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Program 1: MCMI-III Overview

Program 1: MCMI-III Overview. TM. Pearson Assessments and the Institute for Advanced Studies in Personology and Psychopathology. Learning Objectives…. Understanding of central role of personality in multiaxial assessment

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Program 1: MCMI-III Overview

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  1. Program 1: MCMI-III Overview TM Pearson Assessments and the Institute for Advanced Studies in Personology and Psychopathology

  2. Learning Objectives… • Understanding of central role of personality in multiaxial assessment • Overview of the MillonTM Clinical Multiaxial Inventory–III (MCMI-IIITM) • MCMI-IIITM psychometrics and basic interpretation considerations • Recent advances in MCMI-IIITM assessment

  3. Interactive Nature of the Multiaxial System AXIS III & IV Medical & Psychosocial AXIS II Personality Dynamics AXIS I Clinical Presentation (Anxiety, Dysthymia = Fever, Cough) (Borderline, Histrionic = Immune System) (Marital, Economic, Health = Infectious Agents)

  4. Instrumentation: Deductive Personologic Assessment Test Construction Traditions…

  5. Construction of a Psychological Inventory… • Burisch (1984), following Loevinger’s (1957) scale construction paradigm, outlined three primary methods for the construction of item-driven objective instruments… • External (Criterion) Method • Inductive Method • Deductive Method

  6. External—Criterion Method • Externalists: Consider selves to be “scientific realists” • World exists in “categories” such as diagnoses • Develop huge item pools; only qualification is if it differentiates categories • Generate large, loose item pools, disparate variation sources, moderate alpha statistics • Questions of causality/context left for other researchers

  7. Inductive-Statistical Method • Believe in latent dimensional structure of personality; accessible via statistical methodology such as factor analysis • No presumption regarding overarching theory; what’s found in sampling is what is • Advantage: most internally consistent, statistically sound method • Disadvantage: can be prone to mathematical distortion; no real implications for motivating aims

  8. Deductive-Rational Method • Believe structure of personality accessible via overarching theoretical means; statistics used post hoc to substantiate theory. • Test construction: items and structure derived from theorist’s principles, written to represent operational definition of theory • Advantages: Consistency with inherent definition of “construct” (Cronbach & Meehl, 1955); allows for full explanatory system and context; does not make leap between observation and theory, as with inductivists • Drawback: Nearly any theory possible, some better than others.

  9. Construction of the MCMI-IIITM • Data pool: 993 subjects • Self-Report Inventory • Ages: 18-65+ • 14 Axis II scales; 10 Axis I scales; 4 validity indices • Designed to assess Axis I complaint in context with Axis II personality style/disorder • BR scores rather than T-scores; anchored to estimates of prevalence data for a particular disorder; no assumption of normal curve • Constructed via Jane Loevinger’s (1957) logic for test development… • Theoretical-Substantive • Internal-Structural • External-Validational

  10. Development of the MCMI-IIITM • Items written as operational definitions of the theorist’s overarching principles (theoretical-substantive) • Items subject to internal consistency scrutiny including Cronbach’s Alpha and Repeated Measures (internal-structural) processes • Items tested against comparable personality measures as well as more unilateral measures such as the BDI • Scales designed to be closely-coordinated to DSM constructs

  11. Item Assignment for the MCMI-IIITM • Prototypal vs. Non-prototypal items… • Each of the 175 items on MCMI-IIITM is prototypal on one scale only, weighted (2) • Each of the 175 items may also be a non-prototypal (supportive) item on another scale, weighted (1) • System is consonant w/ polythetic personality constructs, but sometimes reduced discriminant validity • System allows for greater detail of profile report, within a relatively brief inventory

  12. MCMI-IIITM: Validity Scales Scale N of items Alpha Validity 3 n/a Disclosure n/a n/a Desirability 21 .85 Debasement 33 .95

  13. MCMI-IIITM: Clinical Personality Patterns Scale N of Items Alpha Schizoid 16 .81 Avoidant 16 .89 Depressive 15 .89 Dependent 16 .85 Histrionic 17 .81 Narcissistic 24 .67 Antisocial 17 .77 Sadistic 20 .79 Compulsive 17 .66 Negativistic 16 .83 Masochistic 15 .87

  14. MCMI-IIITM: Severe Personality Pathology Scales N of items Alpha Schizotypal 16 .85 Borderline 16 .85 Paranoid 17 .84

  15. MCMI-IIITM: Clinical Syndromes Scale N of Items Alpha Anxiety 14 .86 Somatoform 12 .86 Bipolar/Mania 13 .71 Dysthymia 14 .88 Alcohol Dependence 15 .82 Drug Dependence 14 .83 PTSD 16 .89

  16. MCMI-IIITM: Severe Clinical Syndromes Scale N of items Alpha Thought Disorder 17 .87 Major Depression 17 .90 Delusional Disorder 13 .79

  17. MCMI-IIITM:Interpretive Hallmarks • BR score 60+: Possible presence of traits at the domain level • BR score 75-84: Likely psychopathology is present, may still be at trait or feature level • BR score 85+: Prevalence of the disorder, likely to be at an impairing level

  18. MCMI-IIITM:Interpretive Procedure • Validity: 3 validity items, under- or over-report on disclosure scale, general trend on desirability/debasement • Critical items: suicidality, childhood abuse, eating disorder, interpersonal alienation, emotional dyscontrol • Personality: Check elevations on severe scales, flesh out spikes w/ clinical personality scales, look for 1-2 pt. high code on clinical personality scales • Syndromal: Severe syndrome scales, then basic clinical syndromes, convergence with personality styles • Clinical decision making: Clinician’s contextual read of the overall profile in tandem with presenting picture

  19. Overall Strengths of the MCMI-IIITM • Close consonance with DSM-IV constructs • Contextualization of Axis I and II • Brief Instrument – minimal clinical time • Ability to decipher admixtures of personality patterns • Ability to deduce motivating dynamics of personality pathology, clinical syndromes • BR scoring consonant with personality pattern prevalences • Large, stratified, representative sample

  20. Some Non-Strengths of the MCMI-IIITM • Population served: clinical ONLY • Item overlap drawbacks: some discriminant validity issues, difficulty in conducting research • Complex hand-scoring system • Some positive predictive power difficulties on several scales (generally, non-DSM scales) • General statistical difficulties of a deductively-derived instrument • Less robust validity indices than comparable instruments

  21. Recent Advances in MCMI-IIITM Assessment… The Grossman Facet Subscales of the MCMI-IIITM…

  22. Domain by Disorder Matrix Behavioral Acts Interpersonal Conduct Cognitive Style Object Representations Regulatory Mechanisms Morphologic Organization Mood/ Temperament Self-Image Schizoid Impassive Unengaged Impoverished Complacent Meager Apathetic Intellectualization Undifferentiated Avoidant Fretful Aversive Distracted Alienated Vexatious Fantasy Fragile Anguished Depressive Disconsolate Defenseless Pessimistic Worthless Forsaken Asceticism Depleted Melancholic Dependent Incompetent Submissive Naive Inept Immature Introjection Inchoate Pacific Attention- Seeking Histrionic Dramatic Flighty Gregarious Shallow Dissociation Disjointed Fickle Narcissistic Haughty Exploitive Expansive Admirable Contrived Rationalization Spurious Insouciant Antisocial Impulsive Irresponsible Deviant Autonomous Debased Acting-Out Unruly Callous Sadistic Precipitate Abrasive Dogmatic Combative Pernicious Isolation Eruptive Hostile Reaction Formation Compulsive Disciplined Respectful Constricted Conscientious Concealed Solemn Compartmentalized Negativistic Resentful Contrary Skeptical Discontented Vacillating Displacement Divergent Irritable Masochistic Abstinent Deferential Diffident Undeserving Discredited Exaggeration Inverted Dysphoric Distraught or Insentient Schizotypal Eccentric Secretive Autistic Estranged Chaotic Undoing Fragmented Borderline Spasmodic Paradoxical Capricious Uncertain Incompatible Regression Labile Split Paranoid Provocative Suspicious Inviolable Unalterable Projection Inelastic Irascible Defensive Grossman Subscale Domains are highlighted

  23. Avoidant Facet Subscales:Sample Items 1: Interpersonally aversive 146 T I always wonder what the real reason is when someone is acting especially nice to me. 48 T A long time ago, I decided it's best to have little to do with people. 2: Alienated self-image 47 T I tend to always blame myself when things go wrong. 40 T I guess I'm a fearful and inhibited person. 3: Vexatious representations 99 T In social groups I am almost always very self-conscious and tense. 174 T Although I'm afraid to make friendships, I wish I had more than I do.

  24. Narcissistic Facet Subscales:Sample Items 1: Admirable self-image 141 F I feel that most people think poorly of me. 94 F People can easily change my ideas, even if I thought my mind wasmade up. 2: Cognitively Expansive 26 T Other people envy my abilities. 67 T I have many ideas that are ahead of the times. 3: Interpersonally Exploitive 38 T I do what I want without worrying about its effect on others. 5 T I know I'm a superior person, so I don't care what people think.

  25. CODE SCORE PROFILE OF BR SCORES FACET SCALES RAW BR 0 60 70 80 90 100 5.1 6 53 Admirable Self-Image 5.2 2 45 Cognitively Expansive 5.3 6 92 Interpersonally Exploitive CODE SCORE PROFILE OF BR SCORES FACET SCALES RAW BR 0 60 70 80 90 100 C.1 4 62 Temperamentally Labile C.2 4 67 Interpersonally Paradoxical C.3 6 75 Uncertain Self-Image MILLON CLINICAL MULTIAXIAL INVENTORY - IIITMFACET SCORES FOR THREE HIGHEST PERSONALITY SCALES BR65 OR HIGHER CODE SCORE PROFILE OF BR SCORES FACET SCALES RAW BR 0 60 70 80 90 100 8A.1 2 43 Discredited Representations 8A.2 1 10 Cognitively Diffident 8A.3 5 69 Undeserving Self-Image

  26. 1 Schizoid 1.1 Temperamentally Apathetic 1.2 Interpersonally Unengaged 1.3 Expressively Impassive 2A Avoidant 2A.1 Interpersonally Aversive 2A.2 Alienated Self-Image 2A.3 Vexatious Representations 2B Depressive 2B.1 Temperamentally Woeful 2B.2 Worthless Self-Image 2B.3 Cognitively Fatalistic 3 Dependent 3.1 Inept Self-Image 3.2 Interpersonally Submissive 3.3 Immature Representations 4 Histrionic 4.1 Gregarious Self-Image 4.2 Interpersonally Attention-Seeking 4.3 Expressively Dramatic 5 Narcissistic 5.1 Admirable Self-Image 5.2 Cognitively Expansive 5.3 Interpersonally Exploitive 6A Antisocial 6A.1 Expressively Impulsive 6A.2 Acting-Out Mechanism 6A.3 Interpersonally Irresponsible 6B Sadistic 6B.1 Temperamentally Hostile 6B.2 Eruptive Organization 6B 3 Pernicious Representations 7 Compulsive 7.1 Cognitively Constricted 7.2 Interpersonally Respectful 7.3 Reliable Self-Image 8A Negativistic 8A.1 Temperamentally Irritable 8A.2 Expressively Resentful 8A.3 Discontented Self-Image 8B Masochistic 8B.1 Discredited Representations 8B.2 Cognitively Diffident 8B.3 Undeserving Self-Image S Schizotypal S.1 Estranged Self-Image S.2 Cognitively Autistic S.3 Chaotic Representations C Borderline C.1 Temperamentally Labile C.2 Interpersonally Paradoxical C.3 Uncertain Self-Image P Paranoid P.1 Cognitively Mistrustful P.2 Expressively Defensive P.3 Projection Mechanism MILLON CLINICAL MULTIAXIAL INVENTORY - IIITMCOMPLETE LISTING OF MCMI-III GROSSMAN FACET SCALE SCORES

  27. What does this offer? • New potential in personality assessment • Ability to gain perspective w/ either DSM or personologic criteria, or both • Ability to gauge problematic personologic domains, even in the absence of Axis II Dx • Finally: Ability to compare/contrast and specify problematic domains in a personologic subtype… • New potential in personality research • Ability to generate research based on dimensionality of personality, rather than limited to categorical distinction (e.g., age considerations for personality change).

  28. Beyond Assessment • Treatment Implications • Personalized Therapy • Follows same model as MCMI-IIITM and the subscales, recognizing facets, and suggesting treatment strategies. • Established, traditional integrative schemes (e.g., CBT, Cognitive/Pharmacologic, etc.) • Newer brief models utilizing similar synergistic approaches (e.g., cognitive/psychodynamic modes

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