Factor analysis of the Dutch-language version of the MCMI-III

Validity of Adult Psychopathology Model Using Psychiatric Patient Sample from a Developing Country: Confirmatory Factor Analysis

Objectives. This study is aimed at testing and validating the two-factor measurement model of the Millon Clinical Multiaxial Inventory (MCMI). Specifically, this paper reported construct validity, particularly focusing on convergent and discriminant validities of the internalizing-externalizing MCMI model of adult psychopathology using a psychiatric sample from a developing country, the Republic of Yemen. Methods. MCMI was distributed among 232 outpatients from the Hospital of Taiz City and two private psychiatry clinics in Yemen; data were collected using structured interviews over four months. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and confirm the latent structure MCMI and verify the evidence of convergent and discriminant validity. Results. The CFA results indicated that MCMI was a good fit for the internalizing-externalizing two-factor model of adult psychopathology, comparative fit index $\left(\text{CFI}\right)=0.95$ , and $\text{RMSEA}=0.07$ . The results of the CFA provide evidence of convergent and discriminant validity characterized by MCMI with the internalizing-externalizing model. Conclusion. The adult psychopathology of internalizing-externalizing is a valid measurement model of MCMI with ten personality disorders and eight clinical syndromes.

Assessing Personality Pathology Response Sets in Perpetrators of Intimate Partner Violence

Self-report personality inventories may be useful in directing perpetrators of intimate partner violence (IPV) to appropriate intervention programs. They may also have predictive capabilities in assessing the likelihood of desistance or persistence of IPV. However, validity problems are inherent in self-report clinical tools, particularly in forensic settings. Scores of the modifying indices (subsections of the scale designed to detect biases in responding) of the Millon Clinical Multiaxial Inventory-III (MCMI-III) often are not reported in research. This study analyses the response sets of a sample of 492 IPV perpetrators at intake to a Danish perpetrator program. Profiles were grouped into levels of severity, and the proportion of exaggerated or minimized profiles at each severity level was analyzed. Findings suggested that 30% of the present sample were severely disturbed or exaggerating their symptoms. As expected, there were significant levels of exaggerated profiles present in the severe pathology group and significant levels of minimized profiles in the low pathology group. Self-referred participants were more likely to exaggerate their pathology, but minimization was not associated with referral status. Nor was there an association between gender and the modifying indices. It is suggested that so-called "fake good" or "fake bad" profiles should not necessarily be treated as invalid, but that elevations in the modifying indices can be interpreted as clinically and forensically relevant information in their own right and should be reported on in research.

Psychometric Properties of the Millon Clinical Multiaxial Inventory-III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures

Millon Clinical Multiaxial Inventory MCMI–III is a multidimensional measure of psychopathology with excellent construct validity, test-retest reliability as well as internal consistency. Factor analysis of the MCMI-III has produced mixed results, extracting parsimonious three-factor solutions, or replicating the original four-factor solution in psychiatric samples from Western countries. However, little work has been done on the psychometric properties of the MCMI–III, using non-Western psychiatric samples. Outpatients (N = 212) completed the MCMI–III during a semi-structured interview. Eight exploratory factor analysis (EFA) methods were used to explore the underlying structure of MCMI–III. Skewness, kurtosis, and descriptive statistics confirmed that scales of MCMI–III were normally distributed. High-internal consistency was found. The eight EFA methods applied to the 24 clinical scales identified a consensual three-factor solution: factor I (internalizing psychopathology; 18 scales), factor II (externalizing psychopathology; 4 scales) and factor III (psychological disturbance; 2 scales), accounting for a total of 72% of the common variance. Regarding the cross-cultural equivalence of the MCMI–III structure, Tucker's congruence coefficient (Φ) was used and confirmed that internalizing (F1) and externalizing psychopathology (F2) factors obtained in this study are similar to high vs. low psychopathology and emotional constraint factors provided by American study of Haddy et al. (2005) (Φ was 0.86 and 0.97). These two factors are also similar to the general adjustment and antisocial acting out factors provided by the American study of Craig and Bivens (1998) (Φ was 0.82 and 0.96). The first two factors in this study also reflect high similarity with the factor solutions obtained with the Italian and Dutch versions of MCMI-III (Rossi et al., 2007; Pignolo et al., 2017). Despite using a psychiatric sample from a non-Western culture, the two factors identified for this MCMI–III Arabic version were similar to those reported on studies with MCMI–III, using primarily Western samples (Craig and Bivens, 1998; Rossi et al., 2007).

Cardiac Autonomic Function and Psychological Characteristics of Heterosexual Female Perpetrators of Intimate Partner Physical Aggression

Intimate partner violence is predominantly viewed as a social problem of men's violence against women. However, a growing evidence base suggests an equal prevalence rate for male and female perpetrated intimate partner physical aggression. Moreover, female perpetrated intimate partner violence is often assumed to be reactive, yet there is limited evidence to support this notion. In this article, we describe the results of two studies that investigated the prevalence of female perpetrated intimate partner physical aggression, and its correlates in heterosexual female university students. The relationships of personality traits, resting heart rate, and heart rate variability (a correlate of vagal activity) were compared between females who did and did not report having engaged in intimate partner physical aggression. In Study 1, we found that 30.9% of participants reported enacting intimate partner physical aggression during the preceding 12 months. This finding suggests that a considerable number of undergraduate females aggress against their intimate partners. Perpetrators, relative to nonperpetrators, scored higher on secondary psychopathic traits. In Study 2, female intimate partner violence was shown to be associated with low resting heart rate and high heart rate variability. Perpetrators, relative to nonperpetrators, scored higher on psychopathic traits that index emotional resilience and unempathic tendencies, and reported increased proactive and reactive aggression. This raises the possibility that some incidences of female intimate partner physical aggression represent proactive aggressive acts. These findings also support the frequently found association between low resting heart rate and aggression, but raise the prospect that the reported aggressive acts reflect high heart rate variability and strong parasympathetic nervous system activity.

Detecting Differential Item Functioning Using Multiple-Group Cognitive Diagnosis Models

This study proposes a multiple-group cognitive diagnosis model to account for the fact that students in different groups may use distinct attributes or use the same attributes but in different manners (e.g., conjunctive, disjunctive, and compensatory) to solve problems. Based on the proposed model, this study systematically investigates the performance of the likelihood ratio (LR) test and Wald test in detecting differential item functioning (DIF). A forward anchor item search procedure was also proposed to identify a set of anchor items with invariant item parameters across groups. Results showed that the LR and Wald tests with the forward anchor item search algorithm produced better calibrated Type I error rates than the ordinary LR and Wald tests, especially when items were of low quality. A set of real data were also analyzed to illustrate the use of these DIF detection procedures.

Psychometric Properties of the Persian Version of Millon Clinical Multiaxial Inventory-IV (MCMI-IV)

Objective: Millon Clinical Multiaxial Inventory (MCMI) is one of the most widely used clinical tools in research studies and clinical settings. MCMI was revised 4 times and its last version was published in 2015. All previous versions of MCMI have been translated to Persian and validated and have been frequently used by Iranian clinicians or researchers. Thus, this study provides the Persian version of the last version of this popular inventory for clinical or research purposes. Method: The participants of this psychometric study were selected by combining purposeful and convenience sampling methods among inpatients and outpatients who referred to Roozbeh hospital from 2018 to 2019. After data screening by statistical methods and Validity Scales based on MCMI-IV profile, 400 participants' profiles were analyzed to estimate the psychometric properties of the Persian Version of MCMI-IV. MCMI-IV, the Structured Clinical Interview for DSM-5 (SCID-5), and the Brief Symptoms Inventory (BSI) were used for clinical data gathering. Content Validity Ratio (CVR), Correlational Coefficients, Kappa Agreement, Spearman Brown Coefficient, and Cronbach Alpha were performed for data analysis. Results: According to the results of data analysis, the psychometric properties for MCMI-IV were estimated as follows: the content validity index (CVI, 0.29 to 0.99), criterion validity (0.13 to 0.40), convergent validity (-0.35 to 0.72), The Cronbach's alpha for the personality scales was 0.48 to 0.90, the Spearman-Brown coefficient was from 0.49 to 0.90, and test-retest reliability was from 0.51 to 0.86. Conclusion: The psychometric properties of the Persian version of MCMI-IV, including validity and reliability indexes, are appropriate and in line with the findings of its original version.

International Adaptations of the Millon Clinical Multiaxial Inventory: Construct Validity and Clinical Applications

This article examines the influence of the Millon Clinical Multiaxial Inventory (MCMI) as a clinical and research instrument beyond the borders of the United States. The MCMI's theoretical and empirical grounding, its alignment with the Diagnostic and Statistical Manual of Mental Disorders (DSM), and scales that can be interpreted both categorically and dimensionally, are the primary features that make the test attractive. We begin with studies that evaluated the construct equivalence of the different language adaptations. Data from the most widely researched non English-language forms (Danish, Dutch, and Spanish) show excellent comparability with Millon's original. Nevertheless, significant problems were noted in efforts to create clinical groups that would allow for equivalence of diagnostic accuracy when using the cutoff scores. Although dimensional aspects of the scale scores were not affected by this, the adapted measures might show attenuated diagnostic accuracy compared with Millon's original. Next, we present MCMI studies conducted in clinical settings to document where the adapted tests have made their greatest impact in the international literature. A wide variety of clinical applications demonstrated broad utility, and given the high number of issues addressed, we think Millon's influence will certainly stand the test of time in different domains and settings.

Model Similarity, Model Selection, and Attribute Classification

Selecting the most appropriate cognitive diagnosis model (CDM) for an item is a challenging process. Although general CDMs provide better model-data fit, specific CDMs have more straightforward interpretations, are more stable, and can provide more accurate classifications when used correctly. Recently, the Wald test has been proposed to determine at the item level whether a general CDM can be replaced by specific CDMs without a significant loss in model-data fit. The current study examines the practical consequence of the test by evaluating whether the attribute-vector classification based on CDMs selected by the Wald test is better than that based on general CDMs. Although the Wald test can detect the true underlying model for certain CDMs, it is yet unclear how effective it is at distinguishing among the wider range of CDMs found in the literature. This study investigates the relative similarity of the various CDMs through the use of the newly developed dissimiliarity index, and explores the implications for the Wald test. Simulations show that the Wald test cannot distinguish among additive models due to their inherent similarity, but this does not impede the ability of the test to provide higher correct classification rates than general CDMs, particularly when the sample size is small and items are of low quality. An empirical example is included to demonstrate the viability of the procedure.

The association of gender, ethnicity, age, and education with Rorschach scores

We examined the association of gender, ethnicity, age, and education with 60 Rorschach scores using three clinical and nonclinical samples of adults and youths (ns = 640, 249, and 241). As anticipated for our data sets, there were no reliable associations for gender, ethnicity, or adult age. However, in adults years of education was associated with variables indicative of complexity, the articulation of subtlety and nuance, cognitive synthesis, and coping resources. In the clinical sample of youths, increasing age was primarily associated with more conventional perception and less illogical thought processes. Limitations are discussed in conjunction with further research that could address them, along with implications for applied practice.

Dynamic of Change in Pathological Personality Trait Dimensions: A Latent Change Analysis Among at-Risk Women

This study explores longitudinally a four-factor structure of pathological personality trait dimensions (PPTDs) to examine both its structural stability and intra-individual changes among PPTDs over time. Personality Disorder (PD) scales of the Millon Clinical Multiaxial Inventory-III were administered to 361 low-income women with various psychiatric conditions (drug dependence, depression), who were followed in a two-wave study over 5-years. Cross-sectional and longitudinal factor analyses outlined a robust factorial structure of PPTDs, extrinsically invariant over time, representing Negative Emotionality, Introversion, Antagonism and Impulsivity. Despite moderate rank-order stability in the PPTDs, results also indicated substantial intra-individual variability in the degree and direction of change, consistent with trajectories of change in participants' clinical diagnoses. Results are discussed in light of current debates on the structure and dynamic of pathological personality.

Application of the Rasch model in measuring personality disorders

OBJECTIVE

To describe item and person parameters obtained with the Rasch model, one of the item response theory models, in the assessment of personality disorders based on Millon's theory.

METHOD

A total of 350 people participated in the study. Age ranged from 18 to 67 years (mean ± standard deviation = 27.02±10.13), and 71.7% of the participants (n = 251) were female. Of the 350 individuals, 21.1% (n = 74) answered affirmatively about being under psychiatric treatment and taking psychiatric medications. The Personality Disorders Dimensional Inventory (PDDI), an instrument designed to assess personality disorders according to Millon's theory, was applied to all participants. Data were analyzed using the Rasch model.

RESULTS

Overall, analysis with the Rasch model revealed that the PDDI has adequate psychometric properties for the assessment of personality disorders.

CONCLUSION

Among the contributions of item response theory models for clinical instruments, the Rasch person-item map deserves to be highlighted as a successful attempt to improve the understanding of clinical scores obtained in response to particular test items.

Estudos de adaptação do Millon Clinical Multiaxial Inventory-III para avaliação de aspectos psicopatológicos da personalidade no Brasil

OBJETIVOS: Traduzir e adaptar para uso no Brasil o Millon Clinical Multiaxial Inventory-III (MCMI-III), verificando as modificações envolvidas em relação à escala original. MÉTODO: 538 participantes responderam ao MCMI-III, ao Questionário de Saúde Geral de Goldberg e a um questionário sociodemográfico especificamente elaborado para esta pesquisa. Os sujeitos foram, então, divididos entre grupo clínico e não clínico, e seus padrões de respostas foram comparados considerando-se as diferentes variáveis sociodemográficas. RESULTADOS: Os resultados demonstram diferenças estatisticamente significativas nos padrões de respostas para a maioria das escalas quando comparados os grupos clínico e não clínico. CONCLUSÃO: O estudo ratifica a sensibilidade de discriminação entre os diferentes grupos, apresentando indícios da validade do instrumento quanto ao preceito teórico.