an assessment protocol consisting of psychological (depression, self-esteem, psychopathology, Big 5 personality markers) and religiosity (fundamentalism, religious orientation, spiritual well-being, mysticism) measures. Assessments were at: (T1) induction; (T2) six months; (T3) graduation; and (T4) one-year post-graduation. We also assessed a membership group from the sponsoring church using the same protocol. Analyses found that general change in graduate scores occurred from T1 to T2 and persisted to T3 and T4. Comparative analyses found that LP graduate score patterns generally agreed with those of LP dropouts at T1, but diverged at T2, becoming more similar to score patterns of church members. Using all measures, a regression analysis found that the personality marker of (less) openness was the most powerful predictor of resident dropout. The preliminary findings suggest that, among chronic substance abusers, the LP helps to facilitate conversion as a form of spiritual transformation that persists at least one-year post-graduation.     

The consistency of scores and configural patterns between the MMPI and MMPI-2

This article is an extension of the Ben-Porath and Butcher (1989a) study, investigating the claim that the scores and configural patterns of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) are consistent with those of the Minnesota Multiphasic Personality Inventory (MMPI). College students (200 men and 200 women) were randomly assigned to either the original to original condition (O-O), in which they took the MMPI twice, or the original to revised condition (O-R), in which they took the MMPI and the MMPI-2. Correlations and configural patterns of the O-O condition were compared to those of the O-R condition. Results suggest some score changes between the MMPI and MMPI-2, particularly on Scales L, 5, and 8 for men and Scales L and 5 for women.     

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.     

Cross-cultural equivalence and validity of the Vietnamese MMPI-2: assessing psychological adjustment of Vietnamese refugees

The cross-cultural equivalence and validity of the Vietnamese translation of the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) were examined in a sample of 1st-generation Vietnamese refugees in the United States (N = 143). Respondents completed the Vietnamese MMPI-2, the Harvard Trauma Questionnaire, a measure of acculturation, and a demographic questionnaire. An inspection of MMPI-2 mean profiles and items showing extreme endorsement rates suggested that certain symptom tendencies and cultural values may be reflected in responses to some MMPI-2 items. Older age, lower acculturation, greater experienced premigration-postmigration traumas, and military veteran status were all associated with elevated MMPI-2 profiles, suggesting that the MMPI-2 functions in a reasonably equivalent and valid way in this population.     

Validity rates of the MMPI-2 and PAI in a rural inpatient psychiatric facility

This study examines the validity rates of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory (PAI) profiles in a rural inpatient population. The validity scales of 90 MMPI-2 and 90 PAI profiles were analyzed using published criteria for determining validity. Random responding, positive impression management, and negative impression management were also evaluated. The PAI had a higher number of valid profiles compared with the MMPI-2. Evidence suggests the primary source of the invalid profiles within the MMPI-2 is a higher level of endorsement of relatively rare statements. The substitution of the Infrequency-Psychopathology scale (Fp) for the Infrequency scale (F) on the MMPI-2 substantially reduced the number of invalid profiles. Contrary to expectations, the PAI did not demonstrate lower levels of invalid profiles due to random responding. Rates of invalid profiles for each scale are provided.     

Adherence to substance abuse treatment: clinical utility of two MMPI-2 scales.

In this study, we examined the ability of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Addiction Acknowledgment scale (AAS; Weed, Butcher, McKenna, & Ben-Porath, 1992) and Negative Treatment Indicators scale (TRT; Butcher, Graham, Williams, & Ben-Porath, 1990) to predict adherence to and outcomes from substance abuse treatment. There was no evidence that the AAS was related to treatment adherence or outcome in our sample. However, results did reveal a significant positive relation between scores on the TRT scale and readmission to the hospital. Further analyses identified an optimal score for use in similar clinical populations and settings, and characteristics of high and low scorers. Compared to low scorers, high TRT scorers were more likely to not return for treatment after an initial screening interview. If they did return for treatment, high TRT scorers were more likely to experience fewer treatment days and to be rated as having lower motivation, poorer participation, and poorer comprehension of program materials. These findings provide promising initial evidence of the utility of the TRT scale for identifying patients who may be at a high risk for unsuccessful substance abuse treatment.     

Assessing bilingual and monolingual Latino students with translations of the MMPI-2: initial data

This article presents the results of 2 studies conducted with Spanish versions of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with Latino students. Study 1 compared the results of 2 administrations of the MMPI-2, one in English and the other in Spanish. Study 2 compared the results of administrations of 2 Spanish versions of the MMPI-2, the official Mexican adaptation and the Version Hispana. In both cases, scale score differences were not found. Comparability, as operationally defined by test-retest reliability, was found to be higher for the group that was administered the English and Spanish versions than the group administered the 2 Spanish versions. Overall, the results were found to suggest correspondence. Yet, the authors warn against concluding "perfect" correspondence because other key groups need to be studied, including psychiatric patients and persons from the Latino community. Also, the determination of linguistic equivalence needs further refinement.     

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.     

Examining the impact of unscorable item responses on the validity and interpretability of MMPI-2/MMPI-2-RF Restructured Clinical (RC) Scale scores

This article examined the impact of unscorable item responses on the psychometric validity and practical interpretability of scores on the Restructured Clinical (RC) Scales of the Minnesota Multiphasic Personality Inventory-2/Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2/MMPI-2-RF). In analyses conducted with five archival samples, we found that relatively large proportions of unscorable responses (defined as 10% or more of the items scored on a scale) were relatively uncommon, occurring most often in forensic samples. Simulated unscorable responses were inserted in varying proportions (10% to 90%) in place of the responses of participants in two of the archival samples for which criterion data were available. Analyses were conducted to gauge the impact of unscorable responses on the criterion validity of scores on these scales and their interpretability. Impact on validity was evaluated by examining correlations with extra-test variables as a function of increasing levels of unscorable responding. Interpretability was evaluated by examining the proportion of participants who produced clinically elevated RC Scale scores as a function of unscorable responding. Results indicate that whereas scale score validity was relatively robust up to a level of 50% unscorable responses, interpretability was substantially compromised at only 10% unscorable responding. This suggests that prorated scores may be used to correct for the impact of unscorable responses on the interpretability of RC Scale scores at levels as high as 50% unscorable responses. Classification analyses supported this possibility. Further steps needed to explore the feasibility of using prorated scores are discussed.