Assignment: Clinical Personality Assessments

Chapter 6

MINNESOTA MULTIPHASIC PERSONALITYINVENTORY4

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2: Butcher, Dahlstrom, Gra­ ham, Tellegen, & Kaemmer, 1989; Butcher et al., 2001) is a broadband measure of the major dimensions of psychopathology found in Axis I disorders and some Axis II disor­ ders of the DSM-W-TR (American Psychiatric Association, 2000). The MMPI-2 consists of 9 validity and 10 clinical scales in the basic profile, along with 15 content scales, 9 restructured clinical scales, and 20 supplementary scales (see Table 6.1).

There also are subscales for most of the clinical and content scales with easily over 120 scales that can be scored and interpreted on the MMPI-2. Table 6.2 provides general information on the MMPI-2.

HISTORY

Hathaway and McKinley ( 1940) sought to develop a multifaceted or multiphasic person­ ality inventory, now known as the Minnesota Multiphasic Personality Inventory (MMPI), that would surmount the shortcomings of the previous personality inventories. These short­ comings included (a) relying on how the researcher thought individuals should respond to the content of items rather than validating how they actually responded to the items; (b) using only face-valid items whose purpose or intent was easily understood; and (c) failing to assess whether individuals were trying to distort their responses to the items in some manner. Instead of using independent sets of tests, each with a specific purpose, Hathaway and McKinley included in a single inventory a wide sampling of behavior of significance to psychologists. They wanted to create a large pool of items from which various scales could be constructed, in the hope of evolving a greater variety of valid personality descriptions than was currently available.

MMPI (Original Version)

To this end, Hathaway and McKinley (1940) assembled more than 1,000 items from psychiatric textbooks, other personality inventories, and clinical experience. The items were written as declarative statements in the first-person singular, and most were phrased in the affirmative. Using a subset of 504 items, Hathaway and McKinley constructed a series of quantitative scales that could be used to assess various categories of psychopathology. The items had to be answered differently by the criterion group (e.g., hypochondriacal

135

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Table 6.1 Minnesota Multiphasic Personality Inventory-2 (MMPl-2) scales

Validity Scales ?

VRIN

TRIN

F

FB Fp

L K

s Clinical Scales I (Hs) 2 (D)

3 (Hy)

4 (Pd)

5(Mf) 6 (Pa)

7 (Pt) 8 (Sc)

9 (Ma)

0 (Si)

Restructured Clinical Scales RCd

RC/som

RC2lpe

RC3cyn

RC4asb RC6per

RC7dne

RC8abx

RC9hpm

Content Scales ANX

FRS OBS

DEP

HEA

BIZ

ANG

CYN

ASP TPA LSE SOD

FAM

WRK

TRT

Cannot Say

Variable Response Consistency

True Response Consistency Infrequency Back Infrequency Infrequency Psychopathology

Lie

Correction

Superlative

Hypochondriasis Depression Hysteria Psychopathic Deviate Masculinity-Femininity Paranoia

Psychasthenia Schizophrenia Hypomania Social Introversion

Demoralization Somatization

Low Positive Emotionality

Cynicism Antisocial Behavior Persecutory Ideas Dysfunctional Negative Emotions Aberrant Experiences Hypomanic Activation

Anxiety

Fears Obsessions Depression Health Concerns Bizarre Mentation Anger

Cynicism Antisocial Practices Type A Low Self-Esteem Social Discomfort Family Problems Work Interference Negative Treatment Indicators

Minnesota Multiphasic Personality Inventory-2 137

Table 6.1 (Continued)

PSY-5 Scales AGGR PSYC

DISC

NEGE INTR Supplementary Scales

Broad Personality Characteristics A R

Es

Do

Re

Generalized Emotional Distress Mt

PK MDS

Behavioral Dyscontrol Ho

0-H

MAC-R AAS APS

Gender Role GF

GM

Aggression Psychoticism Disconstraint Negative Emotionality Introversion/Low Positive Emotionality

Anxiety Repression Ego Strength Dominance Social Responsibility

College Maladjustment PTSD-Keane Marital Distress

Hostility Overcontrolled Hostility MacAndrew Alcoholism-Revised Addiction Admission Addiction Potential

Gender Role-Feminine Gender Role-Masculine

patients) as compared with normal groups. Since their approach was strictly empirical and no theoretical rationale was posited as the basis for accepting or rejecting items on a specific scale, it is not always possible to discern why a particular item distinguishes the criterion group from the normal group. Rather, items were selected solely because the criterion

group answered them differently than other groups. For each of the criterion groups and the normative group, the frequency of "True" and "False" responses was calculated for each item. An item was tentatively selected for a scale if the difference in frequency of response between the criterion group and the normative group was at least twice the standard error of the proportions of true/false responses of the two groups being compared. Having selected items according to this procedure, Hathaway and McKinley then eliminated some of them for various reasons. First, the frequency of the criterion group's response was required to be greater than 10% for nearly all items; those items that yielded infrequent deviant response rates from the criterion group were excluded even if they were highly significant statistically because they represented so few criterion cases. Additionally, items whose responses appeared to reflect biases on variables such as marital status or socioeconomic

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Table 6.2 Minnesota Multiphasic Personality lnventory-2 (MMPI-2)

Authors: Published: Edition: Publisher: Website: Age Range: Reading Level: Administration Formats: Additional Languages: Number of Items: Response Format: Administration Time: Primary Scales: Additional Scales: Hand Scoring: General Texts:

Computer Interpretation:

Butcher, Dahlstrom, Graham, Tellegen, and Kaemmer 1989 2nd Pearson Assessments www.PearsonAssessments.com 18+ 6th-8th grade paper/pencil, computer, CD, cassette Spanish, Hmong, and French for Canada 567 True/False 60--90 minutes 9 Validity, 10 Clinical, 15 Content 5 PSY-5, 9 Restructured Clinical, 20 Supplementary Templates Friedman et al. (2001); Graham (2006); Greene (2000); Nichols (2001) Caldwell Report (Caldwell); Pearson Assessments (Butcher); Psychological Assessment Resources (Greene)

status were excluded. Evaluation of several methods of weighting individual items showed no advantage over using unweighted items. Therefore, each item simply received a weight of "one" in deriving a total score. In other words, a person's score on any MMPI scale is equal to the total number of items that the individual answers in the same manner as the

criterion group. The empirical approach to item selection used by Hathaway and McKinley, in fact, freed

them of any concerns about how any individual interprets specific items because it assumes that the individual's self-report is just that and makes no a priori assumptions about the relationships between the individual's self-report and the individual's behavior. Items are selected for inclusion in a specific scale only because the criterion group answered the items differently than the normative group irrespective of whether the item content is actually an accurate description of the criterion group. Any relationship between individuals' responses on a given scale and their behavior must be demonstrated empirically.

MMPI-2 (Restandardized Version)

The MMPI-2 (Butcher et al., 1989, 2001) represents the restandardization of the MMPI that was needed to provide current norms for the inventory, develop a nationally representative and larger normative sample, provide appropriate representation of ethnic minorities, and update item content where needed. Continuity between the MMPI and the MMPI-2 was maintained because new criterion groups and item derivation procedures were not used on the standard validity and clinical scales. Thus, the items on the validity and clinical scales of the MMPI are essentially unchanged on the MMPI-2 except for the elimination of 13 items based on item content and the rewording of 68 items.

Minnesota Multiphasic Personality Inventory-2 139

In the development of the MMPl-2, the Restandardization Committee (Butcher et al., 1989) started with the 550 items on the original MMPI; that is, they first deleted the 16 repeated items. They reworded 141 of these 550 items to eliminate outdated and sexist language and to make these items more easily understood. Rewording these items did not change the correlations of the items with the total scale score in most cases (Ben­

Porath & Butcher, 1989). Many of these items were omitted on the original MMPI because individuals did not understand them. Greene (1991, p. 57) provides examples of these items

such as playing drop the handkerchief. The Restandardization Committee then added 154

provisional items that resulted in the 704 items on Form AX, which was used to collect the normative data for the MMPI-2.

When finalizing the items to be included on the MMPI-2, the Restandardization Com­ mittee deleted 77 items from the original MMPI in addition to the 13 items deleted from the standard validity and clinical scales and the 16 repeated items. Consequently, most special and research scales that have been developed on the MMPI are still capable of being scored unless the scale has an emphasis on religious content or the items are drawn predominantly from the last 150 items on the original MMPI.

The Restandardization Committee included 68 of the 141 items that had been rewritten, and they incorporated 107 of the provisional items to assess major content areas that were not covered in the original MMPI item pool. The rationale for including and dropping items from Form AX that resulted in the 567 items on the MMPI-2 has not been made explicit.

The MMPI-2 was standardized on a sample of 2,600 individuals who resided in seven different states (California, Minnesota, North Carolina, Ohio, Pennsylvania, Virginia, and Washington) to reflect national census parameters on age, marital status, ethnicity, educa­ tion, and occupational status. The normative sample for the MMPI-2 varies significantly from the original normative sample for the MMPI in several areas: years of education, rep­ resentation of ethnic minorities, and occupational status. The individuals in the normative sample for the MMPI-2 also are more representative of the United States as a whole because national census parameters were used in their collection. However, they still varied from

the census parameters on years of education and occupational status. The potential im­ pact of this higher level of education and occupation in the MMPI-2 normative sample on codetype and scale interpretation has been a focus of concern (Caldwell, 1997c; Helmes & Reddon, 1993). However, Schink.a and LaLone (1997) compared a census-matched sub­ sample created within the MMPI-2 restandardization sample and found only one difference that exceeded 3 T score points between these two samples on the standard validity and clinical scales, content scales, and supplementary scales.

The extant literature that has examined the empirical correlates of MMPI-2 scales and codetypes has been consistent with the correlates reported for their MMPI counterparts (Archer, Griffin, & Aiduk, 1995; Graham, Ben-Porath, & McNulty, 1999). It appears safe to assume that the correlates of well-defined MMPI-2 codetypes (the two highest clinical scales composing the codetype should be at least five T points higher than the next highest clinical scale) and the individual validity and clinical scales will be very similar to those for the MMPI. The data are less clear for MMPI-2 codetypes that are not well-defined, although it still will be safe to interpret the individual validity and clinical scales in these codetypes using MMPI correlates given the minimal change at the scale level.

New sets of scales have been developed with the MMPI-2 item pool: content scales (Butcher, Graham, Williams, & Ben-Porath, 1990); content component scales (Ben-Porath

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& Sherwood, 1993); personality psychopathology five scales (PSY-5: Harkness, McNulty, Ben-Porath, & Graham, 2002); and restructured clinical scales (Tellegen et al., 2003).

Several major reviews of the MMPI-2 (Butcher, Graham, & Ben-Porath, 1995; Butcher & Rouse, 1996; Caldwell, 1997c; Greene, Gwin, & Staal, 1997; Helmes & Reddon, 1993) provide summaries from a variety of perspectives on this venerable instrument. These reviews provide the interested reader with an excellent starting point for looking at the current status of the MMPI-2. Butcher et al. (1995) and Greene et al. (1997) also outline the general steps that researchers need to follow and issues that need to be addressed in conducting research with the MMPI-2. It is to be hoped that researchers will heed the advice dispensed in these reviews to enhance the quality of the data that are being collected.

Unlike the MMPI which was used with all ages, the MMPI-2 is to be used only with adults /8 years of age and older. Adolescents are to be tested with the MMPI-A (Butcher et al., 1992), which is designed specifically for them (see Chapter 7).

ADMINISTRATION

The first requirement in the administration of the MMPI-2 is ensuring that the individual is invested in the process. It will pay excellent dividends to spend a few extra minutes answer­ ing any questions the individual may have about why the MMPI-2 is being administered and how the results will be used. The clinician should work diligently to make the assessment process a collaborative activity with the individual to obtain the desired information. This issue of therapeutic assessment (Finn, 1996; Fischer, 1994) was covered in more depth in Chapter 2 (pp. 43-44).

Reading level is a crucial factor in determining whether a person can complete the MMPI-2; inadequate reading ability is a major cause of inconsistent patterns of item endorsement to be discussed later. Butcher et al. ( 1989) suggest that most clients who have had at least 8 years of formal education can take the MMPl-2 with little or no difficulty because the items are written on an eighth-grade level or less. A number of authors (Dahlstrom, Archer, Hopkins, Jackson, & Dahlstrom, 1994; Paolo, Ryan, & Smith, 1992; Schinka & Borum, 1993) have studied the readability of MMPl-2 and MMPI-A items. There was general concurrence that the average readability of the MMPI-2 and MMPI-A is in the range of fifth to sixth grade. The scales requiring the highest reading levels were 9 (Ma: Hypomania), the three content scales of Antisocial Practices (ASP), Cynicism (CYN), and Type A (TPA), several of the Harris and Lingoes (1955) subscales: Hy2 (Need for Affection), Pa3 (Naivete), Sc5 (Lack of Ego Mastery, Defective Inhibition), Ma 1 (Amorality), Ma2 (Psychomotor Acceleration), Ma3 (Imperturbability), and Ma4 (Ego Inflation). On most of these scales, at least 25% of their items required more than an eighth­ grade reading level. These estimates of the required grade level are conservative because they are based on assessing the readability of individual MMPI-2 items or groups of items. They are not based on the difficulty of understanding what is meant by saying either "true" or "false" to a specific item. The reader can assess this problem directly by trying to understand exactly what is meant by saying "false" to an MMPI-2 item that is worded in the negative. What do individuals actually mean when they say "false" to an item such as "I do not always have pain in my back"? Schinka and Borum did suggest that individuals be asked to read MMPI-2 items 114, 226, and 445 if they have completed less than a 10th

Minnesota Multiphasic Personality Inventory-2 141

grade education to determine whether their reading skills are adequate. Dahlstrom et al. (1994) also noted that the instructions for the MMPI-2 actually were more difficult than the items on the test so clinicians should be sure the individual fully understands them.

SCORING

Scoring the MMPI-2 is relatively straightforward either by hand or computer. If the MMPI-2 is administered by computer, the computer automatically scores it. If the in­ dividual's responses to the items have been placed on an answer sheet, these responses can be entered into the computer by the clinician for scoring or they can be hand-scored. If the clinician enters the item responses into the computer for scoring, they should be double entered so that any data entry errors can be identified.

The first step in hand-scoring is to examine the answer sheet carefully and indicate omitted items and double-marked items by drawing a line with brightly colored ink through both the "true" and "false" responses to these items. Also, cleaning up the answer sheet helps facilitate scoring. Responses that were changed need to be erased completely if possible, or clearly marked with an "X" so that the clinician is aware that this response has not been endorsed by the client.

There is one scale that must always be scored without a template. The Cannot Say(?) scale score is the total number of items not marked and double marked. All the other scales are scored by placing a plastic template over the answer sheet with a small box drawn at the scored (deviant) response--either "true" or "false"-for each item on the scale. The total number of such items marked equals the client's raw score for that scale; this score is recorded in the proper space on the answer sheet. One scale-Scale 5 (Mf- Masculinity­ Femininity)-is scored differently for men and women, and unusually high or low scores on this scale might indicate that the wrong template was used. Among women, a raw score less than 30 is unusual, and such raw scores should at least arouse a suspicion that the wrong template was used in scoring the scale. All scoring templates are made of plastic and must be kept away from heat.

Plotting the profile is the next step in the scoring process. In essence, the clinician transfers all the raw scores from the answer sheet to the appropriate column of the profile sheet (see Figure 6.1). Some precautions must be taken and data calculations performed. First, separate profile sheets are used for men and women as with the scoring templates for Scale 5; an unusually high or low score plotted for Scale 5 should alert the clinician to the possibility that the wrong profile sheet was selected. Second, each column on the profile sheet is used to represent the raw scores for a specific scale. Each dash represents a raw score of 1 with the larger dashes marking increments of 5. Thus, the clinician notes the individual's raw score on the scale being plotted and makes a point or dot at the appropriate dash. Once the clinician has plotted the individual's scores on the eight validity scales, a solid line is drawn to connect them. The raw score on the Cannot Say(?) scale is merely recorded in the proper space in the lower left-hand comer of the profile sheet.

A similar procedure is followed to plot the 10 clinical scales except that five of the clinical scales (1 [Hs: Hypochondriasis], 4 [Pd: Psychopathic Deviate], 7 [Pt: Psychasthenia], 8 [Sc: Schizophrenia], and 9 [Ma: Hypomania]) are K-corrected; that is, a fraction of K is added to the raw score before the individual's score is plotted. For these five scales that

Minnesota Multiphasic Personality lnventory-2 197

Spike 3 codetypes. A client with a T score of 60 on the F scale is almost 15 points higher than the mean for Spike 3 codetypes, and nearly 40 points lower than the mean for 6-8/8-6

codetypes. A T score of 60 is unusual in both of these codetypes; in the former it is higher than expected and in the latter it is much lower than expected. Similar variations can be seen in the T scores for Scales 2 (D: Depression) and 8 (Sc: Schizophrenia).

A codetype analysis can be further refined by considering additional clinical scales to create three- and four-point codetypes. A number of two-point codetypes have frequent three-point variants that should be considered in the interpretation of the MMPI-2, such as variants of 2-414-2 (2-4/4-2-(3), 2-4/4-2-(7), 2-4/4-2-(8)) and 2-7/7-2 (2-717-2-(1), 2-717- 2-(3), 2-717-2-(8), 2-7/7-2-(0)) codetypes. Again, the interpretation of a client's score on a given scale will change as the prototypic score changes in the three-point codetypes within a particular group.

The final "group" with which the MMPI-2 can be compared in the interpretive process is the individual, or idiographic, interpretation. In this comparison, the relative elevations of the scales become important because they indicate which content domains are more or less important for this particular individual. An individual who has T scores of 75 and 60 on the content scales of Depression (DEP) and Anxiety (ANX), respectively, is saying that symptoms of depression are more of a problem than symptoms of anxiety. The MMPI-2 content (Butcher et al., 1990) and content component (Ben-Porath & Sherwood, 1993) scales are an excellent means of developing such an idiographic interpretation of an individual's MMPI-2 profile, because the various content domains can be juxtaposed so that the clinician can compare them directly.

APPLICATIONS

As a self-report inventory, the MMPI-2 is easily administered in a wide variety of settings and for a variety of purposes. Although the MMPI was developed originally in a clinical setting with a primary focus on establishing a diagnosis for the person (Hathaway & McKinley, 1940), its uses quickly broadened to include more general descriptions of the behavior and symptoms of most forms of psychopathology (cf. Dahlstrom et al., 1972). This use was followed by extensions into the screening of applicants in personnel selection settings and a multitude of uses in forensic settings.

Somewhat different issues must be considered in the administration of the MMPI-2 in personnel selection and forensic settings compared with the more usual clinical setting. First, not only is the administration not going to be therapeutic, the MMPI-2 results have the potential to cause a fairly negative impact on the individual. The individual may not be selected in a personnel-screening setting or be less likely to be considered for custody of children because of the acknowledgment of significant psychopathology.

Second, the assessment of validity is particularly important because different forensic settings can have a significant impact on the data that are obtained from an individual. Items particularly sensitive to this impact are likely to be those items about which an individual is not sure or ambivalent in responding. In civil forensic settings such as personal injury, workers' compensation, and insurance disability claims, this impact is likely to be in the opposite direction from that in parenting examinations or personnel selection. Portraying oneself as being more impaired in cases for civil damages is likely to benefit an individual's

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claim; portraying oneself as being less impaired and more psychologically healthy is likely to benefit an individual's chances of being selected, or at least not screened out, in a personnel-screening setting. Consequently, it behooves the forensic psychologist to know what types of MMPI-2 scores and profiles are to be expected in every forensic setting.

There also are different expectations of whether to report problematic behaviors and symptoms in criminal cases. Individuals who are being evaluated for competency to stand trial or for the introduction of mitigating circumstances during the sentencing phase after a conviction for murder versus probation or parole should have different expectations of the problematic behaviors and symptoms of psychopathology that are, or are not, to be reported. Individuals in the former forensic contexts would be expected to report any and all

problematic behaviors or symptoms that might be in any way relevant to their circumstances, while individuals in the latter would not be expected to report any problematic behaviors or symptoms.

Third, in a forensic setting it must be kept in mind that the MMPI-2 is being used to address a specific psycholegal issue rather than as a general screen for psychopathology. Thus, the interpretations provided of the MMPI-2 must be relevant to this psycholegal issue. For example, the mere presence of psychopathology as indicated by elevation of several clinical scales on the MMPI-2 may not be directly relevant to the psycholegal issue of quality of parenting skills in a child-custody examination or the ability to understand legal proceedings in a competency hearing.

Finally, whether it is the prosecution (plaintiff) or the defense (defendant) that has retained the forensic psychologist also may impact the problematic behaviors and symptoms reported by an individual, but there are minimal empirical data on this point. Hasemann ( 1997) provided data on workers' compensation claimants who were evaluated by forensic psychologists for both the defense and the plaintiff. The claimant reported more symptoms and distress to the forensic psychologist retained by the defense attorney. Consequently, some of the differences in examinations performed by forensic psychologists on the same individual may reflect that he actually describes problematic behaviors and symptoms differently depending on whether he believes that the forensic psychologist is likely to be sensitive or insensitive to his self-report. The underlying heuristic of an individual is likely to be that the opposing forensic psychologist will require more proof to be able or willing to perceive and report an individual as being impaired. These results suggest that being examined by the plaintiff's expert and then by the defense's expert over the same psycholegal issue should be considered as different forensic contexts rather than as the same one.

PSYCHOMETRIC FOUNDATIONS

Demographic Variables

Age

Specific norms are not provided by age on the MMPI-2, even though it is well known that there are substantial effects of age below the age of 20. These age effects are reflected in the development of separate sets of adolescent norms for the original MMPI (Marks & Briggs, 1972), and the restandardization of a different form of the MMPI for adolescents

Minnesota Multiphasic Personality Inventory-2 199

(MMPI-A: Butcher et al., 1992). Colligan and his colleagues (Colligan, Osborne, Swenson, & Offord, 1983, 1989) found substantial effects of age on MMPI performance in their contemporary normative sample with differences of 10 or more T points between 18- and 19-year-olds and 70-year-olds on Scales L (Lie) and 9 (Ma: Hypomania). Several MMPl-2 scales demonstrate differences of nearly 5 T points between 20-year-olds and 60-year-olds (Butcher et al., 1989, 2001; Caldwell, 1997b, 1997c; Greene & Schinka, 1995) with scores on Scales L (Lie: women only), I (Hs: Hypochondriasis), and 3 (Hy: Hysteria) increasing and Scales 4 (Pd: Psychopathic Deviate) and 9 (Ma: Hypomania) decreasing with age. Given that these age comparisons involve different cohorts, it is not possible to know whether these effects actually reflect the influence of age or simply differences between the cohorts. Butcher et al. (1991) found few effects of age in older (>60) men and they saw no reason for age-related norms in these men.

Gender

Gender does not create any general issues in MMPI-2 interpretation because separate norms (profile forms) are used for men and women. Any gender differences in how individuals responded to the items on each scale are removed when the raw scores are converted to T scores. Consequently, men and women with a T score of 70 on Scale 2 (D: Depression) are one standard deviation above the mean, although women have endorsed more items (30) than men (28). When the MMPI-2 is computer scored by Pearson Assessment, unigender norms also are provided for each scale. Even a cursory perusal of these unigender norms will show that men and women have very similar scores on all MMPI-2 scales except for those three scales specifically related to gender (Scale 5 [Mf: Masculinity-Femininity]; Gender-Role Feminine [GF]; Gender-Role Masculine [GM]).

Education

The potential effects of education have not been investigated in any systematic manner either on the MMPI or the MMPI-2, although such research is needed. When the men and women in the MMPI-2 normative group with less than a high school education were contrasted with men and women with postgraduate education (Dahlstrom & Tellegen, 1993, pp. 58-59), the differences on the following scales exceeded 5 T points: L (Lie: women only), F (Infrequency), K (Correction), 5 (MJ- Masculinity-Femininity), and O (Si: Social Introversion). Men and women with less than a high school education had a higher score in all these comparisons except for Scales K (Correction) and 5 (Mf· Masculinity-Femininity). When psychiatric patients with 8 years or less of education were contrasted with patients with 16 or more years of education (Caldwell, 1997b), the differences ranged from 4 to 8 T points on all the scales except 3 (Hy: Hysteria). The individuals with less education had higher scores in all these comparisons except for Scales K (Correction) and 5 (Mf· Masculinity-Femininity).

Occupation

There do not appear to be any systematic effects for occupation or income within the MMPI-2 normative group (Dahlstrom & Tellegen, 1993; Long, Graham, & Timbrook, 1994). There have been no studies of the effects of these two factors in psychiatric patients.

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Ethnicity

The effects of ethnicity on MMPI performance have been reviewed by Dahlstrom, Lachar, and Dahlstrom ( 1986) and Greene ( 1987), and they concluded that there is not any consistent pattern of scale differences between any two ethnic groups. A similar conclusion has been offered in several other reviews of the effect of ethnicity on MMPI-2 performance (Greene,

1991, 2000; Hall, Bansal, & Lopez, 1999).

Multivariate regressions of age, education, gender, ethnicity, and occupation on the

standard validity and clinical scales in the MMPI-2 normative group (Dahlstrom & Tellegen,

1993) and psychiatric patients (Caldwell, 1997 [age, education, and gender only]; Schinka, LaLone, & Greene, 1998) have shown that the percentage of variance accounted for by these factors does not exceed 10%. Such small percentages of variance are unlikely to impact the interpretation of most MMPl-2 profiles. The one exception is Scale 5 (Mf: Masculinity-Femininity) in which slightly over 50% of the variance is accounted for by

gender. In summary, demographic variables appear to have minimal impact on the MMPI-2

profile in most individuals. It may be important to monitor the validity of the MMPI-2 profile more closely in persons with limited education and lower occupations. A major reason that demographic effects are seen in these persons may simply reflect that the reading level of the MMPI-2 is approximately the eighth grade (Butcher et al., 1989, 2001;

Greene, 2000).

Reliability

The MMPI-2 Manual (Butcher et al., 1989, 2001, Appendix E) reports the reliability data for 82 men and 111 women who were retested after an average of 8.58 days. The test­ retest correlations ranged from .54 to .93 across the 10 clinical scales and averaged .74. The standard error of measurement is about 5 T points for the clinical scales, that is, the individual's true score on the clinical scales will be within ±5 T points two-thirds of the

time. The test-retest correlations for the 15 content scales range from .77 to .91 and averaged

.85. The standard error of measurement is about 4 T points for the content scales, that is, the individual's true score on the content scales will be within ±4 points two-thirds of the time.

Codetype Stability

There is little empirical data indicating how consistently clients will obtain the same codetype on two successive administrations of the MMPI or the MMPI-2. The research on the stability of the MMPI historically focused either on the reliability of individual scales as discussed, which leaves unanswered whether clients' codetypes have remained unchanged. There would be at least some cause for concern if a client obtained a 4-9/9-4 codetype on one occasion and on a second administration of the MMPI-2 a few months later in another

setting obtained a2-7/7-2 codetype. Graham, Smith, and Schwartz (1986) have provided the only empirical data on the

stability of MMPI codetypes for a large sample (N = 405) of psychiatric inpatients. They

Minnesota Multiphasic Personality Inventory-2 201

reported 42.7%, 44.0%, and 27.7% agreement across an average interval of approximately 3 months for high-point, low-point, and two-point codetypes, respectively. If the patients were classified into the categories of neurotic, psychotic, and characterological, 58.1 % remained in the same category when retested.

Greene, Davis, and Morse (1993, August) reported the stability of the MMPI in 454 alcoholic inpatients who had been retested after an interval of approximately 6 months. Approximately 40% of the men and 32% of the women had the same single high-point scale on the two successive administrations of the MMPI. However, they had the same two-point codetype only 12% and 13% of the time, respectively. Almost 30% of these men and women had two totally different high-point scales when they took the MMPI on their second admission.

These data on codetype stability, or more accurately the lack thereof, suggest sev­ eral important conclusions. First, clinicians should be cautious about making long-term predictions from a single administration of the MMPI-2. Rather an MMPI-2 profile should be interpreted as reflecting the individual's current status. Second, it is not clear whether the shifts that do occur in codetypes across time reflect meaningful changes in the clients' behaviors, psychometric instability of the MMPI-2, or some combination of both factors.

CONCLUDING COMMENTS

The MMPI-2 (Butcher et al., 1989, 2001) is the oldest and the most widely used of the self-report inventories. The numerous validity scales have served it well in assessing the many forms of response distortion that are encountered in the various settings in which the MMPI-2 is administered. The MMPl-2 is the prototype of an empirically derived test in which the correlates of individual scales and codetypes are determined through research. There is an extensive research base on most of the major issues in the assessment of

psychopathology reflecting its long history of use.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual ofmental disorders (4th ed., text rev.). Washington, DC: Author.

Arbisi, P. A., & Ben-Porath, Y. S. (1995). An MMPI-2 infrequent response scale for use with psychopathological populations: The Infrequency Psychopathology scale: F(p). Psychological Assessment, 7, 424-431.

Archer, R. P., Griffin, R., & Aiduk, R. (1995). MMPI-2 clinical correlates for ten common codes. Journal of Personality Assessment, 65, 391-407.

Bathurst, K., Gottfried, A. W., & Gottfried, A. E. (1997). Normative data for the MMPI-2 in child custody litigation. Psychological Assessment, 9, 205-211.

Ben-Porath, Y. S., & Butcher, J. N. (1989). Psychometric stability of rewritten MMPI items. Journal of Personality Assessment, 53, 645-653.

Ben-Porath, Y. S., & Sherwood, N. E. (1993). The MMPI-2 content component scales: Development, psychometric characteristics, and clinical application. Minneapolis: University of Minnesota Press.

202 Self-Report Inventories

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