Validity of the Substance Abuse Scales of the MMPI-2 in a College Student Sample

This study assessed the validity of three Minnesota Multiphasic Personality Inventory-2-based (MMPI-2: Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) substance abuse scales. The scales were the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., i989) and the recently developed Addiction Acknowledgment Scale and Addiction Potential Scale (AAS & APS; Weed, Butcher, McKenna, & Ben-Porath, 1992), Study participants were 308 male and female college students who completed the MMPI-2 and the substance use disorder modules of the Diagnostic Interview Schedule. The MAC-R and the APS had a nonsignificant-to-weak relationship with substance dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders' (3rd ed., rex. [DSM-III-R]; American Psychiatric Association, 1980). The AAS had a moderate ability to identify the 33 study participants who met DSM-HI-R criteria for a substance use disorder, primarily alcoholism, Broadening the definition of substance abuse to a continuum of alcohol/drug problems did not alter the character of findings, These results highlight the relative superiority of direct (AAS) versus subtle (APS, MAC-R) scales to detect substance dependence and support studies that question the overall utility of traditional MMPI scales to identify substance abuse.     

Use of the MMPI-A to detect substance abuse in a juvenile correctional setting.

In this study, we examined the ability of the MMPI-A (Butcher et al., 1992) to detect substance abuse problems in a juvenile correctional setting. Specifically, we evaluated the Alcohol/Drug Problem Acknowledgment scale (ACK; Weed, Butcher, & Williams, 1994), the Alcohol/Drug Problem Proneness scale (PRO; Weed et al., 1994), and the MacAndrew Alcoholism Scale-Revised (MAC-R; Butcher et al., 1992) in the prediction of substance abuse. In addition, the incremental validity of ACK in comparison to PRO was evaluated, as was the incremental validity of PRO in comparison to ACK. The sample consisted of 123 boys and girls from ajuvenile correctional facility in Northeastern Ohio. Results indicate that ACK and PRO, but not MAC-R, were related to interviewer ratings of substance abuse. Results point to the superiority of ACK over PRO in substance abuse identification.     

A cross-validation of MMPI-2 substance abuse scales.

We evaluated the efficacy of the Addiction Potential Scale (APS) and the Addiction Acknowledgement Scale (AAS), two new scales designed to assess substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in samples from settings different from those used in their development. Results replicate earlier findings that both scales discriminate between psychiatric and substance abuse samples and do so more effectively than other substance abuse scales designed for use with the MMPI and carried over to the MMPI-2. Results also suggest that APS may be more resistant than AAS to response distortion.     

New Measures for Assessing Alcohol and Drug Abuse With the MMPI-2: The APS and AAS

We introduce two new scales for assessing substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2): the Addiction Potential Scale (APS), a 39-item empirically derived scale, developed by contrasting the responses of a large residential substance abuse sample with responses from both normative and psychiatric control groups; and the Addiction Acknowledgement Scale (AAS), a 13-item face-valid scale, constructed rationally and with attention to internal consistency. Both new scales are shown to discriminate well between groups and substantially better than other selected substance abuse scales. Covariation between the scales and joint effectiveness are examined. Finally, limitations for their practical utility are expressed, and considerations for future research are identified.     

New measures for assessing alcohol and drug abuse with the MMPI-2: The APS and AAS.

We introduce two new scales for assessing substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2): the Addiction Potential Scale (APS), a 39-item empirically derived scale, developed by contrasting the responses of a large residential substance abuse sample with responses from both normative and psychiatric control groups; and the Addiction Acknowledgement Scale (AAS), a 13-item face-valid scale, constructed rationally and with attention to internal consistency. Both new scales are shown to discriminate well between groups and substantially better than other selected substance abuse scales. Covariation between the scales and joint effectiveness are examined. Finally, limitations for their practical utility are expressed, and considerations for future research are identified.     

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.     

A Cross-Validation of MMPI-2 Substance Abuse Scales

We evaluated the efficacy of the Addiction Potential Scale (APS) and the Addiction Acknowledgment Scale (AAS), two new scales designed to assess substance abuse problems with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), in samples from settings different from those used in their development. Results replicate earlier findings that both scales discriminate between psychiatric and substance abuse samples and do so more effectively than other substance abuse scales designed for use with the MMPI and carried over to the MMPI-2. Results also suggest that APS may be more resistant than AAS to response distortion.     

The Personality Psychopathology-Five (PSY-5): recent constructive replication and assessment literature review

The Personality Psychopathology-Five (PSY-5; Harkness & McNulty, 1994) is a model of individual differences relevant to adaptive functioning in both clinical and non-clinical populations. In this article, we review the development of the PSY-5 model (Harkness, 1992; Harkness & McNulty, 1994) and discuss the ways in which the PSY-5 model is related to and distinct from other 5-factor models. Using different methods and measures, the dimensions of the PSY-5 model have been constructively replicated (Lykken, 1968) by Tackett, Silberschmidt, Krueger, and Sponheim (2008) and by Watson, Clark, and Chmielewski (2008), and dimensions congruent with the PSY-5 have even been suggested for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; Krueger et al., 2011). PSY-5 Scales can be scored from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al., 2001), the MMPI-Adolescent version (MMPI-A; Butcher et al., 1992), and the Restructured Form of the MMPI-2 (MMPI-2-RF; Ben-Porath & Tellegen, 2008). Because the largest body of research exists for the MMPI-2-based scales, we focus our review of the literature on the MMPI-2-based PSY-5 scales (Harkness, McNulty, & Ben-Porath, 1995), but we briefly cover the small, but growing, body of MMPI-A and MMPI-2-RF PSY-5 scales research. We show that the PSY-5 research literature includes a wide variety of psychometric methodologies as well as diverse samples and clinical problems. An integrative summary reprises the theory behind each PSY-5 construct and links it to the reviewed literature. Advantages and limitations of MMPI-2-based PSY-5 scales are discussed.     

Sex differences on the MMPI-2 substance abuse scales in psychiatric inpatients.

Sex differences on the MMPI-2 addiction scales (MacAndrew Alcoholism Scale-Revised, Addiction Acknowledgement Scale, Addiction Potential Scale) and their ability to distinguish between substance-abusing and nonabusing psychiatric inpatients were examined. Men obtained higher mean raw scores than women on the MacAndrew Alcoholism Scale-Revised and the Addiction Acknowledgement Scale, and substance abusers scored higher on all three scales. Even relatively low cutoff scores, however, on the MacAndrew Alcoholism Scale-Revised resulted in false negative rates of 37 to 39%. The results support the utility of the MMPI-2 substance abuse scales; however, lower cutoff scores should be used with women and within a psychiatric population.     

Convergent validity of alternative MMPI-2 personality disorder scales

The Morey, Waugh, and Blashfield (1985) MMPI (Hathaway et al., 1989) personality disorder scales provided a significant contribution to personality disorder research and assessment. However, the subsequent revisions to the MMPI and the multiple revisions to the diagnostic criteria sets that have since occurred may have justified comparable revisions to these scales. Somwaru and Ben-Porath (1995) selected a substantially different set of items from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) to assess Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) personality disorder diagnostic criteria. In our study, we compared the convergent validity of these alternative MMPI-2 personality disorder scales with respect to 3 self-report measures of personality disorder symptomatology in a sample of 82 psychiatric outpatients. The results suggested that Somwaru and Ben-Porath's scales are as valid as the original Morey et al. scales and might be even more valid for the assessment of borderline, antisocial, and schizoid personality disorder symptomatology.     

Changes in adolescent response patterns on the MMPI/MMPI--a across four decades

The purpose of this study was to explore changes in adolescent self-presentation on the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1940) and MMPI-A (Butcher et al., 1992) over a 40-year period. The primary samples used for comparison in this study include 1,235 adolescents, age 14 through 16, derived from the MMPI-A normative sample (Butcher et al., 1992) collected in 1989 and 10,514 adolescents, age 14 through 16, collected in 1948 and 1954 from Hathaway and Monachesi's (1963) study of adolescent personality and behavior. MMPI basic scale and item-level data were also included for 817 adolescents, age 14 through 16, collected by Colligan and Offord (1992) in 1985 as a further comparison. Between-sample analyses at the profile level revealed that adolescents from the MMPI-A normative sample scored significantly higher across basic clinical scales and lower on validity scales L and K than adolescents from the Hathaway and Monachesi (1963) sample, with mean data from the Colligan and Offord (1992) sample typically falling at a midpoint value. Analyses of Harris-Lingoes (Harris & Lingoes, 1955) subscale and item-level data were conducted to provide refined definitions of the contents of scale-level changes. Results were interpreted as reflecting moderate to large changes in response frequencies between eras of data collection, and emphasis was placed on the relatively high frequency of item endorsements by contemporary adolescents in the clinical direction in the MMPI-A normative sample. A series of cautions and limitations are also offered in interpreting these patterns.     

MMPI-2 as a predictor of change in PTSD symptom clusters: a further analysis of the Forbes et al. (2002) data set

In this study, we reanalyzed the Forbes et al. (2002) data set to examine the Minnesota Multiphasic Personality Inventory (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) as a differential predictor of change across posttraumatic stress disorder symptom clusters following treatment in 141 Vietnam veterans. A series of partial correlation and linear multivariate regression analyses, controlling for initial symptom severity, identified several scales predictive of symptom change. None of the MMPI-2 scales, however, emerged as predictors of change in reexperiencing symptoms. Social alienation and marital distress were the most potent predictors for avoidance symptoms. Anger, alcohol use, and hypomania were the most potent predictors for the hyperarousal symptoms. Of the personality disorders, borderline personality was the strongest predictor of change in the avoidance and hyperarousal clusters. Further replication of the findings of this article and those reported by Forbes et al. (2002) is required.     

The effectiveness of MMPI-A items in discriminating between normative and clinical samples.

The Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A; Butcher et al., 1992) was released in 1992 and has rapidly become the most widely used objective personality assessment instrument with adolescents. Although the MMPI-A reduced or eliminated several problems associated with the use of the original MMPI (Hathaway & McKinley, 1943) with adolescents, the MMPI-A does produce a high frequency of within normal limits basic scale profiles for individuals with substantial psychopathology including adolescents in inpatient psychiatric settings. To better understand the reasons for this phenomenon, we compared the item endorsement frequencies for the MMPI-A normative sample with results from two adolescent clinical samples, and these results were contrasted to the item endorsement frequencies for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) normative sample and a clinical sample of adult psychiatric inpatients. Results showed that the MMPI-A contains a substantial number of items that do not show a significant difference in item endorsement frequency between normative and clinical samples. Furthermore, MMPI-A basic and content scales generally show a much lower percentage of effective items than do the corresponding scales for the MMPI-2. We discuss the findings in relation to the frequent occurrence of low range MMPI-A profiles in clinical samples and the potential usefulness of these results in future efforts to develop viable short forms for the MMPI-A.     

The deconstruction of the Hy Scale of MMPI-2: failure of RC3 in measuring somatic symptom expression

The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Clinical Scales have a long history in psychological assessment. Recently, Tellegen et al. (2003) conducted a series of analyses to restructure the scales to reduce what they considered to be problems that limit scale functioning. In a critique of the Restructured Clinical (RC) Scales published in this issue, Nichols (2006/this issue) questions a number of aspects of the approach Tellegen et al. took including their theoretical assumptions, methods of analysis, and failures to report important information needed for scale evaluation such as relationships with existing scales. We concur with many points raised by Nichols. In our analysis of the performance of the RC3 scale, we found that it has "drifted" so far from the original Hy scale as to be a completely different measure- a scale of cynical attitudes that is already well represented in existing MMPI-2 measures. In this article, we take these concerns a step further and examine the history and construct validity of the Hy scale in evaluating the somatic expression of problems that the original authors (McKinley & Hathaway, 1944) intended. We also include new information from a medical setting, an application not represented in Tellegen et al.'s RC Scale monograph. In agreement with Rogers et al. (2006/this issue), it is our conclusion that some RC Scales do not represent the measurement domain of the original scales and should not be relied on for or used to refine traditional interpretation, particularly in medical or forensic situations (such as personal injury cases) because of their confusing and conflicting results.     

Interpretation of a Full-Information Item-Level Factor Analysis of the MMPI-2: Normative Sampling and Nonpathognomonic Descriptors

An exploratory item-level full-information factor analysis was performed on the normative sample for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). This method of factor analysis, developed by Schilling and Bock (Bock & Schilling, 1997) and based on item response theory, works directly with the response patterns and avoids the artifacts associated with phi coefficients and tetrachoric coefficients. Promax rotation of the factor solution organizes the clinical scale items into 10 factors that we labeled Distrust, Self-Doubt, Fitness, Serenity, Rebelliousness, Instrumentality, Irritability, Artistry, Sociability, and Self-Reliance. A comparison was made to the results of Johnson, Butcher, Null, and Johnson (1984), who performed a principal-component analysis on an item set of 550 items from the previous version of the MMPI (Hathaway & McKinley, 1943). Along with version changes and sampling differences, the essential differences between Johnson et al.'s results and ours may be attributed to differences between the Schilling and Bock method, which uses all information in the item responses, and the principal-component analysis, which uses the partial information contained in pairwise correlation coefficients. This study included 518 of the complete 567 items of the MMPI-2, versus Johnson et al.'s retention of 309 of the initially included 550 items of the previous MMPI. The full-information analysis retained all 518 initially included items and more evenly distributed the items over the 10 resulting factors, all sharply defined by their highest loading items and easy to interpret. Sampling effects and factor label considerations are discussed, along with recommendations for research that would validate the clinical utility of the implied scales for describing normal personality profiles. The full-information procedure provides for Bayes estimation of scores on these scales.     

On the hierarchical structure of mood and anxiety disorders: confirmatory evidence and elaboration of a model of temperament markers

The authors examined D. Watson's (2005) proposed reconceptualization of the diagnostic categories for mood and anxiety disorders for the Diagnostic and Statistical Manual of Mental Disorders--Fifth Edition (DSM-V) and tested an elaboration of the 2-factor (positive and negative activation) model of underlying temperament markers that incorporates A. Tellegen, D. Watson, & L. A. Clark's (1999a, 1999b) higher-order dimension of happiness-unhappiness (or demoralization; see A. Tellegen et al., 2003). In Study 1, 502 undergraduate students completed several symptom measures of mood and anxiety disorders and the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher et al., 2001). Using confirmatory factor analysis, the authors replicated Watson's distress and fear disorder model. Path analyses showed that demoralization was a primary marker of distress disorders, whereas dysfunctional negative emotions was a primary marker of fear disorders. Low positive emotions was a specific marker of depression and social phobia. This 3-factor path model was associated with better fit than was a 2-factor model excluding demoralization. In Study 2, the authors replicated the findings of Study 1 using data from an archival clinical sample of 636 Veterans Affairs hospital outpatients. The authors' findings provide evidence on the important role of demoralization in mood and anxiety disorders.     

Seven issues in Conducting Forensic Assessments: Ethical Responsibilities in Light of New Standards and New Tests

The publication of a new ethics code for the American Psychological Association (1992), new guidelines (Committee on Ethical Guidelines for Forensic Psychologists, 1991), and two new versions of the Minnesota Multiphasic Personality Inventory (the MMPI-2, Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; and the MMPI-A, Butcher et al., 1992) provide an opportunity to review ethical aspects of forensic assessment. Seven major issues-appropriate graduate training, competence in the use of standardized tests, using tests that fit the task, using tests that fit the individual, administering tests correctly, using computers appropriately in forensic assessment, and assessing and reporting factors that may affect the meaning of test findings—are discussed. The revision of the MMPI is used to illustrate some of these issues.     

Interpretation of a full-information item-level factor analysis of the MMPI-2: normative sampling and nonpathognomonic descriptors

An exploratory item-level full-information factor analysis was performed on the normative sample for the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). This method of factor analysis, developed by Schilling and Bock (Bock & Schilling, 1997) and based on item response theory, works directly with the response patterns and avoids the artifacts associated with phi coefficients and tetrachoric coefficients. Promax rotation of the factor solution organizes the clinical scale items into 10 factors that we labeled Distrust, Self-Doubt, Fitness, Serenity, Rebelliousness, Instrumentality, Irritability, Artistry, Sociability, and Self-Reliance. A comparison was made to the results of Johnson, Butcher, Null, and Johnson (1984), who performed a principal-component analysis on an item set of 550 items from the previous version of the MMPI (Hathaway & McKinley, 1943). Along with version changes and sampling differences, the essential differences between Johnson et al.'s results and ours may be attributed to differences between the Schilling and Bock method, which uses all information in the item responses, and the principal-component analysis, which uses the partial information contained in pairwise correlation coefficients. This study included 518 of the complete 567 items of the MMPI-2, versus Johnson et al.'s retention of 309 of the initially included 550 items of the previous MMPI. The full-information analysis retained all 518 initially included items and more evenly distributed the items over the 10 resulting factors, all sharply defined by their highest loading items and easy to interpret. Sampling effects and factor label considerations are discussed, along with recommendations for research that would validate the clinical utility of the implied scales for describing normal personality profiles. The full-information procedure provides for Bayes estimation of scores on these scales.     

An investigation of the psychometric properties of the MMPI-2 Restructured Clinical (RC) scales with mental health inpatients

In this study, we compared the internal psychometric properties and external correlates of the MMPI-2 (Butcher et al., 2001; Tellegen et al., 2003) Restructured Clinical (RC) scales and corresponding MMPI-2 non-K-corrected Clinical scales in a sample of 280 men and 264 women admitted to inpatient psychiatric units. We evaluated the internal psychometric properties of the RC and Clinical scales by intercorrelation analyses and alpha coefficients. We investigated external correlates of scores from the RC and Clinical scales using selected chart variables, selected Symptom Checklist 90-Revised (Derogatis, 1983, 1994) items, and clinician ratings on the Brief Psychiatric Rating Scale (Overall & Gorham, 1988). Results showed psychometric support for the RC scales in terms of improved intercorrelation patterns and comparable or greater alpha coefficients. Further, external correlational analyses revealed varying degrees of evidence of improvement in convergent and discriminant validity.     

The validity and utility of the positive presentation management and negative presentation management scales for the Revised NEO Personality Inventory

Schinka, Kinder, and Kremer developed "validity" scales for the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae) to detect underreporting-the Positive Presentation Management (PPM) Scale and overreporting-the Negative Presentation Management (NPM) Scale. In this investigation, the clinical utility of these scales was examined using the established validity scales from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al.) as the referent. The sample was composed of 370 psychiatric patients who completed the NEO PI-R and the MMPI-2 as part of a routine evaluation. Results indicated that response distortion compromised the utility of the NEO PI-R domain scales. Moreover, the PPM and NPM scales and an NPM-PPM index significantly differentiated invalid under-and overreporting groups from a valid responding group. The PPM and NPM-PPM index were adequate in classifying under- and overreporters, respectively.