MCMI-III Interpretation and Reporting
MCMI-III Interpretation and Reporting Issues Related to Interpretation Gender Ethnicity Age Code types Scale Elevation Personality Patterns: – 70 - 74 - likely to possess traits of the construct – BR 75-84 - clinically significant personality traits – BR 85 + - Personality disorder Clinical Syndromes: – 60 - 74 - likely to possess some symptoms of the syndrome – BR 75-84 - presence of a syndrome – BR 85+ - prominence of syndrome Level of adjustment How many scales are elevated above 75? The higher the elevation, the more the dysfunction - in general – Narcissistic, Histrionic, Compulsive Scales can show strengths of pathology modest Look levels are healthy at Modifying Indices Formulating diagnoses Look at elevation Look at contextual information including clinical impressions Look at prototypal items Steps in Interpretation 1. 2. 3. 4. 5. 6. 7. Determine profile validity Interpret the Personality Disorder Scales Interpret Clinical Syndrome Scales Review noteworthy responses Provide diagnostic impressions Write a personality description Treatment implications and recommendations 1. Determine Profile Validity Scale V (Validity Index) – Items 65, 110, 157 – 2 or more true responses - invalid profile – 1 true response - “questionable validity” Scale X (Disclosure Index) – If raw score is below 34 - invalid and defensive underreporting – If raw score is above 178 - invalid and exaggeration of symptoms 1. Determine Profile Validity Scale Y - (Desirability Index) – Measure of defensive responding – BR above 75 (not necessarily invalid) indicates presenting self in an overly positive, moral, emotionally stable, gregarious manner - “faking good” – the higher the score, the more the person is concealing Scale Z (Debasement Index) – Opposite from Desirability Index – BR above 75 - self description is negative, pathological – Above 85 - could be a cry for help 2. Interpret Personality Disorder Scales 1. Check elevations on Severe Personality Disorders – 2. Check elevations on Clinical Personality Scales — 3. Primary focus for diagnosis Clinical Personality Scales serve to color or elaborate on Severe Personality Pattern elevations (unless extremely elevated compared with severe scales) Guidelines 75-84 = patterns/traits 85+ = disorder Severe Personality Pathology Scale S (Schizotypal) Like DSM IV Schizotypal personality disorder Cognitively dysfunctional Interpersonally detached, prefers social isolation Appear self-absorbed and ruminative Behaviorally eccentric and perceived by others as strange or different Communication style – tangential, personal irrelevancies and magical associations Some are detached and emotionally bland others are more suspicious, anxious and apprehensive Prognosis is poor May need medication FREQUENT CODE TYPES: Clinical: PP, SS; Personality: 1, 2A, P Scale C (Borderline) Unstable moods and behavior Can be self-destructive, self-mutilation Marked mood swings, intermittent periods of depression, generalized anxiety and intense emotional attacks on others Interpersonal difficulties – ambivalence, instability and intensity React strongly to fears of abandonment Idealizes and devalues others Poorly defined sense of self Feelings of emptiness Disorganized thoughts - may have psychotic episodes under stress At risk for depression and suicide FREQUENT CODE TYPES: Clinical: N,D, B,T; Exaggerations of less dysfunctional personality disorders: 3,4,5,8A, 8B Scale P (Paranoid) Suspiciousness and defensiveness with others Feelings of superiority Vigilant to criticism and deceit Abrasive, touchy, hostile and irritable Externalizes blame Describe self as misunderstood, righteous, suspicious, mistreated and defensive Will attack and humiliate those they feel are trying to control or influence them May have delusions of grandeur, ideas of reference, intense fears of being persecuted (psychotic delusions may be present) FREQUENT CODE TYPES: Clinical symptoms: A, PP,SS Personality Scales: 2A, 5, 6B, 8A Clinical Personality Patterns Scale 1(Schizoid) – Little or no interest in others – Detached, impersonal, withdrawn – Peripheral role in family, work, social situations – Lack of depth to feelings – Indifferent to praise or criticism – Communication is vague, distant and unfocused (spacey) – Not disturbed by much, makes decisions easily, self sufficient – FREQUENT CODE TYPES: Clinical symptoms: A, SS; Personality Scales: 2A, 3,7,8A Clinical Personality Patterns Scale 2A: Avoidant – Want to be involved and accepted by others – Vigilant to environment – Sense of unease, disquiet, anxiety and overreaction to minor events – Preoccupied with intrusive, fearful and disruptive thoughts – Perceive themselves as socially inept, inadequate – Feel alone, empty, isolated – Prone to social phobia and frequently depressed – Sensitive to the needs and perspectives of others, compassionate and emotionally responsive – FREQUENT CODE TYPES: Clinical: A, D, H; Personality: 1,3,5, 6A,8A. Clinical Personality Patterns Scale 2B: Depressive – Enduring pattern of thoughts, attitudes, behaviors and self-concepts related to depression – Feels worthless, inadequate, guilty, self critical – Forlorn, discouraged, hopeless – Helpless and immobile in solving life’s problems – Angry, resentful, pessimistic in relationships – FREQUENT CODETYPES: Clinical: D, N Personality: 1,2A,8A,8B,C Clinical Personality Patterns Scale 3 (Dependent) – Feelings of being incapable and incompetent of functioning independently – Inadequate, insecure, low self-esteem – Submissive and cooperative in relationships – Agreeable, minimizes problems – Well-liked because of compliance, values opinion of others., defuses conflict, warm tender, loyal in friendships – FREQUENT CODETYPES: Clinical: A,D,N; Personality: 1, 2A, 4, 7, 8A, 8B Clinical Personality Patterns Scale 4 (Histrionic) Dramatic, colorful and emotional Tolerance for boredom is low Describe self as active, egocentric, exhibitionistic, flighty, extroverted, flirtatious Charming and outgoing, attention seeking Can be loud, demanding and uncontrollable Strong needs for dependency Can be warm, emotionally responsive, good sense of humor, adaptable Good social adjustment, low levels of distress FREQUENT CODETYPES: Clinical: A, H,B,T; Personality: 3,5,6A,7,8A Clinical Personality Patterns Scale 5 (Narcissistic) Exaggerated sense of self-importance and competence Hypersensitive to criticism Conventional rules of behavior do not apply Arrogant, haughty, snobbish, conceited Presents as intelligent, sophisticated, outgoing and charming Lacking in empathy Potential for substance abuse and depression is high Subset will be well adjusted without much emotional distress FREQUENT CODETYPES: Clinical: D,N,B,T ; Personality: 2A,3,4,6A,8A Clinical Personality Patterns Scale 6A (Antisocial) Duplicitous, illegal behavior designed to exploit the environment for self gain Impulsive acting-out Provocative, violent, vicious, self-centered, dominant Avoids perceived abuse and victimization through their behavior Ignores consequences of behavior Lack of empathy and remorse Mistrustful, suspicious, guarded with others Can be gracious, charming and friendly Alcohol and drug dependence are common FREQUENT CODETYPES: Clinical: B,T,N,D; Personality: 2A,3,4,5,6B,7,8A Clinical Personality Patterns Scale 6B (Aggressive-Sadistic) – Gets pleasure by humiliating and violating others’ rights – Hostile and combative – Dominating, antagonistic, frequent persecutory actions – Competitive, hardheaded, authoritarian and socially intolerant – Can be physically aggressive – Sometimes enter socially approved roles and disguise aggression (example police officer) – Unaffected by pain and punishment – No shame, guilt or sentimentality – Can cope effectively with many challenges – unflinching and daring – FREQUENT CODETYPES: Personality:5, 6A, 7, P Clinical Personality Patterns Scale 7 (Compulsive) – Coincides with DSM IV Obsessive-compulsive personality disorder – Conformity, discipline, self-restraint and formality – Adheres strictly to social norms – Conscientious, well prepared, righteous and meticulous – Fears social disapproval, deny hostility – Disciplined, self-restraint, high demands on themselves – Overt passivity and public compliance – Loyalty, prudence, consistency, predictability. – Approaches problems with maturity and competence – High achievers – rarely report psychiatric distress – FREQUENT CODETYPES: Clinical: A,D ; Personality: 1,2A, 2B, 4,5, 6A Clinical Personality Patterns Scale 8A (Passive- Aggressive- Negativistic) – Approximates DSM III-R Passive-Aggressive personality disorder – Indirect expression of negative emotion – Passive compliance combined with resentment and opposition – Guilty and conflicted over their feelings of resentment – Moody, complaining and intermittently hostile – Chronic unhappiness – pessimism, disillusionment and cynicism – Moody and unpredictable – At best can be agreeable and friendly – flexible, emotionally responsive and sensitive – FREQUENT CODETYPES: Clinical: D,A, H; Personality: 1, 2A, 3, 4, 5, 6A, 6B Clinical Personality Patterns Scale 8B (Self-Defeating-Masochistic) – Like DSM III-R self defeating –masochistic personality disorder – Place themselves in the victim role – Relate to others in an obsequious and self-sacrificing manner – Feel they deserve to be shamed and humbled – Inferior, nonindulgent, unassuming and self-effacing – Unempathic and distrustful in relationships – Anxious, apprehensive, mournful, anguished and tormented – They are involved and connected with people – Can have good insight into problems- level of distress high enough to be motivated for treatment – FREQUENT CODETYPES: Clinical: D, A, H; Personality: 2A, 2B, 3, C 3. Interpret Clinical Syndrome Scales 1. Interpret Severe Clinical Syndrome Scales – 2. 3. Often several complementary scales will be elevated together Interpret Basic Clinical Syndrome Scales Guidelines: • • • BR between 60 to 74 are suggestive but not sufficiently indicative of pathology BR 75-84 = clinical syndrome BR 85+ = presence of pathological symptom 4. Review noteworthy responses Similar to Critical Items of MMPI Organized around topics of – Health Preoccupation – Interpersonal Alienation – Emotional Dyscontrol – Self-Destructive Potential – Childhood Abuse – Eating Disorders 5. Provide Diagnostic Impressions (if any) Axis I: Clinical Disorders Axis II: Personality Disorders 6. Personality Description Write a personality description based on previous steps. Attempt to understand meaning of clinical syndrome for client’s personality functioning 7. Treatment Implications and Recommendations Give priority to the Clinical Syndrome Scales Treatment suggestions for personality patterns are listed in Groth-Marnat Mid-term 20 multiple choice/fill-in-the-blank questions (worth 2 points each – 40 pts.) Choose 3 out of five short essay (worth 5 points each -15 pts) 1 MMPI-2 Profile Interpretation worth 35 points (open book) Multiple Choice/Short Essay REVIEW: Lectures 1/15-2/12 Groth-Marnat – Chapters 1, 2, 3, 7, 8 Graham – Chapters 3, 4, 5, 12 For Profile Interpretation/ Write-up Bring and have thorough knowledge of Graham: Chapters 3, 4, 5 and 10 Bring Groth-Marnat –Know how to use Chapter 7
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