Millon Clinical Multiaxial Inventory (MCMI) PDF

Preview

Summary

It summarized Millon Clinical Multiaxial Inventory (MCMI) Psychometric tests in short and precisely....

Description

Running head: Millon Clinical Multiaxial Personality Inventory

University of Gondar Collage of Social sciences and Humanities Department of Psychology

Course Name: Measurement and Test in Psychology Course Code: Psyc

Submitted to: Sisay Haile/PHD/

May,2018 Gondar, Ethiopia

Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel: 0913465212

Millon Clinical Multiaxial Personality Inventory

Summary of Millon Clinical Multiaxial Personality Inventory (MCMI)

1 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory

Table of Contents 1.

Essence of Millon Clinical Multiaxial Inventory (MCMI)...............................................................4

2.

History and Development...................................................................................................................4 2.1. Development of the MCMI-III........................................................................................................4

3.

Theoretical Considerations.................................................................................................................5

4.

Reliability and Validity.......................................................................................................................6

5.

Assets and Limitations of MCMI.......................................................................................................7

6.

Interpretation Procedure....................................................................................................................8 A. Determine Profile Validity.................................................................................................................8 B. Interpret the Personality Disorder Scales.........................................................................................8 C. Interpret Clinical Syndrome Scales..................................................................................................9 D. Review Noteworthy Responses (Critical Items)...............................................................................9 E. Provide Diagnostic Impressions.........................................................................................................9 F. Elaborate on Treatment Implications and Recommendations.........................................................9

7.

Modifying Indices (Validity Scales)..................................................................................................10 I. Validity Index (Scale V).....................................................................................................................11 II. Disclosure Index (X).........................................................................................................................11 III. Desirability Index (Y).....................................................................................................................11 IV. Debasement Index (Z).....................................................................................................................12

8.

Clinical Personality Patterns............................................................................................................12 I. Schizoid (Scale 1)...............................................................................................................................12 Frequent Code Types........................................................................................................................12 Treatment Implications.....................................................................................................................13 II. Avoidant (Scale 2A)..........................................................................................................................13 III. Depressive (Scale 2B)......................................................................................................................14 IV. Dependent (Scale 3).........................................................................................................................15 V. Histrionic (Scale 4)............................................................................................................................16 VI. Narcissistic (Scale 5).......................................................................................................................17 VII. Antisocial (Scale 6A)......................................................................................................................17 VIII. Aggressive (Sadistic; Scale 6B)....................................................................................................18 IX. Compulsive (Scale 7).......................................................................................................................19 X. Passive-Aggressive (Negativistic; Scale 8A)....................................................................................20

2 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory XI. Self-Defeating (Scale 8B)................................................................................................................21 9.

Severe Personality Pathology...........................................................................................................21 I.

Schizotypal (Scale S).....................................................................................................................21

II.

Borderline (Scale C)..................................................................................................................22

III.

Paranoid (Scale P).....................................................................................................................23

10.

Clinical Syndromes........................................................................................................................24

I.

Anxiety (Scale A)...........................................................................................................................24

II.

Somatoform (Scale H)...................................................................................................................24

III.

Bipolar: Manic (Scale N)...........................................................................................................24

IV.

Dysthymia (Scale D)..................................................................................................................25

V.

Alcohol Dependence (Scale B)......................................................................................................25

VI.

Drug Dependence (Scale T).......................................................................................................25

VII.

Posttraumatic Distress Disorder (Scale R)..............................................................................25

11. I.

Sever Syndromes...........................................................................................................................25 Thought Disorder (Scale SS)........................................................................................................25

II.

Major Depression (CC).............................................................................................................26

III.

Delusional Disorder (PP)...........................................................................................................26

References...................................................................................................................................................27

3 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory

1. Essence of Millon Clinical Multiaxial Inventory (MCMI)

The Millon Clinical Multiaxial Inventory (MCMI) is a standardized, self-report questionnaire that assesses a wide range of information related to a client’s personality, emotional adjustment, and attitude toward taking tests. It has been designed for adults (18 years and older) who have a minimum of an eighth-grade reading level. The MCMI is one of the few self-report tests that focus on personality disorders along with symptoms that are frequently associated with these disorders. Originally developed in 1977 (Millon, 1977), it has since been through two revisions (MCMI-II; Millon, 1987; MCMI-III; Millon, 1994, 1997). The current version, the MCMI-III, is composed of 175 items that are scored to produce 28 scales divided into the following categories: Modifying Indices, Clinical Personality Patterns, Severe Personality Pathology, Clinical Syndromes, and Severe Syndromes. The scales, along with the items that comprise the scales, are closely aligned to both Millon’s theory of personality and the DSM-IV (1994). It takes only 20 to 30 minutes to complete. It should not be considered to provide diagnosis. Instead, it provides considerable information relevant to diagnosis. Factors that greatly assist in useful interpretation are familiarity with the theoretical constructs as well as experience with relevant clinical populations. This emphasis on clinical populations also focuses on the principle that the MCMI is intended for psychiatric populations and should not be used with normal persons or those who are merely mildly disturbed. Interpretations should be restricted to persons who scored at or above the designated cutoff scores (75 and 85). Practitioners should resist the temptation to attempt interpretations of persons who have mild “elevations” on the scale but who are still clearly below the formal cutoff.

4 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory

2. History and Development 2.1. Development of the MCMI-III Ongoing research, new conceptual developments, and the publication of the DSM-IV contributed to the MCMI-II’s revision into its latest version, the MCMI-III (Millon, 1994, 1997). With procedures similar to those used for the MCMI and MCMI-II, a provisional 325-item test was developed; Depressive and PTSD scales were added. The Self-Defeating and Sadistic Personality Disorder scales were maintained, although these diagnoses were eliminated from the DSM-IV. The final MCMI-III still totaled 175 items, but 90 of the items from the MCMI-II were “changed” (85 remained the same). Actually, most of the changed items remained essentially the same in their primary content; the alterations related mostly to increasing the severity of the symptoms. This was done to decrease the number of people endorsing particular items, in the hope that the MCMI-III would be more selective in suggesting pathology. In addition, the items per scale were reduced by half, and the number of keying’s was reduced from 953 on the MCMI-II to only 440 for the MCMI-III. The possible ratings per item were reduced from 1, 2, or 3 to either 1 or 2. The resulting 28 scales are divided into the categories.

3. Theoretical Considerations The development of the three versions of the MCMI has been partially guided by Millon’s theories of personality. One of his core principles is the use of the polarities of pleasure pain, active-passive, and self-other (R. Davis, 1999; Millon & Davis, 1996; Strack, 1999, as cited in [ CITATION Gar03 \l 1033 ]). These can be related to the fundamental evolutionary tasks of each person in that they must struggle to exist /survive (pleasure-pain), use various efforts to adapt to their environment or adapt their environment to themselves (passive-active), and invest in other people as well as themselves (other-self). Each of these polarities can be used to describe differences in personality organization for normal persons as well as those with personality disorders. Scale elevations should always be placed into the context of the person’s life. A high score is not diagnostic of a personality disorder in and of itself. If there is no or little distress or impairment, a 5 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory personality disorder should not be diagnosed. This point is particularly crucial for the Compulsive (7), Histrionic (4), and possibly Narcissistic (5) scales because evidence is accumulating that these scales may not be measuring significant levels of pathology (Craig, 1999 as cited in [ CITATION Gar03 \l 1033 ]). Finally, the different categories of scales (Clinical Personality Patterns, Severe Personality Pathology, Clinical Syndrome, Severe Syndrome) are conceptually and clinically related. The first two categories relate to Axis II diagnoses but are separated to designate the greater levels of severity for the schizotypal, borderline, and paranoid conditions.

4. Reliability and Validity Reliability and validity studies on the MCMI indicate that it is generally a well-constructed psychometric instrument. Measures of internal consistency have been particularly strong. For the MCMI-III, alpha coefficients exceed .80 for 20 of the 26 scales, with a high of .90 for the Major Depression scale and a low of .66 for Compulsive (Millon, 1994, 1997 as cited in [ CITATION Gar03 \l 1033 ]). Test-retest reliabilities have been moderate to high. The MCMI-III manual reports that over a 5to 14-day interval, test-retest reliability had a median of .91 (the high was .96 for Somatoform and the low was .82 for Debasement). Craig (1999 as cited in [ CITATION Gar03 \l 1033 ]) has summarized three data sets on test reliabilities ranging from 5 days to 6 months by stating that the median reliability was .78 for the Personality scales and .80 for the Clinical Syndrome scales. Much longer term test-retest reliabilities spanning 4 years ranged from a high of .73 for Passive-Aggressive to a low for Dependent of .59 (Lenzenweger, 1999 as cited in [ CITATION Gar03 \l 1033 ]). This is roughly equivalent to other stable dimensions of personality. Because the personality scales theoretically represent enduring, ingrained characteristics, they should have greater stability than the clinical scales, which are based on more changeable symptomatic patterns. In some cases, this has been found to be true; in others, little difference has been found. Studies on the MCMI-I have indicated the theoretically expected higher stability for the personality scales as opposed to the clinical scales (Piersma, 1986 as cited in [ CITATION Gar03 \l 1033 ]). In

6 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory contrast, as cited in [ CITATION Gar03 \l 1033 ], the Craig (1999) summary found very little difference between the mean personality and clinical scales, despite an extended retesting interval. Similarly, the MCMI-III manual reported a mean of .89 for the personality scales and a slightly greater mean of .91 for the clinical scales. This suggests that the original MCMI may have had the theoretically higher temporal stability for the personality scales versus the clinical scales, but later versions have roughly equivalent temporal stabilities between the two categories of scales. One central issue when evaluating the validity of the MCMI is the extent to which validity studies on previous versions can be generalized to the newer versions. With appropriate caution, some transferability is probable because the correlations between the MCMI-II and MCMI-III scales are moderately high. Specifically, the correlations range from a high of .94 for Debasement to a low of .59 for Dependent, with 12 of the 25 scale comparisons above .70.

5. Assets and Limitations of MCMI The strategy of developing the MCMI has been commendable and innovative. Each of the procedures has progressed in a stepwise manner; only those items that survived the previous steps were retained. The result has been an instrument that adheres closely to theory, demonstrates good reliability, and has shown excellent promise regarding internal and external validity. The use of BR scores has been a noteworthy innovation and has probably resulted in increases in diagnostic accuracy. However, difficulties have been noted related to the extensive item overlap and low level of inter-diagnostician agreement among clinicians using methods such as structured interviews and the MMPI. The scale abbreviations are also “user unfriendly.” The MCMI is a relatively time-efficient test that potentially produces a wide range of information. In addition to knowing the client patterns that lead to symptoms, considerable literature supports the usefulness of knowing a client’s status related to personality disorder. Despite the assets of the MCMI, there are a number of inherent difficulties in the assessment of personality disorders. One central issue is that there is no “benchmark” or “gold standard” with which to compare the MCMI assessments. Individual clinicians relying on interview information generally have low

7 | P a g e Compiled by: Erkihun Alemneh, ID No.-GUR/11463/10, email: [email protected], Tel:0913465212

Millon Clinical Multiaxial Personality Inventory inter-diagnostician agreement (median kappa page.25; J. Perry, 1992 as cited in [ CITATION Gar03 \l 1033 ]).

6. Interpretation Procedure Effective interpretation of the MCMI requires considerable sophistication and knowledge related to psychopathology in general and personality disorders in particular. At a minimum, practitioners should be familiar with issues related to personality disorders, along with the DSM-IV criteria. Ideally, practitioners should also have read Millon and Davis’s (1996) definitive Disorders of Personality: DSM-IV and Beyond, worked with clients with personality disorders, and administered the MCMI to a number of such clients.

A. Determine Profile Validity Before interpreting the personality and clinical scales, practitioners must be assured that the client has not over or underreported symptoms or responded in a random manner. The profile validity can be assessed by noting the pattern of scores on the Modifying Indices (validity indicators): Random responding is suggested by scores of one or more on the three items of the MCMI-III Validity scale (“True” on items 65, 110, and 157). Underreporting of difficulties on the MCMI-III is suggested by low scores (raw score less than 34) on Disclosure (X) and Debasement (Z) and a high score (BR over 75) on Desirability (Y; an “arrow” profile on the Modifying Indices). Fake bad profiles are suggested by a high score (raw score above 178) on Disclosure (X) and a high score (BR above 75) on Debasement (Z; a “valley” profile on the Modifying Indices).

B. Interpret the Personality Disorder Scales As cited in [ CITATION Gar03 \l 1033 ], Retzlaff (1995) recommends that, when interpreting the personality disorder scales, practitioners should first check to see whether any of the Severe Personality Disorder scales are elevated. If so, this strongly suggests that one or more of the Clinical Personality Pattern scales will also be elevated. However, the high scale(s) on the Severe Personality Disorder section should take precedence over equivalently elevated scales on the Clinical Personali...