Millon Clinical Multiaxial Inventory-III (MCMI-III)

Report
Participants will be provided with an
overview of the MCMI-III
 Participants will be familiar with
interpretation guidelines for the MCMI-III
 Participants will have the opportunity to
practice interpretation of the MCMI-III
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MCMI-III Overview
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Models to describe personality prototypes
› Behavioral: observable behavior
› Phenomenological: cognitive styles, object
representations, self-image
› Intrapsychic: regulatory mechanisms
› Biophysical: impact of mood and temperament
› Sociocultural: impact of interpersonal
relationships
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Millon’s theory draws on evolutionary theory
to explain personality
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Theodore Millon’s bioevolutionary theory
› Personality exists on a continuum that is a
combination of 3 polarities:
 Survival aims – survival/pleasure
 Adaptive modes – changing/reacting to environment
 Replication strategies – reinforcement/nurturing
› Similar to DSM but not an exact match
 DSM disorders
 Additional disorders (aggressive/sadistic, self-defeating)
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Medical illness analogy
› Axis I = fever and cough
› Axis II = immune system
› Axis III & IV = medical & psychosocial factors
Test construction – deductive or rational
 Sequential validation strategy, 3 phases
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› Theoretical-substantive: items are evaluated on
how well their content conforms to the theory
from which they were derived (e.g., DSM &
Millon’s)
› Internal-structural validation: evaluated internal
structure of the measure
› External-criterion validation: evaluated measure
externally
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Item assignment and weighting
MCMI was originally published in 1977
 Theodore Millon was active with DSM-III
Axis II criteria work group
 MCMI-II was published in 1987 (same
year as DSM-III-R published adjusted
criteria)
 MCMI-III was published in 1994 (with
introduction of DSM-IV)
 MCMI-III is the 3rd most frequently used
psychological test
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90 items were revised or replaced
 Additional scales
 Noteworthy responses added
 Axis I scales were improved
 Item weighting scheme was changed
 Fewer items per scale
 New validity scale
 Grossman Facet scales
 New norms
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Make an inventory useful for diagnosing
DSM disorders
 Assist with distinguishing between:
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› Persistent, life long characteristics (Axis II)
› Current symptom states (Axis I)
Ability to reflect severity of pathology
 Designed for computer scoring and
analysis
 Base rate (BR) scores
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MCMI-III uses BR instead of T or Z scores
› Millon posits that these better reflect the skewed
distributions of personality disorders
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General interpretation guidelines for a BR
› BR 35 = normal population (non-clinical)
› BR 60 = standard for clinical population (this was
set by Millon)
› BR of 75-84 = some characteristics are present
› BR 85 and higher = most characteristics of a
disorder are present
› Note: BR under 75 are not considered clinically
significant and are not to be interpreted
Five validity scales
 Eleven clinical personality patterns (Axis
II)
 Three scales of severe personality
pathology (Axis II)
 Seven clinical syndromes (Axis I)
 Three severe clinical syndromes (Axis I)
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MCMI-II Norms (1992)
› General norms (998 adults seeking therapy in
inpatient and outpatient settings)
› Correctional norms (1,676 incarcerated adults)
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MCMI-III New Norms (2008)
› Demographics:
 Sex: 397 (52.8%) women, 355 (47.2%) men
 Race/ethnicity: 83 (11%) African American, 4 (0.5%)
Native American, 11 (1.5%) Asian American, 70
(7.6%) Hispanic/Latino, 571 (76%) Caucasian, 12
(1.6%) Other
 Ages: 18-79
Theoretically based
 Strongly corresponds with DSM-IV
 Assess both Axis I and Axis II
 Brief measure
 Strong norms
 Psychometrically sound
 Resources for interpretation
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Clinical population
May indicate pathology when there is none
Heavy item overlap
Requires computer scoring
Unconventional approach to norms (i.e.,
BR)
Validity scales
May be more reflective of theory than DSM
Not all DSM diagnoses are well represented
Designed for individuals with a suspected
mental health disorder
 Appropriate for age 18 and older
 Requires a 6th grade reading level
 175 True or False items
 Can be administered in group or
individual setting
 Typically requires 25-30 minutes
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General MCMI-III Interpretive
Guidelines
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Consider the context of the testing (e.g., how this might impact
approach to test taking)
Examine validity indices
Review critical items
Examine severe personality disorders
Examine clinical personality patterns
Grossman Facet scales
Examine severe clinical syndromes
Examine clinical syndromes
Consider other data (e.g., background, hx, records review, other
test data, etc.)
Establish diagnosis
Generate treatment recommendations
Write report
Provide Feedback
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Omitted items – do not interpret if more than 10 items were omitted
Inconsistency Index (W): 44 pairs
Validity Index (V): 3 items of an improbable nature
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Disclosure (X): Self-revealing vs. defensive
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No BR
Degree of deviation from midrange of an adjusted composite raw score total for
the 11 personality scales
If raw score is below 34 = invalid
If raw score is above 178 = invalid
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21 item scale
BR, if BR is greater than 74 = “faking good”
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33 item scale
BR, if BR is 85 = “cry for help” or “faking bad”
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No BR
True response to 1 of these items = questionable profile; True response to 2 of these
items = invalid (do not interpret)
Desirability (Y): favorable light
Debasement (Z): negative light
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Severe Personality Disorder Scales
› Schizotypal (S)
› Borderline (C)
› Paranoid (P)
Should be interpreted first (prior to clinical personality
patterns)
 Interpret 3 highest personality elevations
 Base rate interpretations:
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BR 35 = normal population (non-clinical)
BR 60 = standard for clinical population (this was set by Millon)
BR of 75-84 = some characteristics are present
BR 85 and higher = most characteristics of a disorder are present
Note: BR under 75 are not considered clinically significant and
are not to be interpreted
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Clinical Personality Disorder Scales
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Schizoid (1)
Avoidant (2a)
Depressive (2b)
Dependent (3)
Histrionic (4)
Narcissistic (5)
Antisocial (6a)
Aggressive-sadistic (6b)
Compulsive (7)
Passive-aggressive (8a)
Self-defeating (8b)
Should be interpreted after severe personality disorder scales
Interpret 3 highest personality elevations
Guidelines for BR interpretation remain the same
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Severe Clinical Syndrome Scales
› Thought disorder (SS)
› Major depression (CC)
› Delusional disorder (PP)
Should be interpreted first (prior to
clinical syndromes)
 BR interpretation guidelines remain the
same
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Clinical Syndrome Scales
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Anxiety disorder (A)
Somataform disorder (H)
Bipolar: Manic disorder (N)
Dysthymic disorder (D)
Alcohol dependence (B)
Drug dependence (T)
Posttraumatic stress disorder (R)
Should be interpreted after severe clinical
syndrome scales
Guidelines for BR interpretation remain the
same
Practice Interpretation
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Patient – fictitious and created for the purpose of practice
interpretation
› Female, 53 years old, Caucasian
› Married with 2 college age children
› Family hx: no hx of bipolar or psychosis, paternal depression and
alcohol abuse, maternal depression
› Successful 20+ year military career, 2 deployments to OIF
(combat trauma exposure)
› Childhood sexual abuse by an uncle
› Retired from Army 2 years ago
› One psychiatric hospitalization (4 months ago)
› Civilian career in health care administration
› Is not applying for or interested in service connection
› Has a diagnosis of breast cancer
› New to outpatient mental health treatment – requesting help
with managing anxiety related to work, previous trauma, and
recent cancer diagnosis
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Consider the context of the testing (e.g., how this
might impact approach to test taking)
Examine validity indices
Review critical items
Examine severe personality disorders
Examine clinical personality patterns
Grossman Facet scales
Examine severe clinical syndromes
Examine clinical syndromes
Consider other data (e.g., background, hx, records
review, other test data, etc.)
Establish diagnosis
Generate treatment recommendations
Resources & References
Craig, R. (1999). Interpreting Personality
Tests: A Clinical Manual for the MMPI-2,
MCMI-III, CPI-R, and 16PF. New York: Wiley.
 Groth-Marnat, G. (2003). The Handbook of
Psychological Assessment. New York: John
Wiley & Sons. (Directed Reading)
 Millon, T. (Ed). (1996). The Millon Inventories.
New York: Guilford.
 Millon, T., Millon, C., Davis, R., & Grossman, S.
(2010). MCMI-III: Independent study training
program for the Millon Clinical Multiaxial
Inventory (MCMI-III) test. Pearson.
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