Comparability of scores on the MMPI-2-RF scales generated with the MMPI-2 and MMPI-2-RF booklets

No relations between executive functions and dimensional models of psychopathology or is time the missing link?

Impaired executive functions (EF) have been found within various mental disorders (e.g., attention deficit hyperactivity disorder, autism spectrum disorder, schizophrenia spectrum disorders) as described in DSM-5. However, although impaired EF has been observed within several categories of mental disorders, empirical research on direct relations between EF and broader dimension of psychopathology is still scarce. Therefore, in the current investigation we examined relations between three EF performance tasks and self-reported dimensions of psychopathology (i.e., the internalizing, externalizing, and thought disorder spectra) in a combined dataset of patients with a broad range of mental disorders (N = 440). Despite previously reported results that indicate impaired EF in several categories of mental disorders, in this study no direct relations were found between EF performance tasks and self-reported broader dimensions of psychopathology. These results indicate that relations between EF and psychopathology could be more complex and non-linear in nature. We evaluate the need for integration of EF and dimensional models of psychopathology and reflect on EF as a possible transdiagnostic factor of psychopathology.

Examining the Performance of the MMPI-2-RF in a Sample of Pretransplant Military Veterans

The present study aimed to describe the personality and psychopathology dimensions reported by veterans seeking organ transplantation, as well as to identify those dimensions associated with subsequent presurgical recommendations and transplant outcomes. Data were collected from 245 veterans undergoing a pretransplant psychological evaluation that included the MMPI-2-RF. Three treatment recommendations resulting from these evaluations, three recommendation adherence variables, and two transplant outcomes were extracted from electronic medical records. The sample's MMPI-2-RF scale scores were compared to the normative sample and two other presurgical samples and contrasted across subgroups defined by organ transplanted. Point-biserial correlations and logistic regression analyses examined associations between MMPI-2-RF scale scores and the eight measured outcomes. Results indicated that over-reporting, internalizing tendencies, negative emotionality, and a lack of positive emotions were uniquely predictive of mental health treatment recommendation, whereas somatic over-reporting, externalizing tendencies, and disinhibition were predictive of substance use treatment recommendation. Veterans who reported higher levels of activation were less likely to initiate mental health treatment. Finally, veterans with greater somatic preoccupation were less likely to be listed for organ transplant. More suspicious and mistrustful veterans were less likely to receive the transplant. These findings offer support for the role of the MMPI-2-RF in veteran pretransplant evaluations.

Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting

INTRODUCTION

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting. This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores.

METHOD

Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge.

RESULTS

Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge.

CONCLUSION

These results indicate a need to further examine these proxy indices in high acuity samples.

An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability

OBJECTIVE

More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF).

METHOD

Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes.

RESULTS

The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD.

CONCLUSIONS

Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.

MMPI-2-RF Differences Between Violent Offending and Institutional Violence Among Incarcerated Women

The examination of violence perpetrated by female offenders remains an understudied topic, as research typically focuses on male offender samples. As such, it remains unclear what personality characteristics may be associated with the perpetration of violence among female offenders. This study sought to examine the relationship between personality characteristics, as assessed by the MMPI-2-RF, and engagement in violence, within a sample of 228 incarcerated women. Results indicated that women serving time for a violent offense obtained higher mean scores on MMPI-2-RF scales related to underreporting, atypical thoughts/experiences, and paranoia. Women who obtained disciplinary reports for violence within the institution obtained higher mean scores on MMPI-2-RF scales related to behavior/externalizing dysfunction, overactivation, and aggression. Taken together, violence was most strongly associated with the MMPI-2-RF scales related to paranoia and atypical thoughts/experiences (e.g., THD, PSYC-r). This study provides new data on the viability of the MMPI-2-RF to provide critical insights into violent and aggression behavior in female inmates, an understudied population and demonstrate the instrument's efficacy in assessing characteristics associated with violent behavior.

Examination of the Generalizability of Underreporting Detected by the MMPI-2-RF in a Correctional Sample

It is relatively unclear if underreporting (UR) detected by Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) L-r (Uncommon Virtues) and K-r (Adjustment Validity) scale scores generalizes to score distortion on criterion measures differently based on test-takers having scored highly on L-r, K-r, or both. Thus, this study reanalyzed the correctional sample of 632 men previously presented by Forbey and colleagues and defined UR groups as high scores on L-r alone (n = 89), K-r alone (n = 45), or both (n = 29). Groups were compared on selected MMPI-2-RF and criterion scales assessing internalizing, externalizing, and thought dysfunction difficulties using analysis of variance (ANOVA) and post hoc tests. Results suggested that UR generalized to score distortion on collateral measures, with K-r outperforming L-r in the prediction of this generalizability on all but measures of specific externalizing difficulties. However, having elevations on both L-r and K-r resulted in the strongest pattern of generalizability.

The structure of dimensions of psychopathology in normative and clinical samples: Applying causal discovery to MMPI-2-RF scales to investigate clustering of psychopathology spectra and p-factors

We applied a Bayesian Constraint-based Causal Discovery method (BCCD) to examine the hierarchical structure of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Restructured Clinical (RC) scales. Two different general psychopathology super spectra (p-factor) scales were extracted from (1) all RC scales and (2) all RC scales except the RCd (Demoralization) scale. These p-factor scales were included in separate models to investigate the structure of dimensions of psychopathology in a normative (n = 3,242) and clinical (n = 2,466) sample, as well as the combined normative/clinical sample (N = 5,708), by applying the BCCD algorithm to obtain a data-driven reconstruction of the internal hierarchical structure of the MMPI-2-RF. Research on the underlying structure of the MMPI-2-RF has clinical relevance as well as conceptual relevance in the context of the HiTOP model. Results demonstrated that the syndromes measured with the RC-scales-in presence of a p-factor-cluster into six spectra: internalizing, disinhibited-externalizing, antagonistic-externalizing, thought disorder, detachment, and somatoform. These results may support a super spectrum construct, as it was necessary for obtaining a bottom-up reconstruction of this six-spectrum structure. We found support for superiority of a broad super spectrum with additional variance over and above demoralization, as it resulted in the clearest structure (i.e., clustering of the RC scales). Furthermore, our results indicate independent support for the bifactor structure model of psychopathology.

Criterion A of the DSM-5 Alternative Model for Personality Disorders in MMPI-2/RF Personality Disorder Scales

The Minnesota Multiphasic Personality Inventory (MMPI) instruments are frequently used to assess personality and psychopathology. Recent publications of personality disorder (PD) spectra scales for dimensionalized PD syndromes with MMPI instruments may advance PD assessment. To this end, we examined MMPI-Second Edition (2) and MMPI-2-Restructured Form (-RF) PD Spectra scales within the lens of a contemporary dimensional model of PDs, the alternative model for personality disorders (AMPD). The core dimension of PD, Criterion A of the AMPD or level of personality functioning (LPF), was characterized quantitatively within the PD Spectra scales. By sequentially factor analyzing the scales of the Severity Indices of Personality Problems (SIPP-118) to a common general factor of PD, an index of LPF external to the MMPI item pool was established. This LPF dimension was strongly represented across most PD Spectra scales. LPF variances within the PD Spectra scales were deconstructed using measures of general demoralization (RCdemoralization) and maladaptive personality traits indexed by the Personality Psychopathology-5 (PSY-5). Nuanced LPF and PD Spectra scale relationships were discerned. Dimensionalized Antisocial PD, Borderline PD, Dependent PD, and Paranoid PD showed meaningful association with LPF after demoralization, and maladaptive trait variances were removed. The examination of the MMPI-3 item pool reveals that the existing PD Spectra scale item sets are largely carried forward in the new edition of the MMPI. This suggests PD Spectra scale correlates, including LPF relationships, may be discernable in the newest edition of the MMPI, pending future study.

Screening of Mood Symptoms Using MMPI-2-RF Scales: An Application of Machine Learning Techniques

(1) Background: The MMPI-2-RF is the most widely used and most researched test among the tools for assessing psychopathology, and previous studies have established its validity. Mood disorders are the most common mental disorders worldwide; they present difficulties in early detection, go undiagnosed in many cases, and have a poor prognosis. (2) Methods: We analyzed a total of 8645 participants. We used the PHQ-9 to evaluate depressive symptoms and the MDQ to evaluate hypomanic symptoms. We used the 10 MMPI-2 Restructured Form scales and 23 Specific Problems scales for the MMPI-2-RF as predictors. We performed machine learning analysis using the k-nearest neighbor classification, linear discriminant analysis, and random forest classification. (3) Results: Through the machine learning technique, depressive symptoms were predicted with an AUC of 0.634-0.767, and the corresponding value range for hypomanic symptoms was 0.770-0.840. When using RCd to predict depressive symptoms, the AUC was 0.807, but this value was 0.840 when using linear discriminant classification. When predicting hypomanic symptoms with RC9, the AUC was 0.704, but this value was 0.767 when using the linear discriminant method. (4) Conclusions: Using machine learning analysis, we defined that participants' mood symptoms could be classified and predicted better than when using the Restructured Clinical scales.

Personality and Psychopathology in Adults with Noonan Syndrome

This is the first controlled study regarding personality and psychopathology in adults with Noonan syndrome (NS). Anxiety, depression, alexithymia and symptoms of Attention Deficit-Hyperactivity Disorder and Autism Spectrum Disorder, have been previously described in NS. More information regarding personality and psychopathology in NS could improve mental health care for this population. Therefore, scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), a widely used self-report questionnaire of personality and psychopathology, were compared between patients with NS (n = 18) and matched, healthy controls (n = 18). Furthermore, correlations between MMPI-2-RF scores and alexithymia, measured by the Toronto Alexithymia Scale-20, were investigated. Patients with NS showed significantly higher scores, with medium effect sizes, on MMPI-2-RF scales reflecting infrequent responses (F-r), somatic and cognitive complaints (FBS-r and RBS-r), internalizing problems (EID), demoralization (RCd) and introversion (INTR-r), although the overall profile in both groups was within the non-clinical range. Alexithymia correlated with internalizing problems and negative emotionality in the patient group. In conclusion, patients with NS showed higher levels of introversion, which may predispose them to internalizing problems. These problems were indeed more frequent in patients with NS, especially higher levels of demoralization. Patients may benefit from psychological interventions aimed to decrease internalizing problems, introversion and alexithymia.

Self-Regulation in Dual Diagnosis: A Multi-Method Approach of Self-Awareness, Error-Monitoring and Emotional Distress

Introduction: Self-regulatory actions direct the achievement of life goals. Awareness of one's state is needed to adequately self-regulate one's life.

Methods: The self-regulatory actions of (cognitive/emotional) self-awareness and (error-)monitoring were assessed in patients with Dual Diagnosis and healthy controls. A multi-method approach was applied.

Results: Patients with Dual Diagnosis reported lower capacity to identify, verbalize and interpret emotions in a cognitive manner. Both groups reported experiencing arousal of emotions, but patients showed less cognitive elaboration on them and they reported more negatively labeled emotions. Patients with Dual Diagnosis signaled errors less adequately, but did not differ in the number of errors.

Discussion: The abundance of negative emotions may overwhelm patients and trigger substance use to handle this negativity. Especially because they do in fact experience the arousal of emotions, but they find it harder to timely identify, interpret and verbalize these emotions. Training self-awareness and emotion regulation may be beneficial.

Clinical Utility of the MMPI-2-RF Hierarchical Description

Abstract. Several studies have addressed the associations between the Minnesota Multiphasic Personality Inventory-2 Restructured form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 ) scale scores and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013 ) Section II personality disorder (PD) criterion counts. While these studies showed which variables were associated with the PDs as well as their combined predictive potency, no information is available on mean patterns of elevation associated with these conditions. To illustrate how the MMPI-2-RF information may amplify categorical diagnostic information, we describe the mean RF profiles of a psychiatric sample with a Cluster C PD diagnosis. PD classification was based on the Structured Clinical Interview for the DSM-IV (SCID-II). Patterns of elevation across the three levels of the MMPI-2-RF scale sets were consistently in line with theoretical expectation. In addition, elevated scores on somatic/cognitive scales were noted. It is concluded that the MMPI-2-RF can enhance DSM Personality disorder model description.

Associations between supernormality ('faking good'), narcissism and depression: An exploratory study in a clinical sample

We explored underreporting of mental health symptoms and its correlates in adults receiving psychological treatment. We administered the Supernormality Scale (SS), the Minnesota Multiple Personality Inventory-2 (Restructured Form, MMPI-2-RF), the Narcissistic Personality Inventory (NPI) and the Beck Depression Inventory-II (BDI-2) to 147 patients at the start of their treatment. Supernormality (i.e., denial of common symptoms) was positively associated with MMPI-2(-RF) faking good parameters supporting the construct validity of the SS. Narcissism was negatively related to self-reported depression symptoms, but this association failed to reach significance (r = -.15, p = .07). This suggests that patients high on grandiose/overt narcissism might tend to deny common symptoms. The link between supernormality and depression symptoms as measured by the BDI-2 was substantial and negative (r = -.72). Our data suggest that supernormality is associated with constricted self-reports of depression. Given the clinical relevance of symptom underreporting, our preliminary findings require a large-scale replication.

Robustness of the Maladaptive Personality Plaster: An Investigation of Stability of the PSY-5-r in Adults over 20 Years

The long-term stability of maladaptive personality traits in the general population has been under-investigated. The current study examined the longitudinal 20-year mean-level stability and rank-order consistency of five maladaptive personality traits-as measured with the Personality Psychopathology-5-r scales. Correlations and regression analysis were conducted to test both types of stability comparing raw scores of scale administrations in a general population sample in both 1992 and 2012 (N = 65). Repeated measures analysis of variance demonstrated significant mean-level stability of the PSY-5-r traits over 20 years. The PSY-5-r scales demonstrated significant rank-order consistency as evidenced by correlational analyses and reliability coefficients. The scales Aggressiveness-r (r = .73), Neuroticism/Negative Emotionality-r (r = .65), Introversion/Low Positive Emotionality-r (r = .63), and Disconstraint-r (r = .56), evidenced strong rank-order stability, whereas Psychoticism-r (r = .3) showed moderate rank-order consistency. The results of the present study indicate that maladaptive personality traits as measured with the PSY-5-r scales are relatively stable over 20 years in an adult community population.

Associations Between MMPI-2-RF Internalizing RC Scales and Positive Characteristics

Past studies indicate that the low scores on the MMPI and MMPI-2 Clinical and Content Scales can reflect positive characteristics. It is currently unclear, however, whether scales on the MMPI-2-Restructured Form (MMPI-2-RF) have that ability. Accordingly, we examined whether low scores on Restructured Clinical (RC) Scales assessing internalizing difficulties (i.e., RCd, RC2, and RC7) can reflect self-esteem, life satisfaction, positive and negative affect, and optimism. When considering the full range of scores, each of the internalizing RC Scales demonstrated the expected pattern of associations with these characteristics. Across difference and percentage bend analyses, however, only RC2 had significant associations-namely, with positive affect, self-esteem, and life satisfaction. This study corroborates that high scores on the internalizing RC scales have interpretations consistent with past literature, but also uniquely suggests that below average RC2 scores may reflect increased positive affect, self-esteem, optimism, and satisfaction with life.

Prospective Comparison of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and MMPI-2-Restructured Form (MMPI-2-RF) in Predicting Treatment Outcomes Among Patients with Chronic Low Back Pain

The purpose of the current study was to examine the relative utility of the most updated MMPI adult instrument, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), which was designed to address psychometric limitations of the MMPI-2. To this end, we compared mean scores and correlates of emotional distress treatment outcomes using the Depression Anxiety Stress Scales in a sample of 230 patients (73 males, 157 females) who had completed an interdisciplinary chronic pain rehabilitation program. Structural equation modeling analyses indicated that higher scale scores from all the MMPI-2-RF substantive domains were meaningfully associated with worse emotional distress outcomes, whereas the MMPI-2 Clinical Scales generally did not have any meaningful associations. Similar results were found in additional analyses using a clinically significant change framework with more direct clinical implications. The results of this study provide preliminary support for the use of the MMPI-2-RF among patients with chronic low back pain.

Predicting therapist ratings of treatment progress and outcomes with the MMPI-2-RF

OBJECTIVE

We examined the ability of scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales to predict treatment progress (compliance and activity in therapy) and outcome at termination (success in therapy, readiness for termination, and functioning at termination).

METHOD

Our sample included 448 (185 males, 263 females) community mental health center outpatients with an average age of 32.2 years (standard deviation = 10.2). We used MMPI-2-RF (self-report) indicators of personality and psychopathology and a composite outcome variable that represents therapist ratings of clients' treatment progress and outcomes.

RESULTS

Scores on several MMPI-2-RF scales were correlated and associated with increased risk for poorer psychotherapy progress and outcomes in a mental health outpatient sample.

CONCLUSIONS

Clinicians can utilize the MMPI-2-RF to identify clients at risk for therapy process challenges and adverse outcomes, suggesting possible problem areas for intervention.

The Moderating Influence of Disorder on Coached Overreporting Using the MMPI-2-RF

Overreporting has always been a concern within psychological evaluations. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008/2011 ) contains validity scales designed for detecting noncredible responses. In this study, 270 undergraduates were instructed to feign either schizophrenia, posttraumatic stress disorder (PTSD) or generalized anxiety disorder (GAD); some participants were coached on symptoms and validity scales. Results at both the individual protocol and mean validity scale score levels suggest that each feigned disorder moderates the effectiveness of coaching on validity scale detection. One finding of this study suggests that schizophrenia is generally more difficult to successfully feign than PTSD or GAD. Another finding suggests that the majority of individuals able to avoid detection as symptom overreporters are able to successfully endorse at least some disorder-relevant symptoms. We suggest that future research focus on the systematic exploration of other factors influencing the effectiveness of validity scales as well as the development of validity scales designed to detect the overreporting of internalizing forms of psychopathology.

Age-Neutrality of a Brief Assessment of the Section III Alternative Model for Personality Disorders in Older Adults

The alternative model for personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5) is considered an important step toward a possibly better conceptualization of personality pathology in older adulthood, by the introduction of levels of personality functioning (Criterion A) and trait dimensions (Criterion B). Our main aim was to examine age-neutrality of the Short Form of the Severity Indices of Personality Problems (SIPP-SF; Criterion A) and Personality Inventory for DSM-5-Brief Form (PID-5-BF; Criterion B). Differential item functioning (DIF) analyses and more specifically the impact on scale level through differential test functioning (DTF) analyses made clear that the SIPP-SF was more age-neutral (6% DIF, only one of four domains showed DTF) than the PID-5-BF (25% DIF, all four tested domains had DTF) in a community sample of older and younger adults. Age differences in convergent validity also point in the direction of differences in underlying constructs. Concurrent and criterion validity in geriatric psychiatry inpatients suggest that both the SIPP-SF scales measuring levels of personality functioning (especially self-functioning) and the PID-5-BF might be useful screening measures in older adults despite age-neutrality not being confirmed.

Distinguishing Levels of Suicide Risk in Depressed Male Veterans: The Role of Internalizing and Externalizing Psychopathology as Measured by the MMPI-2-RF

Suicide occurs at high rates among veterans, underscoring a need for improved identification of veterans at risk of engaging in suicidal behavior. Considering dimensions of psychopathology in the context of an ideation-to-action framework, the present study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form in distinguishing depressed, psychiatrically hospitalized male veterans ( N = 430) at varying levels of suicide risk. Analysis of variance and hierarchical logistic regression analyses indicated that internalizing scales differentiated depressed ideators ( n = 147) and depressed controls ( n = 143); and in line with expectations, both broad and narrowly focused externalizing scales provided incremental validity in distinguishing depressed attempters ( n = 140) from depressed ideators. Interactions between Suicidal/Death Ideation and externalizing scale scores were found to differentiate only depressed ideators from depressed controls. Clinical implications in the areas of suicide risk assessment and therapeutic interventions with suicidal veterans are discussed.

The Utility of MMPI-2-RF Scale Scores in the Differential Diagnosis of Schizophrenia and Major Depressive Disorder

This study was designed to determine whether scores on selected Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales could be used to differentiate between individuals diagnosed with schizophrenia (SCZ) and major depressive disorder (MDD). The sample was drawn from 2 psychiatric inpatient hospitals and included data from 199 individuals with SCZ and 808 individuals with MDD. A series of multivariate analyses of variance, analyses of variance, and odds ratios were calculated to determine which MMPI-2-RF scales provide the best differentiation between individuals presenting with these 2 disorders. Results indicated scales assessing internalizing dysfunction, including Emotional/Internalizing Dysfunction (EID), Restructured Clinical Scales Demoralization (RCd), Low Positive Emotions (RC2), Suicidal/Death Ideation (SUI), and Self Doubt (SFD) best discriminated MDD from SCZ. Scales assessing thought dysfunction, incluidng Thought Dysfunction (THD), Restructured Clinical Scales Ideas of Persecution (RC6) and Aberrant Experiences (RC8), and Psychoticism-Revised (PSYC-r) were demonstrated to best identify SCZ. Comparisons of the examined MMPI-2-RF scales to MMPI-2 scales assessing similar constructs suggested scales from the MMPI-2-RF perform similarly to their MMPI-2 counterparts in detecting MDD or SCZ, but might have increased ability to discriminate SCZ from other conditions. Overall, results of this study suggest that scores on the examined MMPI-2-RF scales provide important information about the differential diagnosis of MDD and SCZ to clinicians working in inpatient settings.

Self-awareness of cognitive dysfunction: Self-reported complaints and cognitive performance in patients with alcohol-induced mild or major neurocognitive disorder

Patients with Korsakoff's syndrome (KS) typically have difficulties in recognizing the impact of their alcohol-related cognitive deficits on daily-life functioning. In this study, mean scores on self-reported complaints (measured with Minnesota Multiphasic Personality Inventory-2-Restructured Form; MMPI-2-RF) and cognitive performance (measured with the Wechsler Adult Intelligence Scale-Third edition; WAIS-III; and the California Verbal Learning Test; CVLT) are compared between two matched patient groups with severe (KS) and mild alcohol-related cognitive disorders or non KS (NKS). KS patients demonstrate significantly lower scores on the WAIS-III indices and on the CVLT than the matched NKS group, and significantly higher scores on MMPI-2-RF validity scales that indicate denial of psychological complaints. Both groups are in the normal range on MMPI-2-RF Cognitive Complaints (COG) and Neurological Complaints (NUC) scales compared with the normative sample. Finally, self-reported complaints and cognitive performance are not correlated significantly in both groups. Despite their alcohol-related cognitive impairments, both groups report no cognitive complaints at all indicating self-awareness impairment. In addition to KS patients, also NKS patients are at risk that their apparently "without cognitive complaints" appearance on self-report questionnaires can be easily overlooked. These findings may have important clinical implications for diagnostic and treatment purposes.

Examination of MMPI-2-RF Substantive Scales as Indicators of Acute Suicidal Affective Disturbance Components

A new suicide-specific diagnostic entity, acute suicidal affective disturbance (ASAD), was recently proposed to fill a void in the nomenclature. Although several studies have examined the reliability, validity, and potential clinical utility of ASAD, no studies have examined personality indicators of ASAD. This study sought to examine the association between personality and psychopathology factors, as assessed by the Minnesota Multiphasic Personality Inventory-2-Revised Form (MMPI-2-RF), and constructs that comprise ASAD in a sample of 554 psychiatric outpatients who completed all measures prior to their intake appointments. A smaller subset of patients (N = 58) also completed a measure designed to assess lifetime ASAD symptoms. Results indicated that ASAD symptoms were associated with traits characterized by emotional turmoil and atypical cognitive processes. Further, suicide-related criteria that comprise ASAD were related to low positive emotionality and hopelessness, whereas the overarousal criteria were associated with somatic symptoms and an inability to tolerate frustration and stress. These findings expand on previous research that examines the convergent and discriminant validity of ASAD and could inform clinical treatment by providing insight into personality traits that might be associated with acute suicide risk.

Mapping the MMPI-2-RF Specific Problems Scales Onto Extant Psychopathology Structures

A main objective in developing the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008 ) was to link the hierarchical structure of the instrument's scales to contemporary psychopathology and personality models for greater enhancement of construct validity. Initial evidence published with the Restructured Clinical scales has indicated promising results in that the higher order structure of these measures maps onto those reported in the extant psychopathology literature. This study focused on evaluating the internal structure of the Specific Problems and Interest scales, which have not yet been examined in this manner. Two large, mixed-gender outpatient and correctional samples were used. Exploratory factor analyses revealed consistent evidence for a 4-factor structure representing somatization, negative affect, externalizing, and social detachment. Convergent and discriminant validity analyses in the outpatient sample yielded a pattern of results consistent with expectations. These findings add further evidence to indicate that the MMPI-2-RF hierarchy of scales map onto extant psychopathology literature, and also add support to the notion that somatization and detachment should be considered important higher order domains in the psychopathology literature.

Development and Validation of MMPI-2-RF Scales for Indexing Triarchic Psychopathy Constructs

The triarchic model characterizes psychopathy in terms of three distinct dispositional constructs of boldness, meanness, and disinhibition. The model can be operationalized through scales designed specifically to index these domains or by using items from other inventories that provide coverage of related constructs. The present study sought to develop and validate scales for assessing the triarchic model domains using items from the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF). A consensus rating approach was used to identify items relevant to each triarchic domain, and following psychometric refinement, the resulting MMPI-2-RF-based triarchic scales were evaluated for convergent and discriminant validity in relation to multiple psychopathy-relevant criterion variables in offender and nonoffender samples. Expected convergent and discriminant associations were evident very clearly for the Boldness and Disinhibition scales and somewhat less clearly for the Meanness scale. Moreover, hierarchical regression analyses indicated that all MMPI-2-RF triarchic scales incremented standard MMPI-2-RF scale scores in predicting extant triarchic model scale scores. The widespread use of MMPI-2-RF in clinical and forensic settings provides avenues for both clinical and research applications in contexts where traditional psychopathy measures are less likely to be administered.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal–Psychological Theory of Suicide With MMPI-2-RF Scales

Given the emerging body of literature demonstrating the validity of the interpersonal–psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale–based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

Utility of the MMPI-2-RF Validity Scales in Detection of Simulated Underreporting: Implications of Incorporating a Manipulation Check

We examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) underreporting Validity Scales in a simulation design with a sample of 257 undergraduate college students. Extending past research by Sellbom and Bagby, we added a manipulation check to determine whether individuals complied with instructions to underreport and examined the impact of underreporting on all of the MMPI-2-RF substantive scales. Results indicated that individuals who complied with instructions to underreport produced statistically significantly and meaningfully higher scores on the MMPI-2-RF underreporting Validity Scales (Uncommon Virtues [L-r] and Adjustment Validity [K-r]) when compared with those who received standard instructions and with individuals who did not comply with instructions to underreport. Moreover, in comparisons with both groups, participants who complied with instructions to underreport had lower scores on the majority of the substantive scales. L-r and K-r added incremental predictive utility (in reference to one another) in differentiating individuals who underreported from individuals who were given standard instructions.

The Generalizability of Overreporting Across Self-Report Measures: An Investigation With the Minnesota Multiphasic Personality Inventory–2–Restructured Form and the Personality Assessment Inventory in a Civil Disability Sample

Elevated overreporting Validity Scale scores on the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) are associated with higher scores on collateral measures; however, measures used in prior research lacked validity scales. We sought to extend these findings by examining associations between elevated MMPI-2-RF overreporting scale scores and Personality Assessment Inventory (PAI) scale scores among 654 non–head injury civil disability claimants. Individuals were classified as overreporting psychopathology (OR-P), overreporting somatic/cognitive complaints (OR-SC), inconclusive reporting psychopathology (IR-P), inconclusive reporting somatic/cognitive complaints (IR-SC), or valid reporting (VR). Both overreporting groups had significantly and meaningfully higher scores than the VR group on the MMPI-2-RF and PAI scales. Both IR groups had significantly and meaningfully higher scores than the VR group, as well as lower scores than their overreporting counterparts. Our findings demonstrate the utility of inventories with validity scales in assessment batteries that include instruments without measures of protocol validity.

Theoretical and empirical concerns regarding the dark triad as a construct

Psychopathy, Machiavellianism, and narcissism are three constructs that have been collectively referred to as the "Dark Triad." Although researchers were initially interested in comparing similarities and differences between these constructs, in recent years researchers have combined items from the measures to create an overall measure of the Dark Triad as a single construct. The authors raise theoretical concerns regarding this approach, arguing that Machiavellianism and narcissism can be viewed as features or traits of psychopathy. They also provide empirical evidence from a large, correctional sample (N = 972) to demonstrate that a latent Dark Triad could not be estimated using confirmatory factor analysis because more than 100% of the variance was attributed to psychopathy. Moreover, the Dark Triad traits, by and large, did not confer incremental validity above and beyond psychopathy, and none of the interaction models indicated that additional information would be gained from considering the Dark Triad traits in constellation.

A Prorating Method for Estimating MMPI-2-RF Scores From MMPI Responses: Examination of Score Fidelity and Illustration of Empirical Utility in the PERSEREC Police Integrity Study Sample

The purpose of the current study was to identify Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) correlates of police officer integrity violations and other problem behaviors in an archival database with original MMPI item responses and collateral information regarding integrity violations obtained for 417 male officers. In Study 1, we estimated MMPI-2-RF scores from the MMPI item pool (which includes approximately 80% of the MMPI-2-RF items) in a normative sample, a psychiatric inpatient sample, and a police officer sample, and conducted analyses that demonstrated the comparability of estimated and full scale scores for 41 of the 51 MMPI-2-RF scales. In Study 2, we correlated estimated MMPI-2-RF scores with information about subsequent integrity violations and problem behaviors from the integrity violation data set. Several meaningful associations were obtained, predominately with scales from the emotional, thought, and behavioral dysfunction domains of the MMPI-2-RF. Application of a correction for range restriction yielded substantially improved validity estimates. Finally, we calculated relative risk ratios for the statistically significant findings using cutoffs lower than 65T, which is traditionally used to identify clinically significant elevations, and found several meaningful relative risk ratios.

Premature termination from psychotherapy and internalizing psychopathology: the role of demoralization

BACKGROUND

Some research suggests that higher levels of depression and anxiety-related symptoms at intake are associated with premature termination from psychotherapy, but findings are mixed. However, theoretical and measurement considerations - introduced by a common mood factor - might complicate literature synthesis. Tellegen (1985) demonstrated that demoralization causes multicollinearity between measures of depression and anxiety, and other lines of research have converged to indicate that this construct is an important non-specific factor to consider when assessing mood pathology.

METHODS

We utilized a sample of 557 community mental health center outpatients (188 males, 265 females; 80% Caucasian) with an average age of 32.2 years (SD=10.2). We used self-report indicators to model latent low positive emotionality and negative emotionality constructs, which are temperament markers of core depressive and anxiety symptoms. We further specified a latent demoralization bifactor from these indicators.

RESULTS

As hypothesized, the bifactor model yielded significantly better fit than competing one-factor and two-factor models. Furthermore, the bifactor was substantially correlated with a demoralization measure (r=.96). As expected, low positive emotionality and negative emotionality were significant predictors of therapist ratings of premature termination. Though demoralization was a non-significant predictor, the structural paths from the other two internalizing constructs markedly increased in the bifactor model relative to the two-factor model.

LIMITATIONS

Replications with other, more diverse clinical populations using multi-method indicators of premature termination are needed.

CONCLUSIONS

This research indicates that after accounting for demoralization patients presenting with core mood disorder symptoms are at substantially increased risk for premature termination.

Psychometric Evaluation of the MMPI-2/MMPI-2-RF Restructured Clinical Scales in an Israeli Sample

The current study cross-culturally evaluated the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)/MMPI-2-Restructured Form Restructured Clinical (RC) Scales in psychiatric settings in Israel with a sample of 100 men and 133 women. Participants were administered the MMPI-2 and were rated by their therapists on a 188-item Patient Description Form. Results indicated that in most instances the RC Scales demonstrated equivalent or better internal consistencies and improved intercorrelation patterns relative to their clinical counterparts. Furthermore, external analyses revealed comparable or improved convergent validity (with the exceptions of Antisocial Behavior [RC4] and Ideas of Persecution [RC6] among men), and mostly greater discriminant validity. Overall, the findings indicate that consistent with previous findings, the RC Scales generally exhibit comparable to improved psychometric properties over the Clinical Scales. Implications of the results, limitations, and recommendations for future research are discussed.

Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Scores Generated From the MMPI-2 and MMPI-2-RF Test Booklets

We investigated the internal structure comparability of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scores derived from the MMPI-2 and MMPI-2-RF booklets in a sample of 320 criminal defendants (229 males and 54 females). After exclusion of invalid protocols, the final sample consisted of 96 defendants who were administered the MMPI-2-RF booklet and 83 who completed the MMPI-2. No statistically significant differences in MMPI-2-RF invalidity rates were observed between the two forms. Individuals in the final sample who completed the MMPI-2-RF did not statistically differ on demographics or referral question from those who were administered the MMPI-2 booklet. Independent t tests showed no statistically significant differences between MMPI-2-RF scores generated with the MMPI-2 and MMPI-2-RF booklets on the test’s substantive scales. Statistically significant small differences were observed on the revised Variable Response Inconsistency (VRIN-r) and True Response Inconsistency (TRIN-r) scales. Cronbach’s alpha and standard errors of measurement were approximately equal between the booklets for all MMPI-2-RF scales. Finally, MMPI-2-RF intercorrelations produced from the two forms yielded mostly small and a few medium differences, indicating that discriminant validity and test structure are maintained. Overall, our findings reflect the internal structure comparability of MMPI-2-RF scale scores generated from MMPI-2 and MMPI-2-RF booklets. Implications of these results and limitations of these findings are discussed.

Using the MMPI-2-RF to discriminate psychometrically identified schizotypic college students from a matched comparison sample

This study investigates the extent to which the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) profiles of 52 individuals making up a psychometrically identified schizotypes (SZT) sample could be successfully discriminated from the protocols of 52 individuals in a matched comparison (MC) sample. Replication analyses were performed with an additional 53 pairs of SZT and MC participants. Results showed significant differences in mean T-score values between these 2 groups across a variety of MMPI-2-RF scales. Results from discriminant function analyses indicate that schizotypy can be predicted effectively using 4 MMPI-2-RF scales and that this method of classification held up on replication. Additional results demonstrated that these MMPI-2-RF scales nominally outperformed MMPI-2 scales suggested by previous research as being indicative of schizophrenia liability. Directions for future research with the MMPI-2-RF are suggested.

The Utility of MMPI-2-RF Substantive Scales in Prediction of Negative Treatment Outcomes in a Community Mental Health Center

This study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) substantive scales in the prediction of premature termination and therapy no-shows while controlling for other relevant predictors in a university-based community mental health center, a sample at high risk of both premature termination and no-show appointments. Participants included 457 individuals seeking services from a university-based psychology clinic. Results indicated that Juvenile Conduct Problems (JCP) predicted premature termination and Behavioral/Externalizing Dysfunction and JCP predicted number of no-shows, when accounting for initial severity of illness, personality disorder diagnosis, therapist experience, and other related MMPI-2-RF scales. The MMPI-2-RF Aesthetic-Literary Interests scale also predicted number of no-shows. Recommendations for applying these findings in clinical practice are discussed.

Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) Predictors of Police Officer Problem Behavior

The purpose of this study was to investigate the predictive validity of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) in a sample of law enforcement officers. MMPI-2-RF scores were collected from preemployment psychological evaluations of 136 male police officers, and supervisor ratings of performance and problem behavior were subsequently obtained during the initial probationary period. The sample produced meaningfully lower and less variant substantive scale scores than the general population and the MMPI-2-RF Police Candidate comparison group, which significantly affected effect sizes for the zero-order correlations. After applying a correction for range restriction, MMPI-2-RF substantive scales demonstrated moderate to strong associations with criteria, particularly in the Emotional Dysfunction and Interpersonal Functioning domains. Relative risk ratio analyses showed that cutoffs of 45 T and 50 T maintained reasonable selection ratios because of the exceptionally low scores in this sample and were associated with significantly increased risk for problematic behavior. These results provide support for the predictive validity of the MMPI-2-RF substantive scales in this setting. Implications of these findings and limitations of these results are discussed.

Elevation discrepancies between MMPI-2 clinical and MMPI-2-RF restructured clinical (RC) scales in people with seizure disorders

PURPOSE

People with seizure disorders experience elevated rates of psychopathology, often undiagnosed and untreated. Accurate diagnosis of psychopathology remains an important goal of quality health care for people with seizure disorders. One of the most widely used dimensional measures of psychopathology is the Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2). Research in heterogeneous mental health samples suggests that the 2008 revision of this measure, the Minnesota Multiphasic Personality Inventory-Second Edition-Restructured Form (MMPI-2-RF), offers better construct fidelity and more cost-effective administration. This study seeks to extend research on MMPI-2-RF scale elevations to a sample of people with seizure disorders.

METHODS

In a consecutive, heterogeneous sample of people with seizure disorders, MMPI-2 and MMPI-2-RF scores were compared in terms of categorical classification agreement (clinically elevated versus not clinically elevated). Scores were also compared in terms of variance attributable to diagnosis-specific items, general demoralization, subtle items, social desirability, and demographic factors.

KEY FINDINGS

Scores on MMPI-2 and MMPI-2-RF provided a statistically significant level of agreement between corresponding clinical diagnostic scales ranging from 68% to 84%. Most classification disagreement was attributable to MMPI-2 clinical scale elevations when MMPI-2-RF scales were not elevated. Regression analysis supported the interpretation that general demoralization, subtle items, social desirability, and demographic factors led to MMPI-2 clinical scale elevations.

SIGNIFICANCE

The results provide evidence that in the context of strong psychopathology classification agreement, the MMPI-2-RF restructured clinical scales provide better construct fidelity compared with the more trait heterogeneous MMPI-2 clinical scales. These results should encourage clinicians to use the MMPI-2 Restructured Form (MMPI-2-RF) for improved psychopathology assessment compared with the MMPI-2 in patients with seizure disorders.

Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Scales as predictors of psychiatric diagnoses

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is an alternative version of the MMPI-2 and is useful for the differential diagnosis of psychiatric disorders. This study sought to assess the relationship between MMPI-2 Scale scores and psychiatric diagnoses, and to identify the scales that best predicted that a diagnosis would be assigned. The sample was comprised of participants who were administered the MMPI-2 between 2001 and 2010 at a university-based psychological services center, and participants were divided into diagnostic categories based on Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnoses. Categories with enough participants to conduct statistical analyses were examined; these categories included participants who were diagnosed with substance-related disorders, depressive disorders, anxiety disorders, and participants who were not given a psychiatric diagnosis. The Substance-Related Disorders category was not significantly correlated with any scale but was best predicted by Cynicism (RC3) and Substance Abuse (SUB). The Depressive Disorders category was significantly correlated with Emotional/Internalizing Dysfunction (EID), Demoralization (RCd), Low Positive Emotions (RC2), and Self-Doubt (SFD) Scales, and was best predicted by RCd. The Anxiety Disorders category did not significantly correlate with any scale but was best predicted by Infrequent Somatic Responses (Fs) and Gastrointestinal Complaints (GIC). The No Diagnosis category was negatively correlated with Infrequent Responses–Revised (F-r), EID, RCd, Helplessness/ Hopelessness (HLP), and Cognitive Complaints (COG), and was best predicted by EID. This study offers important information regarding scales that best predict psychiatric disorders and adds to the research that suggests that the MMPI-2-RF can aid clinicians in the differentiation of psychiatric disorders.

The MMPI-2-RF Personality Psychopathology Five (PSY-5-RF) scales: development and validity research

This article describes the development, internal psychometric, and external validation studies on scales designed to measure the Personality Psychopathology Five (PSY-5) from MMPI-2 Restructured Form (MMPI-2-RF) items. Diverse and comprehensive data sets, representing various clinical and nonclinical populations, were classified into development and validation research samples. Item selection, retention, and exclusion procedures are detailed. The final set of PSY-5-RF scales contain 104 items, with no item overlap between scales (same as the original MMPI-2 PSY-5 scales), and no item overlap with the Demoralization scale. Internal consistency estimates are comparable to the longer MMPI-2 PSY-5 scales. Appropriate convergent and discriminant validity findings utilizing various self-report, collateral rating, and record review data are reported and discussed. A particular emphasis is offered for the unique aspects of the PSY-5 model: psychoticism and disconstraint. The findings are connected to the broader PSY-5 literature and the recommended review of systems (Harkness, Reynolds, & Lilienfeld, this issue) presented in this series of articles.