Interpretation and Reporting MCMI-III Interpretation and Reporting

Issues Related to Interpretation Gender Ethnicity Age Code types

Scale Elevation Personality Patterns: Clinical Syndromes: 70 - 74 - likely to possess traits of the construct BR 75-84 - clinically significant personality traits BR 85 + - Personality disorder Clinical Syndromes: 60 - 74 - likely to possess some symptoms of the syndrome BR 75-84 - presence of a syndrome BR 85+ - prominence of syndrome

Level of adjustment How many scales are elevated above 75? The higher the elevation, the more the dysfunction - in general Narcissistic, Histrionic, Compulsive Scales can show strengths of pathology modest levels are healthy Look at Modifying Indices

Formulating diagnoses Look at elevation Look at contextual information including clinical impressions Look at prototypal items

Steps in Interpretation 1. Determine profile validity 2. Interpret the Personality Disorder Scales 3. Interpret Clinical Syndrome Scales 4. Review noteworthy responses 5. Provide diagnostic impressions 6. Write a personality description 7. Treatment implications and recommendations

1. Determine Profile Validity Scale V (Validity Index) Items 65, 110, 157 2 or more true responses - invalid profile 1 true response - “questionable validity” Scale X (Disclosure Index) If raw score is below 34 - invalid and defensive underreporting If raw score is above 178 - invalid and exaggeration of symptoms X is only scale on MCMI where er interpret high and low - others only interpreted if above 75

1. Determine Profile Validity Scale Y - (Desirability Index) Measure of defensive responding BR above 75 (not necessarily invalid) indicates presenting self in an overly positive, moral, emotionally stable, gregarious manner - “faking good” the higher the score, the more the person is concealing Scale Z (Debasement Index) Opposite from Desirability Index BR above 75 - self description is negative, pathological Above 85 - could be a cry for help Z - feelings of being angry, crying easility, low self-esteem, possible self-destruction,tense, guilty, depressed Can have high score on bot Y and Z but not likely

2. Interpret Personality Disorder Scales Check elevations on Severe Personality Disorders Primary focus for diagnosis Check elevations on Clinical Personality Scales Clinical Personality Scales serve to color or elaborate on Severe Personality Pattern elevations (unless extremely elevated compared with severe scales) Guidelines 75-84 = patterns/traits 85+ = disorder Moderate on severe<high on personality disorder (85+) Marginally elevated = 75 to 80 range 75 to 84=syndorme, pattern is present 85 above indicates promience

Severe Personality Pathology Scale S (Schizotypal) Like DSM IV Schizotypal personality disorder Cognitively dysfunctional Interpersonally detached, prefers social isolation Appear self-absorbed and ruminative Behaviorally eccentric and perceived by others as strange or different Communication style – tangential, personal irrelevancies and magical associations Some are detached and emotionally bland others are more suspicious, anxious and apprehensive Prognosis is poor May need medication FREQUENT CODE TYPES: Clinical: PP, SS; Personality: 1, 2A, P Between schizoid and schizophrenia – can coext Autistic of cognitively confused, tangential thought Eccentricity, disorganization and social isolation Peculiar mannerisms, starneg clothes, bizzare expressions s Alienated, isolated, fragmented Drfters Little distinction between fantasy and reality Lack interest and energy to initiate social interactioj 1=schizoid, SS= Thought Disorder, PP= Delusional Disorder Schizoid and schizophrenic may co-exist 1=schizoid 2-Avoidant P=paranoid SS= thought disorder PP= delusional disorder

Scale C (Borderline) Unstable moods and behavior Can be self-destructive, self-mutilation Marked mood swings, intermittent periods of depression, generalized anxiety and intense emotional attacks on others Interpersonal difficulties – ambivalence, instability and intensity React strongly to fears of abandonment Idealizes and devalues others Poorly defined sense of self Feelings of emptiness Disorganized thoughts - may have psychotic episodes under stress At risk for depression and suicide FREQUENT CODE TYPES: Clinical: N,D, B,T; Exaggerations of less dysfunctional personality disorders: 3,4,5,8A, 8B Mood disorders and substance abuse are frequent Can be seen as exaggerations of masochistic, passive-aggressive, dependent, hsitrionic, narc Extremely concerned with maintain emoional supprt from othesr 3= Dependent 4=Histrionic 5=Narcissistic 8A = Passive agrressive 8B: Self Defeating

Scale P (Paranoid) Suspiciousness and defensiveness with others Feelings of superiority Vigilant to criticism and deceit Abrasive, touchy, hostile and irritable Externalizes blame Describe self as misunderstood, righteous, suspicious, mistreated and defensive Will attack and humiliate those they feel are trying to control or influence them May have delusions of grandeur, ideas of reference, intense fears of being persecuted (psychotic delusions may be present) FREQUENT CODE TYPES: Clinical symptoms: A, PP,SS Personality Scales: 2A, 5, 6B, 8A Anxiety is the Axis 1 complication 0 or OCD Tightly organized and coherent personality and cognitive structure that makes them feel emotionally and physically disconnected 2A – avoidant 5=Narc 6B=Sadistic 8A= Passive aggressive

Clinical Personality Patterns Scale 1(Schizoid) Little or no interest in others Detached, impersonal, withdrawn Peripheral role in family, work, social situations Lack of depth to feelings Indifferent to praise or criticism Communication is vague, distant and unfocused (spacey) Not disturbed by much, makes decisions easily, self sufficient FREQUENT CODE TYPES: Clinical symptoms: A, SS; Personality Scales: 2A, 3,7,8A Avoidants are the most frequent cleitns in therapy Clinical Anxiety – thoguht disorder Personality – Avoidant, dependent, Compulsive, passive aggressive

Clinical Personality Patterns Scale 2A: Avoidant Want to be involved and accepted by others Vigilant to environment Sense of unease, disquiet, anxiety and overreaction to minor events Preoccupied with intrusive, fearful and disruptive thoughts Perceive themselves as socially inept, inadequate Feel alone, empty, isolated Prone to social phobia and frequently depressed Sensitive to the needs and perspectives of others, compassionate and emotionally responsive FREQUENT CODE TYPES: Clinical: A, D, H; Personality: 1,3,5, 6A,8A. Personality – schizoid, dependent, Narc, antisocial, Passive-aggressive

Clinical Personality Patterns Scale 2B: Depressive Enduring pattern of thoughts, attitudes, behaviors and self-concepts related to depression Feels worthless, inadequate, guilty, self critical Forlorn, discouraged, hopeless Helpless and immobile in solving life’s problems Angry, resentful, pessimistic in relationships FREQUENT CODETYPES: Clinical: D, N Personality: 1,2A,8A,8B,C Depresive personality disorered is distinguished from major affective – early, extended onset and many traits of depression Dependent- elevation consistent with bulimia – others see them as gullible, wishy washye Describe self as placating, passive, immature and deserted Pers: avoidant, schizoid, passive aggressive, self defeating, Borderline

Clinical Personality Patterns Scale 3 (Dependent) Feelings of being incapable and incompetent of functioning independently Inadequate, insecure, low self-esteem Submissive and cooperative in relationships Agreeable, minimizes problems Well-liked because of compliance, values opinion of others., defuses conflict, warm tender, loyal in friendships FREQUENT CODETYPES: Clinical: A,D,N; Personality: 1, 2A, 4, 7, 8A, 8B Anxiety – could include – panic attacks, aocial phobias, agiraphobia – fears of separation

Clinical Personality Patterns Scale 4 (Histrionic) Dramatic, colorful and emotional Tolerance for boredom is low Describe self as active, egocentric, exhibitionistic, flighty, extroverted, flirtatious Charming and outgoing, attention seeking Can be loud, demanding and uncontrollable Strong needs for dependency Can be warm, emotionally responsive, good sense of humor, adaptable Good social adjustment, low levels of distress FREQUENT CODETYPES: Clinical: A, H,B,T; Personality: 3,5,6A,7,8A Dissociative behaviors, conversion reactions If histrionic is the only elevated scale =- not a PD but a style of adapting Constantly seeking new situations Conflicted, painful feelings which they avoid Narc – frequently feel entitled – workers comp, make good first impression – interpret as a style if milfdly elevated, or if the only elevation Failures are rationalized, and conflicts are minimized Deprecates others to make selves look superior

Clinical Personality Patterns Scale 5 (Narcissistic) Exaggerated sense of self-importance and competence Hypersensitive to criticism Conventional rules of behavior do not apply Arrogant, haughty, snobbish, conceited Presents as intelligent, sophisticated, outgoing and charming Lacking in empathy Potential for substance abuse and depression is high Subset will be well adjusted without much emotional distress FREQUENT CODETYPES: Clinical: D,N,B,T ; Personality: 2A,3,4,6A,8A

Clinical Personality Patterns Scale 6A (Antisocial) Duplicitous, illegal behavior designed to exploit the environment for self gain Impulsive acting-out Provocative, violent, vicious, self-centered, dominant Avoids perceived abuse and victimization through their behavior Ignores consequences of behavior Lack of empathy and remorse Mistrustful, suspicious, guarded with others Can be gracious, charming and friendly Alcohol and drug dependence are common FREQUENT CODETYPES: Clinical: B,T,N,D; Personality: 2A,3,4,5,6B,7,8A Anti - Interpersonally irresponsible aggressive - Type A personality

Clinical Personality Patterns Scale 6B (Aggressive-Sadistic) Gets pleasure by humiliating and violating others’ rights Hostile and combative Dominating, antagonistic, frequent persecutory actions Competitive, hardheaded, authoritarian and socially intolerant Can be physically aggressive Sometimes enter socially approved roles and disguise aggression (example police officer) Unaffected by pain and punishment No shame, guilt or sentimentality Can cope effectively with many challenges – unflinching and daring FREQUENT CODETYPES: Personality:5, 6A, 7, P Infrequent elevation When 7 is elevated – methodcial and disciplined expressionof aggression

Clinical Personality Patterns Scale 7 (Compulsive) Coincides with DSM IV Obsessive-compulsive personality disorder Conformity, discipline, self-restraint and formality Adheres strictly to social norms Conscientious, well prepared, righteous and meticulous Fears social disapproval, deny hostility Disciplined, self-restraint, high demands on themselves Overt passivity and public compliance Loyalty, prudence, consistency, predictability. Approaches problems with maturity and competence High achievers – rarely report psychiatric distress FREQUENT CODETYPES: Clinical: A,D ; Personality: 1,2A, 2B, 4,5, 6A Comp – relflect more a person’ adaptive stlye, Hard workers – no leisure, Strong sense of duty Usually not accompanied by elevations on other scales – a well developed population – less overlap Depression of the agitated nature Minimize risk by becoming perfoectionsitci, distant and aloof in relations Negativistic individuals Acti on resentments in impulsive and erratic ways “raw deal” in life Externalize blame – little insightinto behaior

Clinical Personality Patterns Scale 8A (Passive- Aggressive- Negativistic) Approximates DSM III-R Passive-Aggressive personality disorder Indirect expression of negative emotion Passive compliance combined with resentment and opposition Guilty and conflicted over their feelings of resentment Moody, complaining and intermittently hostile Chronic unhappiness – pessimism, disillusionment and cynicism Moody and unpredictable At best can be agreeable and friendly – flexible, emotionally responsive and sensitive FREQUENT CODETYPES: Clinical: D,A, H; Personality: 1, 2A, 3, 4, 5, 6A, 6B Frequently feel rejected – likley to experience depression

Clinical Personality Patterns Scale 8B (Self-Defeating-Masochistic) Like DSM III-R self defeating –masochistic personality disorder Place themselves in the victim role Relate to others in an obsequious and self-sacrificing manner Feel they deserve to be shamed and humbled Inferior, nonindulgent, unassuming and self-effacing Unempathic and distrustful in relationships Anxious, apprehensive, mournful, anguished and tormented They are involved and connected with people Can have good insight into problems- level of distress high enough to be motivated for treatment FREQUENT CODETYPES: Clinical: D, A, H; Personality: 2A, 2B, 3, C Can encourage others to take advantage of them Focus on deficits Self deefating – risk of depression, anxiety – paradoc in therapy – make them happier – but they don’t want to be happy

3. Interpret Clinical Syndrome Scales Interpret Severe Clinical Syndrome Scales Often several complementary scales will be elevated together Interpret Basic Clinical Syndrome Scales Guidelines: BR between 60 to 74 are suggestive but not sufficiently indicative of pathology BR 75-84 = clinical syndrome BR 85+ = presence of pathological symptom

4. Review noteworthy responses Similar to Critical Items of MMPI Organized around topics of Health Preoccupation Interpersonal Alienation Emotional Dyscontrol Self-Destructive Potential Childhood Abuse Eating Disorders Rationally categorized – can be used to orgaize the clinical interview – inserted selectuively into a report

5. Provide Diagnostic Impressions (if any) Axis I: Clinical Disorders Axis II: Personality Disorders

6. Personality Description Write a personality description based on previous steps. Attempt to understand meaning of clinical syndrome for client’s personality functioning

7. Treatment Implications and Recommendations Give priority to the Clinical Syndrome Scales Treatment suggestions for personality patterns are listed in Groth-Marnat

Mid-term 20 multiple choice/fill-in-the-blank questions (worth 2 points each – 40 pts.) Choose 3 out of five short essay (worth 5 points each -15 pts) 1 MMPI-2 Profile Interpretation worth 35 points (open book)

Multiple Choice/Short Essay REVIEW: Lectures 1/15-2/12 Groth-Marnat Chapters 1, 2, 3, 7, 8 Graham Chapters 3, 4, 5, 12

For Profile Interpretation/ Write-up Bring and have thorough knowledge of Graham: Chapters 3, 4, 5 and 10 Bring Groth-Marnat –Know how to use Chapter 7