The Millon Adolescent Personality Inventory and the Millon Adolescent Clinical Inventory

The theoretical grounds, purposes, and features of the Millon Adolescent Personality Inventory (MAPI; Millon, Green, & Meagher, 1982) and its forthcoming replacement the Millon Adolescent Clinical Inventory (MACI; Millon, in press) are reviewed. The rationale and procedure for the construction of the component scales are briefly explained, and the logic of configural or profile interpretation is examined and recommended. Uses and limitations of the MAPI and MAC1 are considered. Evaluative research, although limited in scope, points to the general utility of the MAPI and MACI as clinical tools, and to areas where further study may enhance their applicability in a counseling context.     

The Millon Adolescent Personality Inventory profiles of depressed adolescents

The evidence indicates that adolescent depression may be more difficult to recognize than its adult counterpart, although the reasons for this difficulty remain unclear. The research in this area is in part impeded by the lack of adolescent-specific measures of personality functioning. In this study the personality styles, expressed concerns, and behavioral tendencies of depressed adolescents were investigated by means of the Millon Adolescent Personality Inventory (MAPI), a relatively new personality inventory designed specifically for this age group. Three hundred sixty-six high school students completed the Beck Depression Inventory (BDI) and the MAPI, resulting in 332 valid and reliable MAPI profiles. The data were reduced to two factors, accounting for 65.1% of the total variance, by means of a principal components analysis. The two factors were interpreted as two dimensions of personality functioning associated with depression in adolescents. The first dimension suggested a socially withdrawn, overtly recognizable depression, whereas the second presents acting-out tendencies that may overshadow depressive symptomatology. The findings are integrated with the theoretical positions represented in the literature. Theoretical and practical implications for the use of the MAPI with depressed adolescents are discussed.     

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.     

A Variable Response Inconsistency scale and a True Response Inconsistency scale for the Millon Adolescent Clinical Inventory

Variable Response Inconsistency (M-VRIN) and True Response Inconsistency (M-TRIN) scales were developed for the Millon Adolescent Clinical Inventory using 104 male and 78 female delinquents, ages 13-17 years. M-VRIN efficacy was assessed by comparing nonrandom protocols of 76 male and 34 female delinquents, ages 13-17 years, with 100 computer-generated random protocols. Nonrandom protocols were screened using a matched-pair Minnesota Multiphasic Personality Inventory-Adolescent or Jesness Inventory. M-TRIN efficacy was assessed by comparing protocols with 160 simulated acquiescent and nonacquiescent protocols. Specificities of .95 or higher showed sensitivities up to .89 for M-VRIN, and .90 and .79 for M-TRIN. Predictive power and overall effectiveness are reported for several base rates. Small relationships may exist between M-VRIN and race, and between M-TRIN and gender.     

Stability of the Millon Adolescent Personality Inventory in an incarcerated delinquent population

Clinical use of the Millon Adolescent Personality Inventory (MAPI) depends on computerized interpretation of the pattern of scale score elevations in the profile beyond certain cutoff scores rather than the elevations of single scales. There has been no reported work on the stability of the scale scores or the stability of the 2-point codes in a delinquent population. The MAPI was administered to 46 incarcerated male juvenile delinquents and was readministered after a period of 2 to 4 weeks. The test-retest correlations of the base-rate scale scores ranged from .33 to .89 with a mean of .74, which compare favorably to Millon's (1982) standardization sample. However, only 41% of the 2-point codes were judged to be congruent between administrations. The poor congruence of the 2-point codes across administrations raises doubts about interpretive statements based on these codes.     

Factor invariance of the Millon Clinical Multiaxial Inventory

Several factor analyses of the Millon Clinical Multiaxial Inventory (MCMI) have resulted in very similar solutions. Interpretation of this consistency is hampered by the fact that the 20 scales of the inventory share items. Overlapping items cause the scales to be linearly dependent and may create structure in the interscale correlation matrix which is separate from the subject response patterns. A factor analysis was performed on the matrix of item-overlap coefficients which describes the underlying artifactual structure of the instrument. Data from two new subject samples were factor analyzed and compared to previously published studies. Similarity coefficients among factors across studies were calculated.     

Retest reliability of the Millon Clinical Multiaxial Inventory

This article reports on two studies which examined the temporal stability of the personality disorder subscales from the Millon Clinical Multiaxial Inventory (MCMI). The scales demonstrated adequate stability in psychiatric inpatients (retested with an average of just over 1 year between testings). Furthermore, a separate sample of depressed inpatients assessed when depressed and 6 weeks later showed that the stability of MCMI personality scales was observed even after patients displayed an initial reduction in depression severity. Although stability is vital to the accurate assessment of personality disorders, both studies also found high retest correlations for the MCMI clinical syndrome subscales. In general, these results suggest that patients displayed similar symptom patterns over time, whether construed as personality traits or characteristic patterns of responding when symptomatic.     

The operating characteristics of the Millon Clinical Multiaxial Inventory

The operating characteristics of the 20 scales of the Millon Clinical Multiaxial Inventory (MCMI) were analyzed with respect to the construction sample data as presented in the test manual. Sensitivity, specificity, positive predictive power, negative predictive power, and overall diagnostic power of each scale were derived. Results indicated that eight scales show excellent characteristics, nine were classified as fair, and three were determined to have poor positive predictive power for identifying the presence of a syndrome in an individual patient. Five scales had good positive predictive power for identifying the most prominent syndrome in a patient's clinical picture, eleven scales were classified as fair, and four were seen as poor on this dimension. We suggest a method for determining the utility of individual scales for different clinical populations and discuss implications of this type of analysis of the MCMI for diagnosis of the individual case.     

The Operating Characteristics of the Millon Clinical Multiaxial Inventory

The operating characteristics of the 20 scales of the Millon Clinical Multiaxial Inventory (MCMI) were analyzed with respect to the construction sample data as presented in the test manual. Sensitivity, specificity, positive predictive power, negative predictive power, and overall diagnostic power of each scale were derived. Results indicated that eight scales show excellent characteristics, nine were classified as fair, and three were determined to have poor positive predictive power for identifying the presence of a syndrome in an individual patient. Five scales had good positive predictive power for identifying the most prominent syndrome in a patient's clinical picture, eleven scales were classified as fair, and four were seen as poor on this dimension. We suggest a method for determining the utility of individual scales for different clinical populations and discuss implications of this type of analysis of the MCMI for diagnosis of the individual case.     

Predicting dangerousness with two Millon Adolescent Clinical Inventory psychopathy scales: the importance of egocentric and callous traits

Psychopathy in youth has received increased recognition as a critical clinical construct for the evaluation and management of adolescents who have come into contact with the law (e.g., Forth, Hare, & Hart, 1990; Frick, 1998; Lynam, 1996, 1998). Although considerable attention has been devoted to the adult construct of psychopathy and its relation to recidivism, psychopathy in adolescents has been less thoroughly researched. Recently, a psychopathy scale (Murrie and Cornell Psychopathy Scale; Murrie & Cornell, 2000) was developed from items of the Millon Adolescent Clinical Inventory (MACI; Millon, 1993). This scale was found to be highly related to the Psychopathy Checklist-Revised (Hare, 1991) and was judged to have demonstrated good criterion validity. A necessary step in the validation process of any psychopathy scale is establishing its predictive validity. With this in mind, we investigated the ability of the MACI Psychopathy Scale to predict recidivism with 55 adolescent offenders 2 years after they had been evaluated at a juvenile court evaluation unit. In addition, we devised a psychopathy scale from MACI items that aligned more closely with Cooke and Michie (2001) and Frick, Bodin, and Barry's (2001) recommendations for the refinement of psychopathy and tested its predictive validity. Results indicate that both scales had predictive utility. Interpersonal and affective components of the revised scale were particularly important in the prediction of both general and violent reoffending.     

Concurrent validity of the Social Phobia and Anxiety Inventory

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument designed to assess symptoms of social phobia. Although the scale has been shown to have a good test-retest reliability, internal consistency, and construct validity, no studies have examined its concurrent validity with respect to other measures of social anxiety and avoidance. In the present study, the relationship between the SPAI and several self-report measures of social anxiety was examined in a sample of 23 patients meeting DSM-III-R criteria for social phobia. The relationship between the SPAI and other measures of psychopathology, as well as performance during a role play test and an impromptu speech, was also examined. The results strongly support the concurrent validity and the specificity of the SPAI. The Social Phobia subscale may be a better index of social anxiety symptoms than the Difference subscale.This research was supported, in part, by NIMH grants MH 38636 and MH 41577 to the second author.     

Overview and Current Status of the Millon Clinical Multiaxial Inventory

The MCMI (Millon, 1983a, 1987, 1994, 1997a) was developed to operationalize Millon's (1969/1983b) model of psychopathology and has been revised 2 times over the past 20 years to keep pace with changes in theory as well as the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Since its introduction in 1977, it has become one of the most widely used and researched clinical assessment instruments in history, generating over 500 articles and 6 books. It has been translated into several languages and is being used in cross-cultural research. This article presents a historical overview of the measure and summarizes its current status in the literature. I highlight Millon's original vision for the test, changes that have been made, and its strengths and limitations. Future refinement of the MCMI is already in the planning stages and includes trait subscales for the personality disorders and linking codetypes to theory-derived interventions.     

Stability of the Millon Clinical Multiaxial Inventory among psychiatric inpatients

This study investigated the stability of the Millon Clinical Multiaxial Inventory (MCMI) in a sample of psychiatric inpatients over a longer time period and from different perspectives than previous reliability studies. Test-retest reliability was assessed from three perspectives: correlation/regression, equivalence of dimensional structures across testings upon different admissions, and stability of personality style across testings. Some stability from a correlational perspective was found, with higher stability estimates indicated for the basic personality scales in comparison with the clinical symptom scales which is consistent with Millon's theory. The internal structure of the MCMI was essentially identical across testings. Although source of reinforcement and instrumental or coping style were stable across testings beyond chance, the MCMI profiles of a considerable number of subjects were inconsistent across testings. Correspondingly, clinicians should be cautious in using the MCMI to make categorical decisions regarding personality style with inpatients who are tested at admission and who have had repeated hospitalizations.     

Reliability, diagnostic efficiency, and validity of the Millon adolescent clinical inventory: examination of selected scales in psychiatrically hospitalized adolescents

This study examined the internal consistency, diagnostic efficiency, and validity of selected scales of the Millon adolescent clinical inventory (MACI; Millon et al., Manual for the Millon Adolescent Clinical Inventory, National Computer Systems, Minneapolis, MN, 1993). 241 psychiatrically hospitalized adolescents were administered the MACI and a battery of established self-report measures and a multidisciplinary team independently assigned DSM-IV psychiatric diagnoses at the time of discharge. The internal consistency of MACI scales ranged from 0.71 to 0.93. Conditional probabilities (sensitivity, specificity, positive predictive power, and negative predictive power) were calculated for selected disorders using independently generated clinical diagnoses as the standard. The diagnostic efficiencies for the selected scales were variable, with adequate performance for predicting classes of diagnoses but not for specific diagnoses. The MACI showed good criterion validity for most disorders, with participants with a clinical diagnosis having a significantly higher corresponding MACI scale score than participants not assigned that diagnosis. Concurrent validity, tested by correlating MACI scale scores with those of relevant, validated measures, was generally good. The MACI appears to be a psychometrically sound self-report instrument and appears valuable as a screening instrument for many problems found in adolescent psychiatric inpatients.     

The Millon Clinical Multiaxial Inventory (MCMI): a review

This article reviews research conducted to date on the Millon Clinical Multiaxial Inventory (MCMI), a self-report test of psychopathology. The composition of the test and its theoretical basis are described. Data regarding its internal psychometric structure are reviewed. Finally, the article summarizes the research on the validity of the MCMI.     

The stability of the Millon Clinical Multiaxial Inventory for psychiatric inpatients

This study investigated the stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) for a sample of psychiatric inpatients. Patients were administered the MCMI shortly following admission and shortly preceding discharge. As would be expected theoretically, results indicated that stability estimates were greater for the basic personality scales than for the symptom scales. These results were also compared with results from a previous study investigating the stability of MCMI scales. Overall, stability coefficients for the inpatient sample were lower than those reported for other samples. Possible explanations for this and other findings are discussed.     

Validity of the Millon Clinical Multiaxial Inventory in the assessment of affective disorders

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 270 adult outpatients with major affective disorders at the same time that a semistructured, diagnostic interview was conducted by a clinician. The mood of the patient was then rated, and the clinician completed the Hamilton Depression Rating Scale and the Mania Rating Scale. A consensual diagnosis was arrived at by the team of investigators using DSM-III criteria. Significant correlations were found between four MCMI affective scales and the global mood state of the patient. Analysis of covariance indicated that the MCMI affective scales are significantly related to DSM-III affective disorders even after the effect of the current mood of the patient is partialled out. The clinical usefulness of each of the scales is discussed.