Further evidence on the validity of the MMPI-2 Restructured Clinical (RC) Scales: addressing questions raised by Rogers, Sewell, Harrison, and Jordan and Nichols

The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.

Methods for questionnaire design: a taxonomy linking procedures to test goals

BACKGROUND

In the clinical field, the use of questionnaires is ubiquitous, and many different methods for constructing them are available. The reason for using a specific method is usually lacking, and a generally accepted classification of methods is not yet available. To guide test developers and users, this article presents a taxonomy for methods of questionnaire design which links the methods to the goal of a test.

METHODS

The taxonomy assumes that construction methods are directed towards psychometric aspects. Four stages of test construction are distinguished to describe methods: concept analysis, item production, scale construction, and evaluation; the scale construction stage is used for identifying methods. It distinguishes six different methods: the rational method utilizes expert judgments to ensure face validity. The prototypical method uses prototypicality judgments to ensure process validity. In the internal method, item sets are selected that optimize homogeneity. The external method optimizes criterion validity by selecting items that best predict an external criterion. Under the construct method theoretical considerations are used to optimize construct validity. The facet method is aimed at optimizing content validity through a complete representation of the concept domain.

CONCLUSION

The taxonomy is comprehensive, constitutes a useful tool for describing procedures used in questionnaire design, and allows for setting up a test construction plan in which the priorities among psychometric aspects are made explicit.

Identifying non-affective psychosis in first admission patients: MMPI-2, structured diagnostic interview, and consensus lifetime best estimate

PURPOSE

We aimed to evaluate the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) as a potential means of improving on the SCID's diagnostic efficacy.

METHODS

76 first-admission patients were assigned DSM-IV consensus diagnoses by two experienced psychiatrists using all available information, then dichotomized into non-affective psychosis and other mental illness groups. The patients were also given the SCID and the MMPI-2. The diagnostic performance of the MMPI-2 was compared to that of the SCID to assess both diagnostic accuracy and incremental validity.

RESULTS

MMPI-2 scales 8 (Schizophrenia) and BIZ (Bizarre Mentations) correctly identified 58% and 56% respectively of non-affective psychotic patients. The Goldberg Index had an overall correct classification rate of 70%, but only identified 49% of the psychosis group. The SCID had a correct classification rate of 66% but correctly identified only 25% of the non-affective psychosis patients. Three MMPI-2 scales combined with the SCID resulted in an overall correct classification rate of 73%, and identification of 66% of the non-affective psychosis patients.

CONCLUSION

The results suggest that the MMPI-2 may identify early psychosis at least as well as the SCID. Furthermore, using a combination of the MMPI-2 and the SCID shows incremental validity over using the SCID alone.

Of Fallacies and Errors, New and Repeated: A Rejoinder to Butcher et al. (2018)

Butcher, Hass, Greene, Nelson, Nichols, and Williams ( 2018 ) responded to my (Ben-Porath, 2018 ) critique of Butcher, Hass, Greene, and Nelson's (2015) analysis of Ted Kaczynski's MMPI-2-RF, purporting to find logical fallacies in my arguments and shortcomings in my interpretation of MMPI-2-RF scales. Butcher et al. ( 2018 ) repeated several previously refuted arguments and opinions, while failing to acknowledge, let alone consider, prior responses to their claims. In this rejoinder I refute (again) Butcher et al.'s assertion that empirical data raise questions about the "clinical sensitivity" of MMPI-2-RF scales, identify an extensive literature relevant to forensic use of the MMPI-2-RF that Butcher and colleagues have systematically ignored, and identify a series of logical and factual fallacies along with new and repeated errors of omission and commission in Butcher et al.'s response.

Tolerance of negative emotion moderates the amplification of mental contamination following an evoking task: A randomized experimental study

BACKGROUND AND OBJECTIVES

Contamination is a near universal feeling, with mental contamination representing a contamination feeling in the absence of direct physical contact with a source. Extant research indicates that tolerance of negative emotion is important for understanding emotional reactions to images, thoughts, and memories, all of which are common sources of mental contamination. Extending research linking distress tolerance to mental contamination, this study examined if individual differences in the tolerance of negative emotion moderates the amplification of mental contamination following an evoking task.

METHOD

Unselected participants completed a self-report measure of tolerance of negative emotion during an online session. They later attended an in-person session and were randomized to an experimental scenario group: betrayal (n = 49) or control (n = 49). Participants imagined themselves in a scenario, with the betrayal scenario designed to evoke mental contamination. Mental contamination was assessed by self-report before and after the scenario.

RESULTS

The betrayal, but not control, scenario caused an increase in mental contamination. Tolerance for negative emotion moderated the effect of group on mental contamination. Group differences in mental contamination evidenced at low, but not high, distress tolerance.

LIMITATIONS

A novel experimental manipulation and an unselected sample were used. Future research could assess tolerance of negative emotion using a behavioral task.

CONCLUSIONS

These results indicate that tolerance of negative emotion may be important for understanding when individuals experience mental contamination.

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.

Comparative prediction of nonepileptic events using MMPI-2 clinical scales, Harris Lingoes subscales, and restructured clinical scales

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a psychological testing tool used to measure psychological and personality constructs. The MMPI-2 has proven helpful in identifying individuals with nonepileptic events/nonepileptic seizures. However, the MMPI-2 has had some updates that enhanced its original scales. The aim of this article was to test the utility of updated MMPI-2 scales in predicting the likelihood of non-epileptic seizures in individuals admitted to an EEG video monitoring unit. We compared sensitivity, specificity, and likelihood ratios of traditional MMPI-2 Clinical Scales against more homogenous MMPI-2 Harris-Lingoes subscales and the newer Restructured Clinical (RC) scales. Our results showed that the Restructured Scales did not show significant improvement over the original Clinical scales. However, one Harris-Lingoes subscale (HL4 of Clinical Scale 3) did show improved predictive utility over the original Clinical scales as well as over the newer Restructured Clinical scales. Our study suggests that the predictive utility of the MMPI-2 can be improved using already existing scales. This is particularly useful for those practitioners who are not invested in switching over to the newly developed MMPI-2 Restructured Form (MMPI-2 RF).

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.

MMPI-2-RF characteristics of individuals with interstitial cystitis

OBJECTIVES

This study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring.

METHODS

The MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid.

RESULTS

Elevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales.

CONCLUSION

Over 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.

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.

Common genetic influences on negative emotionality and a general psychopathology factor in childhood and adolescence

Previous research using confirmatory factor analysis to model psychopathology comorbidity has supported the hypothesis of a broad general factor (i.e., a "bifactor"; Holzinger & Swineford, 1937) of psychopathology in children, adolescents, and adults, with more specific higher order internalizing and externalizing factors reflecting additional shared variance in symptoms (Lahey et al., 2012; Lahey, van Hulle, Singh, Waldman, & Rathouz, 2011). The psychological nature of this general factor has not been explored, however. The current study tested a prediction, derived from the spectrum hypothesis of personality and psychopathology, that variance in a general psychopathology bifactor overlaps substantially-at both phenotypic and genetic levels-with the dispositional trait of negative emotionality. Data on psychopathology symptoms and dispositional traits were collected from both parents and youth in a representative sample of 1,569 twin pairs (ages 9-17 years) from Tennessee. Predictions based on the spectrum hypothesis were supported, with variance in negative emotionality and the general factor overlapping substantially at both phenotypic and etiologic levels. Furthermore, stronger correlations were found between negative emotionality and the general psychopathology factor than among other dispositions and other psychopathology factors.

Assessing DSM-5 Section III Personality Traits and Disorders With the MMPI-2-RF

An alternative model for diagnosing personality disorders (PDs) appears in DSM-5 Section III. This model includes a set of dimensional personality traits, which along with impairment in personality functioning can be configured to represent one of six PDs. Although specific assessment instruments for these personality traits have already been developed (e.g., the Personality Inventory for DSM-5 [PID-5]), clinicians will likely continue to use omnibus measures of psychopathology that are familiar to them to inform diagnostic decision making. One such measure, the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF), will likely remain in the test armamentarium of many practitioners and be employed to assess the DSM-5 dimensional traits. In the current investigation, we examined the associations between MMPI-2-RF scale scores and the PID-5 trait scores and DSM-5 Section III PDs in a combined sample of university students ( n = 668) from the United States and Canada. Our results indicated that the MMPI-2-RF scale scores mostly converge with PID-5 dimensional traits as well as the Section III PDs in a conceptually expected manner. As such, we conclude that the MMPI-2-RF is a potentially useful instrument in assessing personality psychopathology as conceptualized in DSM-5 Section III.

PTSD symptoms in a cohort of National Guard soldiers deployed to Iraq: evidence for nonspecific and specific components

BACKGROUND

There is evidence that some of the symptoms included under the current diagnostic criteria for PTSD are not unique to PTSD and instead represent general distress. This study attempted to delineate the nonspecific and specific components of PTSD by examining the relation of PTSD symptoms to trauma exposure and demoralization in a cohort of National Guard soldiers deployed to Iraq.

METHODS

Data were collected from a cohort of 348 combat deployed National Guard soldiers participating in the readiness and resilience in National Guard soldiers (RINGS) study. Current DSM-IV PTSD diagnoses and trauma exposure were determined 6 to 12 months following soldiers' return from deployment using the Clinician Administered PTSD Scale. Level of trauma exposure (as measured by a combat exposure scale), demoralization and self-reported PTSD symptoms were assessed with self-report questionnaires.

RESULTS

Dysphoria symptoms had the weakest relation with trauma exposure and the strongest relation with demoralization. In addition, these symptoms had high rates of endorsement in a group of soldiers without trauma exposure. Intrusions were strongly related to trauma and were significantly higher in the group with trauma exposure compared to the no-trauma group.

LIMITATIONS

These findings may not generalize to survivors of other types of trauma, service members from other era's, or even service members from different regions or military branches who have different demographic and duty characteristics.

CONCLUSIONS

Emphasizing symptoms of PTSD that are strongly related to trauma exposure will be important for the differential diagnosis of PTSD.

Development and Preliminary Validation of a Simplified-Wording Form of the Multidimensional Personality Questionnaire

The Multidimensional Personality Questionnaire (MPQ) assesses a range of personality characteristics pertaining to affective and interpersonal style, behavioral restraint versus disinhibition, and capacity for sensory and imaginal engagement. Its 11 lower order trait scales map onto 3 higher order factors that reflect temperament dimensions. Its content and measurement properties have made the MPQ useful for elucidating constructs relevant to normal and abnormal behavior and investigating their neurobiological underpinnings. However, a barrier to its use in certain populations is the reading difficulty of some MPQ items. We describe efforts to develop a simplified-wording form, the MPQ-SF, composed of items readable at or below the seventh grade level (with most below sixth grade). Simplified-wording items demonstrated high convergence with original-wording items, and resulting trait scales showed adequate internal consistencies and appropriate higher order structure. The availability of a simplified version expands the potential utility of the MPQ to a wider range of samples.

Differentiating PTSD symptomatology with the MMPI-2-RF (Restructured Form) in a forensic disability sample

The current study was designed to explore models of assessing various forms of Post-Traumatic Stress Disorder (PTSD) symptomatology that incorporate both broad and more narrowly focused affective markers. We used broader markers of demoralization, negative activation, positive activation, and aberrant experiences to predict global PTSD scores, whereas more narrowly focused markers of positive and negative affect were used to differentiate between PTSD symptom clusters. A disability sample consisting of 347 individuals undergoing medico-legal psychological evaluations was used for this study. All participants completed symptom measures of PTSD and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (from which MMPI-2-RF scores were derived). The results indicated that demoralization was the best individual predictor of PTSD globally, and that more narrowly focused MMPI-2-RF Specific Problems scales provided a differential prediction of PTSD symptom clusters. Theoretical and practical implications of these findings are discussed within contemporary frameworks of internalizing personality and psychopathology.

Diagnostic Construct Validity of MMPI-2 Restructured Form (MMPI-2-RF) Scale Scores

In the current investigation, the authors examined the diagnostic construct validity of the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF) in a patient sample. All participants were diagnosed via the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P). The data set used in this study was composed of 544 patients—67 with bipolar disorder, 407 with major depressive disorder, and 70 with schizophrenia. Multivariate analyses revealed a pattern of mean scale differences among patient groups that was mostly consistent with the prominent features of each diagnostic group; logistic regression analyses identified a number of scales that were strong, unique predictors in the differentiation between pairs of diagnostic groups. The higher order scales (H-O)—the Emotional/Internalizing Dysfunction (EID) and Thought Dysfunction (THD) scales were most useful in differentiating between patient groups. For differentiating bipolar disorder patients from the other diagnostic groups, the Activation (ACT) Specific Problem scale was most useful. Although not all hypothesized scale differences emerged; overall, the pattern of results provides support for the diagnostic construct validity of the MMPI-2-RF scales.

Empirical correlates and expanded interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism)

The recent release of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has received much attention from the clinical psychology community. Particular concerns have focused on Restructured Clinical Scale 3 (RC3; Cynicism). This article briefly reviews the major criticisms and responses regarding the restructuring of Clinical Scale 3. The primary purpose of the article is to provide expanded interpretive perspectives on RC3 by correlating it with a selection of external variables that are conceptually related. Forty undergraduate volunteers completed the MMPI-2-RF as well as measures of Machiavellianism, alienation, faith in people, and locus of control. Results showed strong correlations between RC3 and Machiavellianism (.47) and alienation (.60), with item-level information that may extend existing interpretive statements to include, not just a cynical view of others, but a willingness to intentionally lie, cheat, deceive, and manipulate (i.e., Machiavellianism).

An evaluation of competing models for the structure of PTSD symptoms using external measures of comorbidity

Research on the structure of posttraumatic stress disorder (PTSD) symptoms has yielded support for two 4-factor models: the King (King, Leskin, King, & Weathers, 1998) and Simms/Watson models (Simms, Watson, & Doebbeling, 2002). This study evaluated them using data drawn from 1,128 Vietnam veterans by comparing associations with a latent internalizing comorbidity variable and five scales from the MMPI-2 Restructured Clinical (RC) Scales (Tellegen et al., 2003). The Simms/Watson dysphoria factor failed to show evidence of superior convergent or discriminant validity in association with external measures relative to the numbing or hyperarousal factors of the King model. Findings raise questions about proposals to abandon the distinction between numbing and hyperarousal symptoms in favor of a dysphoria-based model.

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

In most validity studies on the recently released 338-item MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008; Tellegen & Ben-Porath, 2008), scale scores were derived from the 567-item MMPI-2 booklet. In this study, we evaluated the comparability of the MMPI-2-RF scale scores derived from the original 567-item MMPI-2 booklet with MMPI-2-RF scale scores derived from the 338-item MMPI-2-RF booklet in a Dutch student sample (N = 107). We used a counterbalanced (ABBA) design. We compared results with those previously reported by Tellegen and Ben-Porath (2008). Our findings support the comparability of the scores of the 338-item version and the 567-item version of the 50 MMPI-2-RF scales. We discuss clinical implications and directions for further research.

The Concurrent and Incremental Validity of the Trauma Symptom Inventory in Women Reporting Histories of Sexual Maltreatment

The Trauma Symptom Inventory (TSI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and Posttraumatic Diagnostic Scale (PDS) were administered to 71 women who reported histories of childhood and/or adult sexual maltreatment and 25 women who did not report a history of victimization. The TSI validity scales were not effective in identifying MMPI-2 defined invalid responding although were moderately related to MMPI-2 validity scales designed to identify similar response styles. In contrast, the TSI clinical scales displayed good convergent validity with conceptually related scales on the MMPI-2 and PDS. Also, the TSI added incrementally, albeit modestly, to the MMPI-2 in prediction of PDS defined PTSD.

Personality trait predictors of bipolar disorder symptoms

The purpose of the current investigation was to examine the personality predictors of bipolar disorder symptoms, conceptualized as one-dimensional (bipolarity) or two-dimensional (mania and depression). A psychiatric sample (N=370; 45% women; mean age 39.50 years) completed the Revised NEO Personality Inventory and the Minnesota Multiphasic Personality Inventory -2. A model in which bipolar symptoms were represented as a single dimension provided a good fit to the data. This dimension was predicted by Neuroticism and (negative) Agreeableness. A model in which bipolar symptoms were represented as two separate dimensions of mania and depression also provided a good fit to the data. Depression was associated with Neuroticism and (negative) Extraversion, whereas mania was associated with Neuroticism, Extraversion and (negative) Agreeableness. Symptoms of bipolar disorder can be usefully understood in terms of two dimensions of mania and depression, which have distinct personality correlates.

The MMPI-2 restructured clinical scales in the assessment of posttraumatic stress disorder and comorbid disorders

This study examined the psychometric properties of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Restructured Clinical Scales (RCSs) in individuals with posttraumatic stress disorder (PTSD) receiving clinical services at Department of Veterans Affairs medical centers. Study 1 included 1,098 men who completed the MMPI-2 and were assessed for a range of psychological disorders via structured clinical interview. Study 2 included 136 women who completed the MMPI-2 and were interviewed with the Clinician Administered Scale for PTSD. The utility of the RCSs was compared with that of the Clinical Scales (CSs) and the Keane PTSD (PK) scale. The RCSs demonstrated good psychometric properties and patterns of associations with other measures of psychopathology that corresponded to current theory regarding the structure of comorbidity. A notable advantage of the RCSs compared with the MMPI-2 CSs was their enhanced construct validity and clinical utility in the assessment of comorbid internalizing and externalizing psychopathology. The PK scale demonstrated incremental validity in the prediction of PTSD beyond that of the RCSs or CSs.