Why the MMPI?
First, Let's Start with an Interview
In the mental health fields, professionals of every stripe rely extensively on “clinical interviewing.” It should be self-evident that in order to understand our clients’ troubles, professionals must talk to them. It is also obvious that an interview approach that is flexible enough to be useful with almost any problem and with almost any client is going to be indispensible.
That said, while indispensible, the clinical interview is problematic. No two people conduct interviews the same way. Furthermore, no interviewer ever conducts any two interviews in exactly the same way. The scientifically trained reader will recognize what I am hinting at: flexibility and adaptability–the very strengths of unstructured or semi-structured interviews–are the antithesis of consistency, i.e., reliability. It will be no surprise, then, to learn that professional judgments (e.g., diagnoses) are least reliable when made based on the clinical interview. Interview findings are also subject to biases and distortions in a number of ways. Of most concern to psychologists like me, interviews can fail to detect problems or issues that a patient cannot report (e.g., because they do not know) or will not accurately report their experiences because they have a motivation to down play problems (e.g., if assessed in an employment screening context) or over – state problems (e.g., pleading “insanity” in a legal context). One of psychology’s most important contributions to mental health is the development of questionnaires that are scientifically (or “empirically”) validated. This validation involves conducting research to develop and confirm that an assessment measure is
1. reliable, or consistent in measuring what it measures. Were we to set out to measure an attribute that is understood to be stable over time, such as, for example, intelligence in adulthood, and we developed a measure that gave vastly different scores for the same respondent when taking the test multiple times, we should suspect a problem. Consistency of test scores begins to build a case that the same attribute underlying the test score is reliably being tapped by our measurement instrument. Alternatively, as scores diverge from “consistency,” they ultimately converge on a completely random distribution of scores, suggesting the test is measuring nothing meaningful at all.
2. Once establishing a test is reliable, we want to establish that it is “valid”, i.e., that it measures what it is intended to measure and, relatedly, that it does not also measure other attributes that are not intended. Take, for instance, a paper and pencil vocabulary test that is intended to be a measure of . . . your vocabulary. That seems a fair way to go about it. This vocabulary test has 50 words, is that still fair? You read the word, and select the correct definition from among several multiple choice options. Straight forward. Let’s add the condition of a 3 minute time limit. Does this seem reasonable? It could be argued that mastry of the vocabulary items will result in shorter response times, and that well may be true, but something about this seems deeply unfair. It has turned the test into both a test of vocabulary and of reading speed. At least those two things. Perahps it also taps performance anxiety that is activated by being tested against time constraints. It is important to establish, via research, that a test is measuring what it is supposed to be measuring, while minimizing the inclusion of unintended “error variance.” Next, we need some norms.
3. We can only know what a given test score means once we have norms for a reference population against which to compare a client’s test scores.
The Minnesota Multiphasic Personality Inventory (MMPI) is a standardized psychological test for use by qualified psychologists to help assess the patient’s personality and mental health. First published in 1943, the original purpose of the test was for routine diagnostic assessments of hospitalized psychiatric patients.
What is the MMPI-2?
The MMPI-2 is the revised and currently used version of the original (MMPI) test. It is a standardized, empirically validated, norm-referenced, structured, true-or-false format self-report measure of personality and psychopathology. It assists psychologists in the assessment of mental health across diverse settings through the identification of specific problem areas including, but not limited to, symptom disorder and personality disorder diagnoses, as well as other psychological problems and vulnerabilities. The test is grounded in an extensive scientific research foundation that reaches back to the 1940’s, and it is the most widely used personality assessment test.
The 10 Clinical Scales
The test is comprised of 567 items. There are 10 clinical main scales reflecting, more or less, a number of the major mental health diagnostic categories. It seems that every discussion of the MMPI on the web organizes around a presentation of the 10 “main scales.” Why should I do any different? Actually, I will do something different after, but I will start with those 10 scales that are the cornerstone of MMPI-2 interpretation, as they were for the preceding original MMPI.
Originally developed to identify people with symptomatic preoccupations with the body and related fears of illness.
Developed to assess symptoms of clinical depression, such as questions persistent sadness, hopelessness, apathy, low morale, or suicidal thoughts.
Initially developed to identify hysterical reactions, i.e., the psychogenic (or caused by the mind) loss of physical functioning.
Originally intended to diagnose psychopathic personalities, this scale taps a wide variety of behaviours that might best be understood as reflecting an underlying trait of rebelliousness at one end of a continuum, contrasted with acceptance of authority at the other end of the continuum.
Not really a “clinical” scale, M/F identifies the extent to which patients conform with traditional stereotypes of gender norms.
Paranoia- This scale was developed for the purpose of diagnosing pateints with paranoid symptoms (e.g., delusions of reference, persecution, grandiosity, resentment).
Psychasthenia is an entity long since relegated to the history books of diagnostic antiquity. Literally meaning weakness or fatigue (“asthenia”) of the mind (“psyche”), it was an anxiety disorder broader in spectrum than those in use today, characterized by (a.) obsessions, (b.) compulsions, (c.) tics, (d.) fears or phobias, (e.) derealization and depersonalization, and (f.) feelings of inadequacy. Despite its antiquated (diagnostic) origin, the scale is retained as a useful, broad-spectrum index of turmoil or maladjustment.
Initially developed to identify and diagnose schizophrenia, this scale, especially when used in combination with other scales, is helpful for detecting and characterizing (including diagnosing) the nature of a psychotic condition.
Originally conceived as a measure for diagnosing hypomania, this scale also captures the more severe symptom manifestations of hypomania’s first – cousin, Mania.
Again, this scale is not meant to assess a discrete diagnostic syndrome, but rather, measures tendencies toward social withdrawal.
- Are you experiencing feelings of worthlessness and despair?
- Are you constantly preoccupied with your weight and taking drastic measures to avoid gaining weight?
- Do you wish that your personal relationships could be more satisfying?
- Do you feel a daily sense of panic and it’s impacting your lifestyle?
Information about the 10 main scales, such as given above, is meant to be informative, and it is, but it is also misleading. Most people imagine questionnaires they are familiar with already — brief “diagnostic” tests taken in their doctors office or in a magazine with a few items (10 to 20 or so) featuring highly “face valid” item content. Patients are often put to the task of scoring their own test results by summing the ratings given to each item. Isn’t the MMPI-2 a longer version of these simple, straight forward questionnaires? In a word, “no.”
MMPI -2 interpretation is complex. It begins with reviewing several validity scales which determine 1. if the client responded meaningfully to test items, or were their responses inconsistent (e.g., from confusion, attentional problems, lack of cooperation that led to inconsistent responding) and 2. if they responded accurately, or if they consciously or unconsciously down-played or over-stated their problems and symptoms. The main scales often come next, and here we examine not only individual scales and their score values, but, often more importantly, we examine the combination of scales that are considered to be elevated and outside of normal limits.
Turning back to individual scales again, each of these scales is considered to be “multi-faceted,” and 8 of the 10 have a number (between 3 and 8) of derivative subscales which are typically reviewed to help clarify how the main scale elevation is to be understood. In addition to those scales, there are some 56 other (supplementary and content) scales that are commonly used, not to mention there are literally thousands of research scales that have been developed and made available for use in the robust research literature on the test.
For more information about depression and to schedule a therapy session, please contact Dr. Crowhurst.