MMPI-2 Overview and Interpretation

MMPI-2

Dale Pietrzak, Ed.D., LPC-MH, NCC, CCMHC Counseling & Psychology in EducationUniversity 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

Con’t

I think myhand 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• 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• 82 were rewritten and 15 reworded

– 154 new items tried• National Solicitation of Sample

– Phone Books, etc.– Paid $15 individual and $40 couple– Emphasis on special populations– 2900 subjects tested 2600 retained

Abouttime

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

• 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

• 1 to 1.5 hours to take• 8th grade reading level• Supervised administration• (No TV or movies, etc.)• 200+ scales, VRIN/TRIN

May the forcebe with you!

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 of Basic Scales

MALESScale 1 Week SEM L .77 1.0 F .78 1.5 K .84 1.91 Hs .85 1.52 D .75 2.33 Hy .72 2.34 Pd .81 2.05 Mf .82 2.06 Pa .67 1.67 Pt .89 2.28 Sc .87 2.49 Ma .83 1.80 Si .92 2.4

FEMALESScale 1 Week SEM L .81 1.0 F .69 1.8 K .81 1.91 Hs .85 1.92 D .77 2.43 Hy .76 2.34 Pd .79 2.25 Mf .73 2.36 Pa .58 2.07 Pt .88 2.58 Sc .80 3.59 Ma .68 2.50 Si .91 2.9

Stability

Scale Males Females L .62 .57 F .64 .63 K .74 .721 Hs .77 .812 D .59 .643 Hy .58 .564 Pd .60 .625 Mf .58 .376 Pa .34 .397 Pt .85 .878 Sc .85 .869 Ma .58 .610 Si .82 .84

Internal Consistency

Did you see that!

MMPI-2 Interpretation Process

• Determine Profile Validity• Configural (Code types)• Content (Basic, Content, and Supplemental)

As easy as1, 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

Con’t

I think I wouldrather be

home.

Deviant Response Sets: General• 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 doto 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 validityI 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 youego 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 isthe 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

• Subtle-Obvious• Harris-Lingoes• Content Component Subscales• Personality Disorder scales• Over 300 other scales

Doesn’t he everstop?!

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 inter-correlations & Item overlap

I survived theMMPI-2!