The Minnesota Multiphasic Personality Inventory (MMPI) is one of the most frequently used personality tests in mental health. The test is used by trained professionals to assist in identifying personality structure and psychopathology.

History and development

The original authors of the MMPI were Starke R. Hathaway, PhD, and J. C. McKinley, MD. The MMPI is copyrighted by the University of Minnesota. The standardized answer sheets can be hand scored with templates that fit over the answer sheets, but most tests are computer scored. Computer scoring programs for the current standardized version, the MMPI-2, are licensed by the University of Minnesota Press to Pearson Assessments and other companies located in different countries. The computer scoring programs offer a range of scoring profile choices including the extended score report, which includes data on the newest and most psychometrically advanced scales?the Restructured Clinical Scales (RC scales).^[1] The extended score report also provides scores on the more traditionally used Clinical Scales as well as Content, Supplementary, and other subscales of potential interest to clinicians. Use of the MMPI is tightly controlled for ethical and financial reasons. The clinician using the MMPI has to pay for materials and for scoring and report services, as well as a charge to install the computerized program. The tests are mentioned in Thomas Harris' 1988 novel The Silence of the Lambs, by character Clarice Starling, as ones she is familiar with.

MMPI

The original MMPI was developed in 1939 (Groth Marnat, Handbook of Psychological Assessment, 2009) using an empirical keying approach, which means that the clinical scales were derived by selecting items that were endorsed by patients known to have been diagnosed with certain pathologies.^{[2][3][4][5][6]} The difference between this approach and other test development strategies used around that time was that it was atheoretical (not based on any particular theory) and thus the initial test was not aligned with the prevailing psychodynamic theories of that time. The atheoretical approach to MMPI development ostensibly enabled the test to capture aspects of human psychopathology that were recognizable and meaningful despite changes in clinical theories. However, because the MMPI scales were created based on a group with known psychopathologies, the scales themselves are not atheoretical by way of using the participants' clinical diagnoses to determine the scales' contents.

MMPI-2

The first major revision of the MMPI was the MMPI-2, which was standardized on a new national sample of adults in the United States and released in 1989.^[7] It is appropriate for use with adults 18 and over. Subsequent revisions of certain test elements have been published, and a wide variety of subscales was also introduced over many years to help clinicians interpret the results of the original clinical scales, which had been found to contain a general factor that made interpretation of scores on the clinical scales difficult. The current MMPI-2 has 567 items, all true-or-false format, and usually takes between 1 and 2 hours to complete depending on reading level. There is an infrequently used abbreviated form of the test that consists of the MMPI-2's first 370 items^[8]. The shorter version has been mainly used in circumstances that have not allowed the full version to be completed (e.g., illness or time pressure), but the scores available on the shorter version are not as extensive as those available in the 567-item version.

MMPI-A

A version of the test designed for adolescents, the MMPI-A, was released in 1992.^[9] The MMPI-A has 478 items, with a short form of 350 items.

MMPI-2 RF

A new and psychometrically improved version of the MMPI-2 has recently been developed employing rigorous statistical methods that were used to develop the RC Scales in 2003.^[10] The new MMPI-2 Restructured Form (MMPI-2-RF) has now been released by Pearson Assessments. The MMPI-2-RF produces scores on a theoretically grounded, hierarchically structured set of scales, including the RC Scales. The modern methods used to develop the MMPI-2-RF were not available at the time the MMPI was originally developed. The MMPI-2-RF builds on the foundation of the RC Scales, which have been extensively researched since their publication in 2003. Publications on the MMPI-2-RC Scales include book chapters, multiple published articles in peer-reviewed journals, and address the use of the scales in a wide range of settings.^{[11][12][13][14][15][16][17][18][19][20][21][22][23]} The MMPI-2-RF scales rest on an assumption that psychopathology is a homogenous condition that is additive. ^{[24][25][26][27][28][29][30]}

Current scale composition

Clinical scales

Scale 1 (formerly known as the Hypochondriasis Scale) : Measures a person's perception of their health or actual injuries or health issues., Scale 2 (formerly known as the Depression Scale) : Measures a person's discouragement level., Scale 3 (formerly known as the Hysteria Scale) : Measures the emotionality of a person., Scale 4 (formerly known as the Psychopathic Deviate Scale) : Measures a person's need for control or their rebellion against control., Scale 5 (formerly known as the Femininity/Masculinity Scale) : Measures a stereotype of a person and how they compare. For men it would be the Marlboro man, for women it would be June Cleaver or Donna Reed., Scale 6 (formerly known as the Paranoia Scale) : Measures a person's ability to trust., Scale 7 (formerly known as the Psychestenia Scale) : Measures whether someone made it into adulthood with or without unresolved issues., Scale 8 (formerly known as the Schizophrenia Scale) : Measures a person's ability to have original or unique thoughts and whether they can think outside the box., Scale 9 (formerly known as the Mania Scale) : Measures a person's psychic energy., scale 0 (formerly known as the Social Introversion Scale) : Measures whether people like to be around other people.

The original clinical scales were designed to measure common diagnoses of the era. While the descriptions of each type were originally used in assessment, the current practice is to use the numbers only.

Codetypes are a combination of the one or two highest-scoring clinical scales (ex. - 8, 48). Codetypes and interaction of clinical scales can be quite complex and require specialized training to properly interpret.

Validity scales

The validity scales in the MMPI-2 RF are minor revisions of those contained in the MMPI-2, which includes three basic types of validity measures: those that were designed to detect non-responding or inconsistent responding (CNS, VRIN, TRIN), those designed to detect when clients are over reporting or exaggerating the prevalence or severity of psychological symptoms (F, Fb, Fp, FBS), and those designed to detect when test-takers are underreporting or downplaying psychological symptoms (L, K)). A new addition to the validity scales for the MMPI-2 RF includes an over reporting scale of somatic symptoms scale (Fs).

Content scales

To supplement these multidimensional scales and to assist in interpreting the frequently seen diffuse elevations due to the general factor (removed in the RC scales)^[31][32] were also developed, with the more frequently used being the substance abuse scales (MAC-R, APS, AAS), designed to assess the extent to which a client admits to or is prone to abusing substances, and the A (anxiety) and R (repression) scales, developed by Welsh after conducting a factor analysis of the original MMPI item pool.

Dozens of content scales currently exist, the following are some samples:

PSY-5 scales

Unlike the Content and Supplementary scales, the PSY-5 scales were not developed as a reaction to some actual or perceived shortcoming in the MMPI-2 itself, but rather as an attempt to connect the instrument with more general trend in personality psychology.^[33] The five factor model of human personality has gained great acceptance in non-pathological populations, and the PSY-5 scales differ from the 5 factors identified in non-pathological populations in that they were meant to determine the extent to which personality disorders might manifest and be recognizable in clinical populations. The five components were labeled Negative Emotionality (NEGE), Psychoticism (PSYC), Introversion (INTR), Disconstraint (DISC) and Aggressiveness (AGGR).

Scoring and interpretation

Like many standardized tests, scores on the various scales of the MMPI-2 and the MMPI-2-RF are not representative of either percentile rank or how "well" or "poorly" someone has done on the test. Rather, analysis looks at relative elevation of factors compared to the various norm groups studied. Raw scores on the scales are transformed into a standardized metric known as T-scores (Mean or Average equals 50, Standard Deviation equals 10), making interpretation easier for clinicians. Test manufacturers and publishers ask test purchasers to prove they are qualified to purchase the MMPI/MMPI-2/MMPI-2-RF and other tests.

Criticism and controversy

RC and Clinical Scales

Some questions have been raised about the RC Scales and the forthcoming release of the MMPI-2-RF, which eliminates the older clinical scales entirely in favor of the more psychometrically appealing RC scales. The replacement of the original Clinical Scales with the RC scales has not been met with universal approval, and has warranted enough discussion to prompt a special issue of the academic Journal of Personality Assessment (Vol 87, Issue 2, October 2006) to provide each side with a forum to voice their opinions regarding the old and new measures.

Individuals in favor of retaining the older Clinical scales have argued that the new RC scales are measuring pathology which is markedly different than that measured by the original clinical scales.^[34][35] This claim is not supported by results of research, which has found the RC scales to be cleaner, more pure versions of the original clinical scales because 1) the interscale correlations are greatly reduced and no items are contained in more than one RC scale and, 2) common variance spread across the older clinical scales due to a general factor common to psychopathology is parsed out and contained in a separate scale measuring demoralization (RCdem).^[36][37] Critics of the new scales argue that the removal of this common variance makes the RC scales less ecologically valid (less like real life) because real patients tend to present complex patterns of symptoms. However, this issue is addressed by being able to view elevations on other RC scales that are less saturated with the general factor and, therefore, are also more transparent and much easier to interpret.

Critics of the RC scales assert they have deviated too far from the original clinical scales, the implication being that previous research done on the clinical scales will no longer be relevant to the interpretation of the RC scales and the burden of proof should be on the RC scales to demonstrate they are clearly superior to the original clinical scales. Proponents of the RC scales assert that research has adequately addressed those issues with results indicating that the RC scales predict pathology in their designated areas better than their concordant original clinical scales while using significantly fewer items and maintaining equal to higher internal consistency reliability and validity, and are not weaker at identifying the core elements of the original clinical scales; further, unlike the original clinical scales, the RC scales are not saturated with the primary factor (demoralization, now captured in RCdem) which frequently produced diffuse elevations and made interpretation of results difficult; finally, the RC scales have lower interscale correlations and, in contrast to the original clinical scales, contain no interscale item overlap.^[38] A more basic criticism is that the MMPI-2 RF scales rest on an assumption that psychopathology is a homogenous condition that is additive. Although symptoms are mainly homogenous, most psychodiagnostic conditions such as hysteria, PTSD, DID are composed of defenses, contradictory states, and seemingly unrelated signs and symptoms that can not be measured by scales that were made to have high internal consistency.

Lees-Haley "Fake Bad" Scale

The following discussion concerns the Lees-Haley "fake bad" scale; there are several other "fake bad" scales (aside from the standard F and Fb scales, which are the original "fake bad" scales) that have been in existence since 1950, and which have not been subject to the same kind of controversy as the Lees-Haley "fake bad" scale. These include the F-K scale ^[39], the Gough Dissimilation index (Ds-r) ^[40], and the Wiener-Harmon Subtle and Obvious Scales (S-O) ^[41].

In March 2008 a front page article in the Wall Street Journal^[42] exposed what it claimed to be the lack of scientific validity of the Lees-Haley "fake bad" scale, which is used in courts as argument for malingering in injury litigation. According to the article two Florida judges barred use of the scale after special hearings on its scientific validity.

The article reports that this particular "fake bad" scale was developed by psychologist Paul Lees-Haley, who works mainly for defendants (insurance companies etc.) in personal injury cases. The article reports that in 1991 Lees-Haley paid to have an article supportive of his scale published in Psychological Reports, which the Wall Street Journal described as "a small Montana-based medical journal." The scale was introduced in MMPI after a review of the literature. This review was considered flawed by its critics because at least 10 of 19 studies reviewed were done by Lees-Haley or other insurance defense psychologists, while 21 other studies critical of the test were excluded from the review.

One of the critics of the Lees-Haley "fake bad" scale is retired psychologist James Butcher, who found that more than 45 percent of psychiatric patients he studied had Lees-Haley Fake Bad Scale scores of 20 or more, which according to the Lees-Haley "fake bad" scale meant they were malingering. Butcher contends that it is unlikely that so many psychiatric patients misled doctors. The article quotes Butcher concluding:

However, Butcher's own study has been criticized on methodological and conceptual grounds, including the likelihood that his subject pool included many malingerers, that he ignored recommended gender-related cut-offs, and used a less sensitive or specific MMPI-2 scale as his 'gold-standard.' ^[43]

Despite the reservations of the MMPI-2 and MMPI-R authors (including James Butcher) who have a degree of proprietary control over the test, an independent professional panel recommended that the Lees-Haley FBS be included in the standard Pearson scoring system. ^[44]

Several studies by independent Neuropsychologists have since been published in respected peer-reviewed journals supporting the Lees-Haley FBS scale as highly sensitive and specific (when proper cut-offs are used) in identifying individuals who are exaggerating somatic symptoms (as opposed to psychiatric, mood, or neurological symptoms) in settings where the base-rate of malingering is typically high (litigation, pain clinics, etc.), as it was designed to do. ^[45]

The Lees-Haley "fake bad" scale is now regarded by some authors as a 'gold standard' in such populations. ^[46]

Notes

See also

• Employment testing
• Big five personality traits
• 16PF Questionnaire
• Meyers-Briggs Type Indicator (MBTI)
• Neuroticism Extraversion Openness Personality Inventory (NEO-PI)

External links

• MMPI-2, Pearson Website
• MMPI-A (Minnesota Multiphasic Personality Inventory-Adolescent)
• MMPI Research Project
• National Institute of Mental Health (NIMH) Home Page

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