Transcript MMPI-2 Overview and Interpretation

MMPI-2
Dale Pietrzak, Ed.D., LPC-MH, NCC, CCMHC
Counseling & Psychology in Education
University of South Dakota
MMPI: General
• 1st published in 1943 (Stark Hathaway,
Ph.D, & J. Chaney McKinley, M.D.)
• Group administered procedure to reliably
diagnose
• Used Empirical keying approach (new at
time)
Graham (2000) MMPI-2: Assessing Personality & Psychopathology (3rd ed)
Butcher, Et. Al (1989) MMPI-2: Manual for Admin & Scoring
MMPI: Development
• About 1000 potential items were collected
• Hathaway & McKinley selected 504
believed to be relatively novel from each
other
• Appropriate criterion groups were selected
– “Minnesota Normals”
– “Clinical Subjects”
– 504 items administered to groups
MMPI: Development Con’t
• Item Analysis (Discrimination Index) used
to determine items
• Selected items were cross validated
• Later 5 (Mf) and 0 (Si) were added
MMPI Validity Scale Development
• 3 scales (?, L & F) were originally intended
with K added shortly thereafter
• ? (Cannot Say): Number of omitted and double
marked items
• L (Lie): Unsophisticated attempts to present
oneself in an overly favorable light
• F (Infrequency): Designed to detect deviant
test taking behaviors (<10% of normals)
MMPI Validity Scale Development
• K (Defensiveness): Meehl & Hathaway
(1945) to identify defensiveness
– Clinical subjects who scored low for level
of pathology were contrasted with
“normals” to select items
– Later incorporated as a correction factor for
basic scales
I think my
hand is broken!
MMPI Validity Scale Development
• F(p): Infrequency-Psychopathology: Try to
reduce impact of pathology on F scale.
Although officially no cut score set, scores
of 100 are seen as cutoff.
Changes Due to Use
• 10 years saw MMPI could not do intend
job of independent classification accurately
• Too many normals scored high
• Scales Highly inter-correlated
• Approach from pure classification to
locating empirical correlates of scales and
code types
• Scale names dropped in favor of numbers
Need for Revision of MMPI (MMPI-2)
• MMPI was consistently ranked as one of the
most used instruments
• Clinicians (not just “testers”) found it
valuable
• Several weakness were Identified
MMPI Weaknesses
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No revision since 1943
Representativness of standardization sample
Non-Normal distributions of scales scores
Item content dated, bias, or objectionable
Insufficient coverage of pathology (drug use,
relationships, suicide, etc.)
• 1982 U of M Press appoints restandardization
committee (Graham, Butcher, Dalstrom)
Revision Process Form AX (Adults)
• 704 total items
– 550 original items maintained
About
time
• 82 were rewritten and 15 reworded
– 154 new items tried
• National Solicitation of Sample
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Phone Books, etc.
Paid $15 individual and $40 couple
Emphasis on special populations
2900 subjects tested 2600 retained
Standardization Sample
Characteristics
• Under represents the below HS educated
(little statistical impact)
• 81% Cauc., 12% Black, 3% Hispanic, 3%
Native Am., 1% Asian Am.
• Age: 18-85 (Mean 41; SD 15)
• Education: 3 years to 20+ (Mean 15; SD 2)
• Mostly Married I can’t take anymore!
Final MMPI-2 Booklet
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567 Items
Objectionable Items & Bias removed
New Scales Developed
Most Supplemental and All Clinical Scales
Retained
Ta Da!
Comparability of MMPI & MMPI-2
• The results of the 2 tests have proven to be
generally comparable
• The less defined the profile the less reliable
the comparison
• Greene (1991) suggests conversion to
MMPI scores with table K-1 from Manual
• Graham says to use individual scales when
not clear code type
Administration & Scoring
• Advanced degree in mental health,
supervised testing (25) and
Psychopathology
May the force
• 1 to 1.5 hours to take
be with you!
• 8th grade reading level
• Supervised administration
• (No TV or movies, etc.)
• 200+ scales, VRIN/TRIN
Distributions and T-Scores
• Non-normal distributions
• Uniform T-Scores (Averaged distribution)
– Clinical Scales, Content Scales & MDS use
Uniform
– Supplemental, Harris-Lingoes, Mf and Si use
Linear
– T of 30 = 99%, T of 50 = 45%, T of 65 = 8%, T
of 80 = 1%
I’m Back!
Stability
MALES
Scale 1 Week
L
.77
F
.78
K
.84
1 Hs
.85
2D
.75
3 Hy
.72
4 Pd
.81
5 Mf
.82
6 Pa
.67
7 Pt
.89
8 Sc
.87
9 Ma
.83
0 Si
.92
SEM
1.0
1.5
1.9
1.5
2.3
2.3
2.0
2.0
1.6
2.2
2.4
1.8
2.4
FEMALES
Scale 1 Week
L
.81
F
.69
K
.81
1 Hs
.85
2D
.77
3 Hy
.76
4 Pd
.79
5 Mf
.73
6 Pa
.58
7 Pt
.88
8 Sc
.80
9 Ma
.68
0 Si
.91
SEM
1.0
1.8
1.9
1.9
2.4
2.3
2.2
2.3
2.0
2.5
3.5
2.5
2.9
Stability of
Basic Scales
Internal Consistency
Scale
L
F
K
1 Hs
2D
3 Hy
4 Pd
5 Mf
6 Pa
7 Pt
8 Sc
9 Ma
0 Si
Males
.62
.64
.74
.77
.59
.58
.60
.58
.34
.85
.85
.58
.82
Females
.57
.63
.72
.81
Did you
.64
see that!
.56
.62
.37
.39
.87
.86
.61
.84
MMPI-2 Interpretation Process
• Determine Profile Validity
• Configural (Code types)
• Content (Basic, Content, and Supplemental)
As easy as
1, 2,3 ...
Yah!
right...
Validity scales:
General Guidelines
• ? 30+ Definitely Invalid; 10+ Great Caution
• L > 65 probably Invalid
• F, Fb >100 Likely Invalid (Highly
correlated with severity of pathology)
• K > 70 Invalid (Correlated with ego
Strength)
• F(p)> 100 Invalid
Validity scales:
General Guidelines
• VRIN > 80 Invalid
• TRIN > 80 Invalid
I think I would
rather be
home.
Deviant Response Sets: General
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Random: F >100, Fb >100, F(p)> 100 VRIN >80
All True: F > 100, Fb > 100, TRIN > 80
All False: L > 65, F > 100, Fb > 100, TRIN > 80
Negative Impression: F > 100, F(p) < 100, K Low,
VRIN & TRIN Acceptable;
• Exaggeration: Clinical Judgment
• Positive Impression: L > 65, K > 65, Low F
Defensiveness: K & L 10 points higher than F; either F
or K elevated (experimental: S [superlative] greater than
29).
Interpretation Examples
• Random
– VRIN=98, F=103 and F(p)=99
• Fake Good
– K=70, L=67 and S=68
• Fake Bad
– F=110, F(p)=78 often L,K & S are very low
Configural Information: Slant
• Level of F and profile elevation
• Left of Profile elevated “neurotic slope”
• Right of Profile Elevated more sever
pathology
• Conversion “V” (1 & 3 elevated with 2
lower)
• Psychotic valley (6 & 8 Elevated with 7
lower)
• Cry for Help (2-7)
Configural Information:
Code Types
• Use the highest 2 or 3 scales (NOT
including 5 or 0)
• If over 65 think more pathology, if under
think more “normal” expression of
configuration
• Highest scale determines but all scales
within 5 to 7 points are interchangeable
• Most codes order is not vital
Basic Clinical Scales
• 1: Hypocondrical complaints
• 2: subjective depression, psychomotor
retardation, physical symptoms, mental
dullness & brooding
• 3: denial of social anxiety, need for
affection, general icky feelings, somatic
complaints, inhibition of anger
Basic Clinical Scales Con’t
• 4: family discord, authority problems,
social imperturbability, social alienation and
self-alienation
• 5: stereotypic gender interests, sexuality
• 6: persecutory ideas, hypersensitivity, naive
trust
I have an idea about what to do
to this presenter ....
Basic Clinical Scales Con’t
• 7: anxiety and compulsivity
• 8: concentration, thought disorders,
creativity, social alienation, apathy,
depression, lack of emotional control &
hallucinations
• 9: manipulative, distrust, Over activity,
imperturbability & ego inflation
Basic Clinical Scales Con’t
• 0: shyness, self-consciousness, social
avoidance, alienation
Sounds like me after this class.
Content Scales: General
• More stable and consistent than clinical
scales
• Graham see these scales as more
meaningful than the clinical scales in many
ways (“T” greater than 65)
• Good validity for the scales
• Content is obvious and so can be
manipulated
Content Scales
• Anx General Anxiety
• FRS Specific fears
• OBS Compulsive, problems with decisions,
rigidity, ruminate
• DEP Down, fatigued, pessimistic
• HEA Feel unhealthy, health preoccupation
I think the rust is out.
Content Scales Con’t
• BIZ psychotic thinking, hallucinations,
paranoia
• ANG anger, hostility, grouchy, easily
frustrated
• CYN sees others as selfish & self-centered,
guarded, hostile, resent mild demands
• ASP legal/school trouble, believe breaking
law is acceptable, resent authority, anger
Content Scales Con’t
• TPA: hard-driven, work-oriented, sees
more to be done, impatient, irritable,
critical, hold grudges
• LSE poor self-concept, expect to fail, quit,
hypersensitive, passive, poor at making
decisions
• SOD: shy, rather be alone
Content Scales Con’t
• FAM: family discord, resent or angry at
family
• WRK: poor work attitudes and behaviors
• TRT: negative attitudes towards mental
health treatment & doctors, give up easily
I hate them...
Supplemental Scales: General
• Each tends to have been developed
independently using various methods
• Generally use linear T-scores (MDS uses
uniform)
• Generally good reliability and validity
I surrender!
Supplemental Scales
• Anxiety (A) and Repression (R)
– Developed using factor analysis. These are the
2 strongest factors.
– A- thinking & thought processes, negative
emotional tone, pessimism & lack of energy
– R-health, emotionality, violence, activity,
reactivity, dominance, adequacy
– Quadrant interpretation
Supplemental Scales Con’t
• Ego Strength (Es) :
– When defensive artificially high
– improvement of neurotics but fail cross
validation
– Seems to be general emotional stability
I’ll show you
ego strength!
Supplemental Scales Con’t
• MacAndrew Alcoholism Scale (MAC-R):
– 28+ substance abuse problems (24-27
suggestive), 24 or less not likely
• Addiction Acknowledgment Scale (AAS):
– T > 60 openly acknowledge substance abuse
problems
Supplemental Scales Con’t
• Addiction Potential Scale (APS):
– T > 60 possible substance abuse
• Marital Distress Scale (MDS):
– T > 60 indicate possible marital discord
• Overcontrolled-Hostility (O-H):
– Theory of overcontrol and hostility (prison)
– T > 70 intrapunative, repress, self-depreciative
Supplemental Scales Con’t
• Dominance (Do):
– T > 70 tend to be confident in self to dominant
• Social Responsibility (Re):
– T > 70 willing to accept personal responsibility,
ethical, even rule bound
• College Maladjustment (Mt):
– T > 70 pessimistic, procrastinate, ineffectual
Supplemental Scales Con’t
• Masculine Gender Role (GM) and Feminine
Gender Role (GF) :
– Experimental
– Quadrant interpretation?
– T > 70 indicate stereotypic attitudes
So what is
the point?
Supplemental Scales Con’t
• Post-traumatic Stress Disorder Scale (PK):
– T > 70 many PTSD symptoms
• Post-Traumatic Stress Disorder Scale (PS)
– Experimental
Fire one!
Other Scales
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Subtle-Obvious
Harris-Lingoes
Content Component Subscales
Personality Disorder scales
Over 300 other scales
Doesn’t he ever
stop?!
Critical Item Lists
• Suicide:
– 75(F), 303(T), 506(T), 520(T), & 524(T)
• Assault:
– 27(T), 37(T), 85(T), 134(T), 213(T), & 389(T)
Special Populations
• No adolescents (MMPI-A: 20-25% 8th
grading reading level)
• Historically the MMPI has had certain
scales which score differently for minorities
– Bias Vs Environmental responses (Sue & Sue)
• Little statistical evidence there are
consistent differences with the MMPI-2
• Not to be used to screen for organic
disorders
Evaluation
• Good standardization
sample
• Great research on
validity
• Major test used in area
• Little bias
• Recent revision
• Reliability
• Form length could
provide more
information
• No data on normal
personality
• Scale intercorrelations & Item
overlap
I survived the
MMPI-2!