Construct Validity of MMPI-2-RF Scales in a Forensic Inpatient Hospital Setting Nasreen Toorabally & Isabella Romero Supervised by Dr. Danielle Burchett California State University, Monterey Bay In collaboration with Dr. David Glassmire Patton State Hospital 1

MMPI-2-RF The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) one of the most widely used assessment tools by mental health clinicians in the U.S. (Camara, et. al, 2000; Graham, 2011) The MMPI-2-RF [Restructured Form] is a 338-item self-report measure. Using 51 scales, it measures o psychopathology (mental illness), personality constructs o accuracy of self-report 2

Research Question Can the MMPI-2-RF distinguish between individuals diagnosed with different disorders (construct validity) in a forensic inpatient setting? 3

Past Research 4

Psychopathology in Mood vs. Psychotic Disorders EID and THD scales are especially useful in differentiating between patients diagnosed with schizophrenia or mood disorders (e.g., major depressive disorder) (Sellbom et al., 2012). 5

Psychopathology in Sex Offenders Paraphilic disorders are assessed by MMPI-2-RF, such as pedophilic disorder Sex offenders against children tend to report higher levels of depression, anxiety, and somatic concerns, as well as lower self-esteem (Kalichman, 1991). 6

Current Study *Can the MMPI-2-RF distinguish between patients diagnosed with different disorders (Construct validity) in a forensic inpatient setting? Two studies: Study 1: Study 1: Mood vs. Psychotic Study 2: Study 2: Pedophilic Disorder vs. Other Paraphilic Disorders 7

Study 1 Study 1 Mood vs. Psychotic Disorders 8

Study 1 Sample Demographics 66.7% Male 57.1% Caucasian 20% African American Mean Age = 41 Years (SD = 11.4) 9

Study 1 Method 1, Psychotic Disorder All other Diagnoses Total Sample Mood & Psychotic Disorder Mood Disorder Mood & Psychotic Disorder All other Diagnoses Psychotic Disorder Random responders and underreporters removed (n=119) Final Sample Approved by California Committee for the Protection of Human Subjects 10

Study 1 Hypothesis 1 Mood/Internalizing-Related Scales Emotional / Internalizing Dysfunction EID DemoralizationRCd Low Positive EmotionsRC2 Suicidal IdeationSUI HelplessnessHLP Self-DoubtSFD InefficacyNFC Negative EmotionalityNEGE-r 11

Study 1 Hypothesis 2 Psychoticism-Related Scales Thought DysfunctionTHD Ideas of PersecutionRC6 Aberrant ExperiencesRC8 PsychoticismPSYC-r 12

Mood [1] (n = 80) Mood/ Psychotic [2] (n = 213) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges’ g Effect Sizes MMMM g 12 g 13 g 14 g 23 g 24 g 34 EID: Emotional/ Internalizing * * RCd: Demoralization * * RC2: Low Positive Emotions * * SUI: Suicidal/ Death Ideation * * SFD: Self-Doubt * * NFC: Inefficacy * NEGE-r: Negative Emotionality * * Study 1 Results & Discussion Internalizing Scales 13

Mood [1] (n = 80) Mood/ Psychotic [2] (n = 213) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges’ g Effect Sizes MMMM g 12 g 13 g 14 g 23 g 24 g 34 EID: Emotional/ Internalizing * * RCd: Demoralization * * RC2: Low Positive Emotions * * SUI: Suicidal/ Death Ideation * * SFD: Self-Doubt * * NFC: Inefficacy * NEGE-r: Negative Emotionality * * Study 1 Results & Discussion Internalizing Scales 14

Mood [1] (n = 80) Mood/ Psychotic [2] (n = 213) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges’ g Effect Sizes MMMM g 12 g 13 g 14 g 23 g 24 g 34 EID: Emotional/ Internalizing * * RCd: Demoralization * * RC2: Low Positive Emotions * * SUI: Suicidal/ Death Ideation * * SFD: Self-Doubt * * NFC: Inefficacy * NEGE-r: Negative Emotionality * * Study 1 Results & Discussion Internalizing Scales 15

Mood [1] (n = 80) Mood/ Psychotic [2] (n = 213) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges’ g Effect Sizes MMMM g 12 g 13 g 14 g 23 g 24 g 34 EID: Emotional/ Internalizing * * RCd: Demoralization * * RC2: Low Positive Emotions * * SUI: Suicidal/ Death Ideation * * SFD: Self-Doubt * * NFC: Inefficacy * NEGE-r: Negative Emotionality * * Study 1 Results & Discussion Internalizing Scales 16

Mood [1] (n = 80) Mood/ Psychotic [2] (n = 213) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges’ g Effect Sizes MMMMg 12 g 13 g 14 g 23 g 24 g 34 THD: Thought Dysfunction RC6: Ideas of Persecution RC8: Aberrant Experiences PSYC-r: Psychoticism * Study 1 Results & Discussion Psychoticism-Related Scales 17

Study 2 Pedophilic Disorder vs. Other Paraphilic Disorders 18

Study 2 Hypotheses DepressionSomatic Concerns AnxietyInterpersonal Deficits/Introversion RCdRC1RC7IPP RC2MLSSTWSAV EIDGICAXYSHY SUIHPCANPDSF HLPNUCNEGE-r SFDCOG NFC 19

Study 2 Method 1,1111, Pedophilic and other paraphilic disorders No paraphilic disorders/missing diagnoses Total Sample Pedophilic Disorder Other Paraphilic Disorders Did not meet inclusion criteria Random responders and overreporters removed Other Paraphilic Disorders Pedophilic Disorder Final Sample 20

Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Higher-Order Scales EID: Emotional/Internalizing Dysfunction * Restructured Clinical Scales RCd: Demoralization RC1: Somatic Complaints RC2: Low Positive Emotions * RC7: Dysfunctional Negative Emotions Study 2 Results & Discussion Depression 21

Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Higher-Order Scales EID: Emotional/Internalizing Dysfunction * Restructured Clinical Scales RCd: Demoralization RC1: Somatic Complaints RC2: Low Positive Emotions * RC7: Dysfunctional Negative Emotions Study 2 Results & Discussion Depression 22

Study 2 Results & Discussion Somatic Concerns Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Somatic/Cognitive Specific Problems Scales MLS: Malaise * GIC: Gastrointestinal Complaints HPC: Head Pain Complaints * NUC: Neurological Complaints COG: Cognitive Complaints

Study 2 Results & Discussion Anxiety Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Internalizing Specific Problems Scales SUI: Suicidal/Death Ideation HLP:Helplessness/Hopelessness SFD: Self-Doubt NFC: Inefficacy STW: Stress / Worry AXY: Anxiety ANP: Anger-Proneness Personality Psychopathology Five Scales (Revised) NEGE-r: Negative Emotionality

Study 2 Results & Discussion Anxiety Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Internalizing Specific Problems Scales SUI: Suicidal/Death Ideation HLP:Helplessness/Hopelessness SFD: Self-Doubt NFC: Inefficacy STW: Stress / Worry AXY: Anxiety ANP: Anger-Proneness Personality Psychopathology Five Scales (Revised) NEGE-r: Negative Emotionality

Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Interpersonal Specific Problems Scales IPP: Interpersonal Passivity SAV: Social Avoidance SHY: Shyness DSF: Disaffiliativeness Study 2 Results & Discussion Interpersonal Deficits/Introversion 26

Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges’ g Effect Sizes MSDM g Interest Scales AES: Aesthetic-Literary Interests * MEC: Mechanical-Physical Interests * Study 2 Results & Discussion Unanticipated Differences 27

Integrated Discussion Extended empirical literature demonstrating the utility of the MMPI-2- RF in differential diagnosis. Important to treat mood, anxiety, somatic, and psychotic symptoms throughout many patient groups. Future studies: Examine replicability and generalizability of findings in larger samples and other diagnostic groups. 28

Acknowledgements We would like to thank the following for making both this study possible, and our attendance today: Grant from the University of Minnesota Press, which supported data collection Our mentor, Dr. Danielle Burchett, CSU Monterey Bay Our collaborator, Dr. David Glassmire, Patton State Hospital The CSUMB Undergraduate Research Opportunities Center U.S. Department of Education, McNair Scholars References Camara, W.J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: Implications in professional psychology. ProfessionalPsychology: Research and Practice, 31, 141–154. Graham, J. R. (2011). MMPI-2: Assessing personality and psychopathology (3rd ed.). New York, NY: Oxford. Kalichman, S. C. (1991). Psychopathology and personality characteristics of criminal sexual offenders as a function of victim age. Archives of Sexual Behavior, 20, Sellbom, M., Bagby, R. M., Kushner, S., Quilty, L. C., & Ayearst, L. E. (2012). Diagnostic construct validity of MMPI-2 Restructured Form (MMPI- 2-RF) scale scores. Assessment, 19,

MMPI-2-RF Scales 30 Validity Indicators CNS - Cannot Say VRIN-r -Variable Response Inconsistency TRIN-r -True Response Inconsistency F-r - Infrequent Responses Fp-r - Infrequent Psychopathology Responses Fs - Infrequent Somatic Responses FBS-r - Symptom Validity RBS - Response Bias L-r - Uncommon Virtues K-r - Adjustment Validity Higher-Order (H-O) Scales EID - Emotional / Internalizing Dysfunction THD - Thought Dysfunction BXD - Behavioral / Externalizing Dysfunction

31 Restructured Clinical Scales RCd-(dem) -Demoralization RC1-(som) -Somatic Complaints RC2-(lpe) - Low Positive Emotions RC3-(cyn) - Cynicism RC4-(asb) - Antisocial Behavior RC6-(per) - Ideas of Persecution RC7-(dne) - Dysfunctional Negative Emotions RC8-(abx) - Aberrant Experiences RC9-(hpm) -Hypomanic Activation Somatic / Cognitive Scales MLS - Malaise GIC - Gastro-Intestinal Complaints HPC -Head Pain Complaints NUC -Neurological Complaints COG -Cognitive Complaints

32 Internalizing Scales SUI - Suicidal/Death Ideation HLP - Helplessness/Hopelessness SFD - Self-Doubt NFC -Inefficacy STW -Stress / Worry AXY - Anxiety ANP -Anger Proneness BRF - Behavior-Restricting Fears MSF -Multiple Specific Fears Externalizing Scales JCP - Juvenile Conduct Problems SUB - Substance Abuse AGG - Aggression ACT - Activation

33 Interpersonal Scales FML - Family Problems IPP - Interpersonal Passivity SAV - Social Avoidance SHY - Shyness DSF - Disaffiliativeness Interest Scales AES - Aesthetic-Literary Interests MEC - Mechanical-Physical Interests PSY-5 (Personality Psychopathology Five) Scales, Revised AGGR-r - Aggressiveness-Revised PSYC-r - Psychoticism-Revised DISC-r - Disconstraint-Revised NEGE-r -Negative Emotionality / Neuroticism - Revised INTR-r - Introversion / Low Positive Emotionality- Revised

Statistics M1M1 M2M2 *Independent Samples t-test: Statistical significance (p <.05) Comparing means of independent samples Hedges' g values Practical significance Small: Medium: Large:

EID RCdRC2 SUI HLP SFD NFC RC7 STW AXY ANP BRF MSF THD RC6RC8 NEGE-r PSYC-r IPP, SAV, SHY, DSF Normative: Mean= 50 Clinically Significant: Mean ≥ 65 35

Paraphilic Disorders To be diagnosed with a paraphilic disorder people with atypical sexual interests must: o feel personal distress about their interest, OR o have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent. Examples include: exhibitionistic disorder and voyeuristic disorder. 36