The MMPI-2 is a standardized questionnaire used to quantitatively measure an individual's emotional adjustment and attitudes toward test-taking.
It is the most widely used clinical testing instrument in the United States, with over 11,000 published research articles.
The MMPI-2 consists of 567 true/false items.
An adolescent version, MMPI-A, is available for individuals aged 14–18 years old.
It can be administered to individuals 18 years or older.
An eighth-grade reading level is required.
The MMPI-2 includes 10 clinical or personality scales.
T scores above 65 are considered clinically elevated.
The two or three highest scales are used to determine the codetype.
Several validity scales assess the test-taker's approach to the instrument.
It takes approximately 60–90 minutes to complete.
If administration time significantly exceeds 90 minutes, consider: obsessive indecision, major psychological disturbance (e.g., psychosis, severe depression), central nervous system impairment, below-average IQ, or poor English-language reading ability.
MMPI-2 History and Development
The development of the MMPI began in 1939 at the University of Minnesota by Starke Hathaway and J. Charnley McKinley.
It was needed for routine assessment of adult psychiatric patients and to assess change produced as a result of psychotherapy or other life experiences.
Development utilized the empirical criterion keying method.
The Empirical Criterion Keying Method of Test Development
Test items are administered to both a criterion group (e.g., people with major depression) and a comparison group ("normals").
Items to which the criterion and comparison group answer differently are included on the criterion scale.
MMPI Clinical Scales
Scale 1: Hypochondriasis (Hs)
Scale 2: Depression (D)
Scale 3: Hysteria (Hy)
Scale 4: Psychopathic Deviate (Pd)
Scale 5: Masculinity/Femininity (Mf)
Scale 6: Paranoia (Pa)
Scale 7: Psychasthenia (Pt)
Scale 8: Schizophrenia (Sc)
Scale 9: Hypomania (Ma)
Scale 0: Social Introversion (Si)
MMPI Restandardization
The original normative sample for the MMPI was Caucasian, from mainly rural areas in Minnesota, and had an average level of education of eighth grade.
Recognition that test normative data were limited emerged as early as 1969.
The restandardized MMPI, known as MMPI-2, was not published until 1989.
The sample was expanded to 2,600 individuals from across the U.S.
The sample was designed to match 1980 U.S. census data.
Outdated, poorly worded items were removed or modified.
New items were added to allow for the construction of additional content and supplemental scales.
Items relating to contemporary issues of concern (e.g., substance abuse, marital relationship) were added.
Examples of Changed Items
"My father was a good man" became "My father is a good man or (if your father is dead) my father was a good man."
"In school I found it very hard to talk before the class" became "In school I found it very hard to talk in front of the class."
"Except by a doctor’s orders I never take drugs or sleeping powders" became "Except by a doctor’s orders I never take drugs or sleeping pills."
MMPI-2 and Cultural Issues
An area of controversy, with some studies showing certain ethnic groups score higher on some MMPI scales than other groups.
Examples:
African Americans: higher on scales F, 8, and 9.
Latinos: higher on scale L and 5 but lower on K, 3, and 4.
Native Americans: higher on scales L, F, K, 4, 8, 9, and certain content scales.
Many studies are not consistent.
Sometimes differences between ethnic groups are seen for normal populations but not for clinical populations.
Pope, Butcher, and Seelen suggest that there is not strong evidence that the MMPI-2 norms are not applicable for ethnic minorities.
Groth-Marnat suggests that when an MMPI is administered to an ethnic minority client, the clinician should:
Consult culture-specific norms if possible.
Become familiar with research that has been done with this group.
MMPI-2 Harris and Lingoes Subscales and Critical Items
Harris and Lingoes Subscales
Provide information concerning the kinds of items that clients endorsed for clinical scales that are elevated.
There are no Harris and Lingoes subscales for every MMPI scale because some scales (such as 1 and 7) have more homogenous item content.
Harris and Lingoes subscales exist for scales 2, 3, 4, 5, 6, 8, and 9.
Look for T-scores >65.
Example: Schizophrenia Scale (8)
SC1: Social Alienation (Feelings of emotional deprivation, detachment from others)
SC2: Emotional Alienation (Existence devoid of interests, engagement, aspiration)
SC3: Lack of Ego Mastery—Cognitive (Cognitive deficits: memory, attention, concentration; disruption of thought processes)
SC4: Lack of Ego Mastery—Conative (Inability to act purposively, constructively; lack of interest, motivation; indifference)
SC5: Lack of Ego Mastery—Defective Inhibition (Fear of loss of control, unstable emotions)
Consists of a pool of items endorsed by less than 10% of subjects in the normative sample.
Item content is varied.
High F scores are typically accompanied by elevations on several clinical scales.
Scores >100 likely indicate an invalid profile.
For psychiatric inpatients, invalidity may not be reached until even higher T-scores (e.g., 120).
Moderate scores (80–99) can indicate exaggeration of problems as a plea for help or malingering, or may reflect significant levels of pathology.
Scores between 65–75 may be associated with unconventional and unusual thoughts; moody, unstable, psychologically complex, and opinionated individuals.
Mild elevations can also reflect problems in certain areas (e.g., unusual feelings triggered by some life circumstance such as grief).
Validity Scales: L (Lie)
Measures a rather naïve and unsophisticated way of trying to present oneself favorably.
High scores (T > 65) suggest the possibility that the test taker is not being honest and the resulting profile may not be valid.
Moderate elevations (T = 55–65) can indicate that the test taker was somewhat defensive, is overly conventional, socially conforming, rigid, and moralistic.
Very low scores (T < 35) can be produced by individuals who are overly critical of themselves or who are exaggerating problems and negative characteristics.
Validity Scales: K (Correction)
A more sophisticated scale to detect psychological defensiveness.
Items were selected by comparing the responses of known psychiatric patients who still managed to produce normal MMPI profiles and “true” normals who also produced normal profiles.
Used as a “correction factor” for certain clinical scales: 1 (Hs), 4 (Pd), 7 (Pt), 8 (Sc), 9 (Ma).
Scores >65 suggest a response set that likely invalidates the profile.
Scores 56–65 indicate that the subject’s defensiveness needs to be taken into consideration when interpreting the clinical scales.
Moderate elevations on K can also suggest ego strength and psychological resources.
MMPI-2 Scale 1
Scale 1 (Hypochondriasis: Hs)
Originally designed to distinguish hypochondriacs from other types of psychiatric patients.
Now most useful as a measure of various personality characteristics that are often consistent with but do not necessarily indicate a diagnosis of hypochondriasis.
Many items on Hs scale concern vague, somatic complaints.
High scorers tend to be preoccupied with illness and disease and to be stubborn, pessimistic, narcissistic, and egocentric.
Psychological insight tends to be poor.
When combined with elevations on scale 3 (the 1–3 profile), individuals tend to be immature and demanding, have strong needs for attention and affection, and tend to be quite dependent.
There is a use of repression and denial.
MMPI-2 Scale 2
Scale 2 (Depression: D)
High scores (especially T > 70) can signal a clinical depression.
Always assess possible suicidality among persons with a high 2 score (especially if 4, 7, 8, and/or 9 are also elevated).
Elevations on scale 2 are the best single predictor of the level of dissatisfaction.
Scales 2 and 7 are often referred to as the distress scales.
Interpersonally, elevated scores can suggest pessimism, lack of self-confidence, a tendency to give up easily, and to feel easily overwhelmed by life.
Explore loss issues.
The 2/7 profile is the most common profile among psychiatric patients.
If T > 80, psychotropic medication is likely to be needed.
MMPI-2 Scale 3
Scale 3: (Hysteria: Hy)
Originally developed to identify conversion hysteria.
Items on scale 3 fall into two groups: physical complaints and denial of emotional or psychological problems.
Elevations on scale 3 are often associated with what we would consider histrionic traits.
Individuals appear superficial, attention seeking, childish, naïve, very concerned with appearances, and immature.
Vagueness is present in the way incidents or events are described.
Therapy is apt to be difficult due to a lack of insight and difficulty accepting responsibility for behavior.
In a 3–4 codetype, when 4 is higher, there tends to be periodic explosions of anger following periods of over-controlled, bottled-up feelings.
With 3 higher than 4, there tends to be a passive-aggressive acting out of anger.
Likely to experience marital disharmony; relationships are marked by turbulence.
MMPI-2 Scale 4
Scale 4 (Psychopathic Deviate: Pd)
Originally designed to assess amoral behavior.
Good general indicator of a person’s general level of social adjustment.
Questions deal with a variety of problems—difficulties with authority figures, alienation from oneself and one’s family, etc.
Very high scorers (e.g., T > 75) can indicate serious problems obeying social norms and acting out in antisocial ways (cheating, stealing, sexually acting out, lying).
Elevated scorers are often immature, egocentric, hostile and aggressive, and impulsive, and they strive for immediate gratification of impulses.
Substance abuse may be a problem (e.g., 4/8, 8/4, 4/9, and 9/4 codetypes).
The 9/4 codetype is often seen as a red flag codetype.
Therapy is difficult with high 4 individuals due to the use of projection and difficulty taking responsibility for their actions.
MMPI-2 Scale 5
Scale 5 (Masculinity/Femininity: MF)
Higher T-scores for men and women indicate nontraditional gender attitudes and behaviors.
Elevated scores for men are associated with a lack of stereotypic masculine interests (tend to have aesthetic or artistic interests).
Elevated scores for women are associated with rejection of the traditional female role.
Low 5 for men (46–55) is associated with traditional male interests.
Scores below 46: “macho” orientation.
Low 5 for women: more stereotypically feminine; likely to derive satisfaction from their role as mothers/spouses.
Scores below 40: “hyperfeminine."
Implications for practice: knowledge of how traditionally feminine or masculine a client is may help you understand his/her relationships better (e.g., pinpoint potential conflict if a partner has a very different gender role orientation).
MMPI-2 Scale 6
Scale 6 (Paranoia: Pa)
Scale was originally designed to identify persons with paranoid conditions or paranoid states.
Contains items that tap overtly psychotic symptoms, but also interpersonal sensitivity and self-righteousness.
Individuals who have elevations on scale 6 often dichotomize people.
Because many of the items on scale 6 have fairly obvious content, it can be fairly easy for a person who is bright or psychologically sophisticated to conceal.
Elevations on 6 can be a red flag for clinicians and is often suggestive of suspiciousness, hostility, blaming, rigidity and poor insight.
Elevations on scale 6 and 8 are suggestive of paranoid schizophrenia.
MMPI-2 Scale 7
Scale 7 (Psychasthenia: Pt)
Scale taps obsessive worrying/preoccupations.
Scale 7 is a good indicator of psychological turmoil and discomfort.
High scorers tend to be neat and meticulous, introspective, reliable, and persistent with being often shy and unassertive.
Elevations are associated with low self-confidence, self-blame, and heightened sensitivity.
Also the tendency of these patients to “stay in their heads.”
Often remain in therapy a long time.
MMPI-2 Scale 8
Scale 8 (Schizophrenia: Sc)
Scores in range of 75–90 may indicate a psychotic disorder.
Many items on the MMPI Sc scale concern neurological-type symptoms such as difficulties with thinking and concentrating.
Elevations on 8 often associated with confusion, poor decision-making and judgment, feelings of alienation, and feelings of being inferior or damaged.
Elevated scale 8 is a potential red flag for a clinician.
8/9: disordered thinking and energy.
6/8: disordered thinking and suspiciousness.
4/8/9 profile often associated with antisocial behavior.
MMPI-2 Scale 9
Scale 9 (Hypomania: Ma)
Originally developed to identify persons experiencing hypomanic symptoms such as euphoria, increased irritability, and excessive unproductive activity.
High scores (T > 85) may be indicative of a bipolar disorder.
Scores between 70 and 85 can also suggest a restless, enthusiastic, energetic, narcissistic person.
Aspirations may be grandiose.
High scorers can become bored easily, have difficulty inhibiting impulses, and may be irritable.
Although energetic, high 9 individuals may not use energy productively.
A high scale 9 score can be a red flag for a clinician.
MMPI-2 Scale 0
Scale 0 (Social Introversion: Si)
Originally designed to assess introversion vs. extraversion.
Elevated scores indicate discomfort in social situations, shyness, a lack of confidence and being withdrawn, indecisive, and insecure.
Sensitive to how others may judge them, serious, often irritable/anxious/moody, and compliant/overly accepting of authority.
Good index of ability to be interpersonally engaged.
High scorers need time for therapeutic relationship to develop.
Low scorers: warm, outgoing, assertive, self-confident, but also potentially exhibitionistic, manipulative, immature, and superficial.
Child Behavior Checklist Overview
Designed by Thomas Achenbach, PhD.
Part of a family of measures (for childhood through adulthood) collectively known as the ASEBA system (Achenbach System of Empirically Based Assessment).
Multidimensional measure of child problems, competencies, and adaptive functioning.
For youth aged 6–18.
Parent, teacher, and youth self-report (11–18) forms are available.
There is also a CBCL for ages 1.5–5.
Forms take approximately 20 minutes each to complete.
Asks about common symptoms (113) that come to the attention of mental health professionals.
Rated on a 0- to 2-point scale:
0 = Not true
1 = Somewhat or sometimes true
2 = Very true or often true
No validity scales: Very low scores could reflect faking good/defensiveness/misunderstanding. High scores could reflect faking bad/exaggeration/misunderstanding.
Competencies:
Activities
Social
School
CBCL Competency Scales
Compare the child’s score to non-referred children in the client’s age-range and gender.
For competencies: lower scores are concerning.
T-Scores Area:
Clinical: Activities (<31), Social (<31), School (<31), Total (<37)
Borderline: Activities (31-35), Social (31-35), School (31-35), Total (37-40)
Normal: Activities (>35), Social (>35), School (>35), Total (>40)
CBCL Syndrome Scales
Eight syndrome scales: anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior.
DSM-oriented scales are available that are comprised of items consistent with different DSM-IV categories.
Scales:
Affective problems
Anxiety problems
Attention deficit/hyperactivity problems
Conduct problems
Oppositional defiant problems
Somatic problems
Scales were formed by including CBCL items rated by the majority (64%) of a group of experienced child psychiatrists and psychologists as being consistent with various DSM syndromes.
CBCL Norms and Psychometrics
National normative samples available.
Multicultural norms also available based upon data collected in many different societies.
Group 1 norms: combine data from societies whose mean scores were more than 1SD below the omnicultural mean.
Group 2 norms: combine data from societies whose mean scores were within +1SD of the omnicultural mean.
Group 3 norms: combine data from societies whose mean scores were >1SD above the omnicultural mean.
A table can be consulted that lists different countries and which mean group to consult (comparison to more than one group can also be made).
Test-retest reliabilities:
One week—clinical scales: .82–.92; competencies: .82–.93.
Coefficient alpha:
Clinical scales: .78–.94; competencies: .63–.79.
Validity:
Items can discriminate between referred and non-referred children.
Scale shows strong correlations with other measures of child problems (e.g., Conner’s Parent Questionnaire).