2.  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. MCMI-III Overview

4.  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.  Theodore Millon’s bioevolutionary 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 – 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.  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 3 rd most frequently used psychological test

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

14.  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.  Designed for individuals with a suspected mental health disorder  Appropriate for age 18 and older  Requires a 6 th grade reading level  175 True or False items  Can be administered in group or individual setting  Typically requires 25-30 minutes

20. General MCMI-III Interpretive Guidelines

21.  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.  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.  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.  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.  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.  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. Practice Interpretation

28.  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.  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. Resources & References

31.  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.