Millon Clinical Multiaxial Inventory-III (MCMI-III)

1. Millon Clinical Multiaxial Inventory-III (MCMI-III) Allison C. Aosved, PhD

2. Objectives • 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

3. Objective 1 MCMI-III Overview

4. Personality Models & Theories • 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

5. Theoretical Underpinnings • Theodore Millon’sbioevolutionary 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

6. Test Construction & Development • 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

7. Brief History of the MCMI • 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

8. MCMI-II vs. MCMI-III • 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

9. Rationale for MCMI-III • 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

10. Base Rates (BR) • 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

11. MCMI-III Final Form • 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)

12. MCMI-III Norms • 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

13. Strengths • Theoretically based • Strongly corresponds with DSM-IV • Assess both Axis I and Axis II • Brief measure • Strong norms • Psychometrically sound • Resources for interpretation

14. Limitations • 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

15. Administration • 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

16. Administration in VA MHA

17. Administration in VA MHA

18. Administration in VA MHA

19. Administration in VA MHA

20. Objective 2 General MCMI-III Interpretive Guidelines

21. General Interpretative 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

22. Interpretation – Validity Indices • 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 • No BR • True response to 1 of these items = questionable profile; True response to 2 of these items = invalid (do not interpret) • 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 • Desirability (Y): favorable light • 21 item scale • BR, if BR is greater than 74 = “faking good” • Debasement (Z): negative light • 33 item scale • BR, if BR is 85 = “cry for help” or “faking bad”

23. Interpretation – Severe Personality • 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

24. Interpretation – Clinical Personality • 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

25. Interpretation – Severe Clinical Syndromes • 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

26. Interpretation – Clinical Syndromes • 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

27. Objective 3 Practice Interpretation

28. Practice: Case • 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

29. Practice: Profile • 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

30. References Resources & References

31. 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.