MCMI-III
Million clinical multiaxial inventory 3
MCMI
- developed by
- dates (III) (IV)
Initially developed by Theodore Millon, Ph.D. in 1972
MCMI-III released in 1994
MCMI-IV released in 2015
Charactersitcs
- 3
- completion time
Objective - Standardized instrument
Theoretical
Self-report instrument (175 items)
Completion Time: 25-30 minutes
Scales
- 5
27 scales
3 modifier scales (like validity scales)
14 personality disorder scales (Axis II)
10 clinical syndrome scales (Axis I)
42 Grossman Personality Facet Scales
Psychometric properties
- general
- norm sample
In general, a well constructed psychometric instrument
Normative Sample
1,079 Clinical patients who had come from a diversity of backgrounds and treatment settings (not for use with nonclinical)
Theoretical underpinnings
- 3
1. Individuals must struggle to exist
(pleasure-pain)
2. Individuals adapt to their environment or adapt their environment to themselves
(passive-active)
3. Individuals must invest in others and themselves
(self-others)
Framework of pathology
- 4
1. Instrumental Coping Style/Interpersonal Pattern
?Dependent ?Independent ?Ambivalent ?Discordant ?Detached
2. Passive Variant
?Dependent ?Narcissistic ?Compulsive ?Self-defeating ?Schizoid
3. Active Variant
?Histrionic ?Antisocial ?Passive ?Aggressive ?
Modes of adaption (2)
- Two part polarity - accommodation vs. modification
1. Accommodation - passive orientation - person desires to accommodate to one's environment (we modify existing schemas to include new information)
2. Modification - active orientation - attempts to mod
Replicatory strategies (2)
- Propagation vs. Nurturance
1. Propagation - egocentric, insensitive, inconsiderate, and uncaring
2. Nurturing - oriented toward behaviors which are intimate, protective, and solicitous
Expression of personality disorders
- 2 domains
Functional Processes
- Expressive emotion
- Interpersonal Conduct
- Cognitive Style
- Intrapsychic dynamics
Structural Attributes
- Self-image
- Intrapsychic content
- Intrapsychic Architecture
- Mood/Temperament
Example: schizoid
Functional
- Inert emotional state
- Lacks energy
- Unanimated
- Deficits in activation
- undemonstrative
Structural attributes
- Minimal introspection
- Impervious to emotions in everyday life
- Indifferent to praise or criticism
Primary diagnostic settings (7)
Mental Hospitals
Outpatient clinics
Forensic Settings
Substance abuse evaluations
Correctional Institutions
Marital Counseling
Treatment Planning & Psychotherapy
Uses of the MCMI (3)
Clinical decision making
Identification of specific psychological attributes
Describing a population with similar attributes
appropriate examinee
- age
- reading level
- adminstration formats
- items time
Individuals 18 yrs & older
Reading Level: 8th grade
Administration Formats: Paper-and-pencil, CD, or computer administration
175 items and can be taken in 20-30 mins
Instrument development timeline
Millon-Illinois Self-Report Inventory (1972)
?
Millon Clinical Multiaxail Inventory (MCMI; 1977)
?
MCMI-II (1982)
?
MCMI-III (1994)
Psychometric properties
- strengths
- limitations (8)
- Sensitivity and specificity above .70 (West & Finch, 1997)
Sensitivity = probability of a test being positive if a disorder is present (true positive cases)
Specificity = probability of a test being negative in the absence of any disorder (true negative
MCMI Scale categories (5)
Modifying indices
Clinical Personality Patterns
Severe Personality Pathology
Clinical Syndromes
Severe Syndromes
Modifying indices (4) *
Disclosure X
Desirability Y
Debasement Z
Validity V
Clinical personality patterns (11)
Schizoid
Avoidant
Depressive
Dependent
Histrionic
Narcissistic
Antisocial
Aggressive (Sadistic)
Compulsive
Passive-Aggressive
Self-defeating
Axis II prototypes (1-4)
1) Schizoid
Lack desire, low pleasure, low pain.
2A) Avoidant
Limited positive reinforcement from self/others
Low pleasure
Fear & mistrust of others.
Want relationships but withdraw to protect
2B) Depressive
Unable to experience pleasure (low pleasure, hi
Axis II prototypes (5-8)
5) Narcissistic
Self-involved, overvalue self worth.
Assume others know
Exploit others
High self, low others
6A) Antisocial
Acts to avoid expected pain & depredation
Exploits for self-gain.
Distrustful, insensitive, ruthless as only means of avoiding abus
Severe personlaity pathology (3)
Schizotypal S
Borderline C
Paranoid P
Severe personality patterns (4)
- Pervasive characteristics of functioning
- Individual is often unaware of issues present
- Highly destructive
- Under stress or adversity maladaptive styles are very evident and decomposition is typical
Schizotypal (5)
S: Schizotypal
Cognitive dysfunction
Detached, prefer social isolation.
Passive
Odd
Flat affect
Borderline (6)
C: Borderline
Often underlies less severe pxy do.
Intense moods
Periods of dejection & apathy w/spells of anger, anxiety & euphoria.
Self-mutilate, suicidal.
Preoccupied with security, affection
No sense of self.
Paranoid (7)
P: Paranoid
Anticipate criticism & deception
Draw out exasperation & anger
Resist external influence
Mistrustful, defensive
Fear independence
Irritable
Inflexible
Clinical syndromes (7)
Anxiety A
Somatoform H
Bipolar: Manic N
Dysthymia D
Alcohol Dependence B
Drug Dependence T
Posttraumatic Stress Disorder PT
- Anxiety
- somatoform
A: Anxiety
Either vaguely apprehensive or specifically phobic.
Examine item content
H: Somatoform
Express psych difficulty via somatic
Employed to gain attention
May be hypochondriacal.
- Bipolar manic
- Dysthymia
- Alc depend
- drug depend
- ptsd
N: Bipolar-Manic
Superficial, elated, inflated self-esteem
Restless, pressured speech
Impulsive, irritable.
High score may be related to hallucinations
D: Dysthymia
Remain involved w/life, but years of guilt, lack of initiative, low self-esteem, apathy.
B
Severe syndromes
- 3
Thought Disorder SS
Major Depression CC
Delusional Disorder PP
Severe clinical syndromes
- Thought disorder
- Major depression
- delusional disorder
SS Thought Disorder
Disorganized behavior, confused, disoriented, inappropriate affect, hallucinations. Blunted affect. Socially withdrawn.
High scorers are usually diagnosed with: schizophrenia, shizophreniform, or brief reactive psychosis.
CC Major Depr
Base rate
- is
- designed to
- Different than a standard score; Is a weighted score that is anchored based on the prevalence rates of a characteristic in a psychiatric population
- BRs were "designed to anchor cutoff points to the prevalence of a particular attribute in the psychiatr
Assessment of response
- 2
- score adjustments (4)
- There is a validity index (V Validity)
- Modifying indices (X, Y, Z)
- There are several score adjustments
Disclosure Adjustment
Anxiety / Depression Adjustment
Inpatient Adjustment
Denial / Compliant Adjustment
Interpret the MCMI (7)
Determine profile validity
Interpret personality disorder scales
Grossman facet scales
Interpret clinical syndrome scales
Review noteworthy responses (critical items)
Provide diagnostic impressions/clinical integration
Elaborate on Tx implications and rec
Validity index
- items
- examples
- scoring
- represents
Items 65, 110, 157.
I flew across the Atlantic 30 times last year.
I was on the front cover of several magazines last year
I have not seen a car in the last 10 years.
0 = valid
1 = questionable
2-3 = invalid
Sensitive to careless, confused or random respo
Scale X
- reveals
- scores
Scale X (Disclosure )
Reveals: was client frank & self-revealing or reticent & secretive?
Raw score < 34 or > 178 = invalid
Scale Y
- high score
Scale Y (Desirability)
BR > 75 suggests an individual responded in a manner to "appear more socially attractive, morally virtuous, or emotionally well composed."
Higher the score, more likely to be hiding something.
Scale Z
- high scores
Scale Z (Debasement)
BR > 75 suggests an individual responded in a manner that "depreciate[s] or devalue[s] oneself by presenting more emotional and personal difficulties than are likely to be uncovered upon objective review."
May be a cry for help
Test validity
- 5 clues of invalidity
1. Sex or Age is not indicated
Or individual is < 18 yrs. old
2. 12 or more omitted or double marked items
3. Scale V (Items 65, 110, 157)
If > 2 = invalid protocol
4. Raw score on Scale X (disclosure) is < 34 or > 178
5. None of the BR scores for the Cli
Base rate scoring (4)
BR > 85-characteristics definitely present
BR > 75-some features present
BR pf 35-,median score of non-psychiatric groups
BR of 60-median for psychiatric populations
MCMI profile (3)
Based on high BR elevations
It is rare that there is only one elevated scale
Scales are best interpreted together rather than separate