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

Outlining the Psychological Profile of Persistent Depression in Fibromyalgia Patients Through Personality Assessment Inventory (PAI)

Background: Fibromyalgia (FM) is a complex condition marked by increased pain sensitivity and central sensitization. Studies often explore the link between FM and depressive anxiety disorders, but few focus on dysthymia or persistent depressive disorder (PDD), which can be more disabling than major depression (MD). Objective: To identify clinical scales and subscales of the Personality Assessment Inventory (PAI) that effectively describe and differentiate the psychological profile of PDD, with or without comorbid MD, in FM patients with PDD previously dimensionally classified by the Millon Clinical Multiaxial Inventory III (MCMI-III). Method: An observational, cross-sectional study was conducted with 66 women (mean age 49.18, SD = 8.09) from Hospital del Mar. The PAI, the MCMI-III, and the Fibromyalgia Impact Questionnaire (FIQ) were used to assess the sample. Results: The PAI showed strong discriminative ability in detecting PDD, characterized by high scores in cognitive and emotional depression and low scores in identity alteration, dominance, and grandeur. High scores in cognitive, emotional, and physiological depression, identity alteration, cognitive anxiety, and suicidal ideation, along with low scores in dominance and grandeur, were needed to detect MD with PDD. Discriminant analysis could differentiate 69.6-73.9% of the PDD group and 84.6% of the PDD+MD group. Group comparisons showed that 72.2% of patients with an affective disorder by PAI were correctly classified in the MCMI-III affective disorder group, and 70% without affective disorder were correctly classified. Conclusions: The PAI effectively identifies PDD in FM patients and detects concurrent MD episodes, aiding in better prognostic and therapeutic guidance.

Romanian Inventory of Depression and Anxiety Symptoms (IDAS-II)

Background

The Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure comprising 99 items divided into 18 non-overlapping scales that allows for a dimensional assessment of depression, anxiety, and bipolar symptoms. The IDAS-II is currently available in English, Turkish, Spanish, German, and Swedish. This study's major goal was to adapt and validate the IDAS-II to the Romanian population.

Method

Participants from a community sample (N = 1,072) completed the IDAS-II (Romanian version) and additional measures assessing depression and anxiety disorders.

Results

Item-level factor analyses validated the unidimensionality of the scales, and internal consistency results indicated that most symptom scales had satisfactory alpha coefficient values. Based on previous structural analyses, a confirmatory factor analysis (CFA) on the IDAS-II scales confirmed a three-component model of "Distress," "Obsessions/Fear," and "Positive Mood." Convergent and discriminant validity were established by correlational analyses with other symptom measures.

Limitations

This study was conducted using a sample from the general population and several of the employed measures have limitations. Specifically, the current study was unable to employ Romanian versions of the gold-standard instruments that assess well-being, obsessive-compulsive disorder, and claustrophobia.

Conclusion

The IDAS-II (Romanian version) is the first clinical measure to assess internalizing dimensions of the Hierarchical Taxonomy of Psychopathology (HiTOP) model that is available for the Romanian population.

Development of the College Student Acute Stress Scale (CSASS)

PURPOSE

The purpose of this study is to develop and validate the College Student Acute Stress Scale, a measure of acute stress specific to college students.

DESIGN AND METHODS

A total sample of 440 young adults from a university in the northeast United States were surveyed across three separate research studies. Exploratory principal component analysis, internal consistency reliability, convergent and divergent validity, and test-retest reliability analyses were performed.

FINDINGS

Evidence of convergent and divergent validity were obtained, and adequate internal consistency and test-retest reliability were identified.

PRACTICE IMPLICATIONS

This study provides evidence for the validity and reliability of a self-report measure of college students' acute stress experiences.

Social Capital of Parents of Children and Adolescents and Its Relation to Psychiatric Disorders; A Population-Based Study

Social capital is a complex concept that is considered an effective factor in the development of societies. Considering the importance of burdens of psychiatric disorders in Iran, we studied the relationship between various dimensions of social capital of parents of children and adolescents and psychiatric disorders among them. In this cross-sectional study, 18,940 parents of children and adolescents aged 6 to 18 years old were randomly selected from all provinces of Iran and were evaluated by the Millon clinical multiaxial inventory-III (MCMI-III) and a modified version of Nahapiet and Ghoshal questionnaire. MCMI-III was designed as a self-report tool for investigating psychiatric clinical disorders and personality traits in the general population. Modified Nahapiet and ghoshal questionnaire has 20 items and measures four components of social capital included trust, values, communication, and collaboration. Validity and reliability of both questionnaires have been approved in Iran. In the regression model, the relationship between social capital components and clinical and sever clinical syndromes, in the form of regression weight and standard weight for trust was - 0.558 and - 0.062 with p value less than 0.0001, and for values was - 0.466 and - 0.057, respectively, with p value less than 0.0001. There was a reverse correlation between social capital components of parents of children and adolescents and psychiatric disorders in Iran. In regression statistical models, the two components of values and trust were negative predictors of psychiatric disorders. Considering the high prevalence of psychiatric disorders in Iran, it seems that the strengthening of cognitive and structural aspects of social capital of parents of children and adolescents is one of the effective factors in reducing the prevalence of these disorders among them.

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.

Psychopathological and Personality Pro file in Chronic Nononcologic Nociceptive and Neuropathic pain: Cross-sectional Comparative Study

Introduction

Adaptation to chronic non-oncologic pain is associated with the development of psychopathology and personality disorders, creating severity, chronicity, poorer treatment response, and exacerbations in patients with neuropathy.

Objective

To identify the psychopathological and personality profiles of patients with chronic nociceptive and neuropathic pain and their association with pain progression and intensity.

Method

A cross-sectional, descriptive and comparative study was conducted in the Pain Treatment Unit of Hospital Universitari Sagrat Cor, with systematic randomized recruitment for 25 months; 115 patients were evaluated using the Hamilton Depression and Anxiety Rating Scale (HAM-D, HAM-A) and the Millon Clinical MultiaxialInventory-III (MCMI-III).

Results

The neuropathic group achieved significantly higher scores for pain intensity and depressive and anxiety symptoms. With greater magnitude and frequency, the neuropathic group related pain intensity and progression with depressive/anxiety symptoms, clinical syndromes, and personality patterns. Both groups revealed tendencies towards a compulsive personality pattern, followed by narcissistic, histrionic, and schizoid patterns.

Conclusions

When treating chronic pain, the presence of various psychopathological indicators requires an individualized strategy.

Predictors of personality disorders in prisoners

Personality disorders can lead to difficult social or occupational functional processes rooted in chronic maladaptive thoughts, feelings, and behaviors. This study aimed to investigate factors of personality disorder in prisoners from the central prison of Sanandaj, Iran. We conducted a cross-sectional study, which included all prisoners in the central prison of Sanandaj, Iran. The study sample includes 343 prisoners, of which 329 were male, and 14 were female, selected by randomized multistage sampling method. Participants filled in Millon's multi-axis clinical questionnaire. The data were analyzed using Chi-square, multiple logistic regression, and bootstrap analysis. There were 183 participants without personality disorders (53.4%) and 99 participants (28.9%) with cluster B personality disorders (narcissistic, histrionic, anti-social, and borderline). Male gender (OR=0.07) and elementary education level (OR=0.18) have a significant relationship with cluster A personality disorders (paranoid, schizoid, schizotypal). Cluster B has a significant relationship only with the elementary education level (OR=0.27). Cluster C (avoidant, dependent, obsessive-compulsive personality disorder) has a significant relationship with male gender (OR=0.20), elementary education level (OR=0.30), unemployment (OR=2.64), theft crime types (OR=0.38) and disputes and assaults (OR=0.18). Based on these results, psychological and psychiatric interventions in prisoners are suggested.

Psychotherapeutic Techniques for Distressing Memories: A Comparative Study between EMDR, Brainspotting, and Body Scan Meditation

Objectives: We explored the effects of a single 40-min session of Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting (BSP), and Body Scan Meditation (BSM) in the processing of distressing memories reported by a non-clinical sample of adult participants. Design: A within-subject design was used. Methods: Participants (n = 40 Psychologists/MDs) reported four distressing memories, each of which treated with a single intervention. EMDR, BSP, and BSM were compared with each other, and with a Book Reading (BR) active control condition, using as dependent measures, SUD (Subjective Units of Disturbance) and Memory Telling Duration (MTD) on a 4-point timeline: Baseline, Pre-Intervention, Post-Intervention, Follow-up. Results: SUD scores associated with EMDR, BSP, and BSM significantly decreased from Pre- to Post-Intervention (p < 0.001). At Post-Intervention and Follow-up, EMDR and BSP SUD scores were significantly lower than BSM and BR scores (p < 0.02). At both Post-Intervention and Follow-up, BSM SUD scores were lower than BR scores (p < 0.01). A reduction in MTD was observed from Pre- to Post-Intervention for EMDR and BSP conditions (p < 0.001). Conclusions: Overall, results showed beneficial effects of single sessions of EMDR, BSP, or BSM in the processing of healthy adults’ distressing memories. Study limitations and suggestions for future research are discussed.

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).

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.

Personality Profiles and Psychological Adjustment in Breast Cancer Patients

Dispositional personality characteristics may play a role in psychosocial adjustment to any disease, including cancer.

PURPOSE

The purpose of this study is to identify personality profiles in breast cancer patients and to determine whether these profiles are associated with psychological adjustment or psychopathology.

METHODS

Participants were 109 women (mean age, 52.01) diagnosed with breast cancer. They completed the Millon Clinical Multiaxial Inventory-III (MCMI-III), the Life Orientation Test-Revised (LOT-R), the Satisfaction with Life Scale, and the Positive and Negative Affect Scales.

RESULTS

The analysis revealed two different personality profiles: (a) one group, comprising 38.23% of the sample, was characterized by paranoid, negativistic, and dependent personality traits and was considered as a "vulnerable group"; and (b) another group (61.77%) was characterized by compulsive, histrionic, and narcissistic personality traits and was considered as a "psychologically adjusted group". The vulnerable group scored higher than the psychologically adjusted group on all clinical syndromes, with scores above 60 on the anxiety, somatoform, dysthymic, and bipolar scales (score on anxiety being above 75); in contrast, the psychologically adjusted group did not reach a base rate score of 60 on any of the clinical syndromes, showing no manifestations of psychopathology. Additionally, the vulnerable group scored lower than the psychologically adjusted group on optimism, life satisfaction, and positive affect, but higher on negative affect.

CONCLUSIONS

The results suggest that personality traits could affect the psychological adjustment of breast cancer survivors. We discuss the implications of belonging to each group and highlight the importance of early identification of vulnerable women in order to facilitate clinical and psychological support.

Personality and psychiatric disorders in chronic pain male affected by erectile dysfunction: prospective and observational study

The prevalence of personality disorders (PDs) and sexual dysfunction in chronic pain patients is higher than in general population. Our main objective was to analyse the influence of PD in patients with erectile dysfunction and chronic non-cancer pain and their response to andrological treatment. One-hundred one patients were included along 30 months. Pain intensity, quality of life, sexual life quality, anxiety and depression were analysed together with opioid dose. Erectile functioning was measured with the International Index of Erectile Function (IIEF) and PDs with Millon Clinical Multiaxial Inventory (MCMI-III). The mean age was 57 ± 12 years old, with moderate to severe pain, 70% were sexually active and presented moderate to severe ED. PDs were very frequent (31%, cut-off 85 and 84% cut-off 75 scores) mostly anxiety, compulsive, though disorder, somatoform and narcissistic. Self-defeating feature presence was significantly correlated (r = -0.4, 95% CI = -0.605 to -0.145, p = 0.002) with a more severe baseline ED and narcissistic, and a better response to andrological treatment (p = 0.010, d = 1.082). Patients with dysthymia features required significantly higher opioid doses vs. control (238 vs. 102 mg/day, respectively). These findings underline the importance of diagnosing PDs to rigorously treat patients with chronic pain and ED.