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 MCMI-III Overview 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 Millon’s theory draws on evolutionary theory to explain personality 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) 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 › 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 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 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 Make an inventory useful for diagnosing DSM disorders Assist with distinguishing between: › 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 MCMI-III uses BR instead of T or Z scores › Millon posits that these better reflect the skewed distributions of personality disorders 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) MCMI-II Norms (1992) › General norms (998 adults seeking therapy in inpatient and outpatient settings) › Correctional norms (1,676 incarcerated adults) 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 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 General MCMI-III Interpretive Guidelines 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 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 › › Disclosure (X): Self-revealing vs. defensive › › 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 › › 21 item scale BR, if BR is greater than 74 = “faking good” › › 33 item scale BR, if BR is 85 = “cry for help” or “faking bad” › › 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 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: › › › › › 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 Clinical Personality Disorder Scales › › › › › › › › › › › 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 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 Clinical Syndrome Scales › › › › › › › 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 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 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.