Transcript MCMI-III - Universitat de Lleida

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
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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
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Check elevations on Clinical Personality Scales
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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)
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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)
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Interpret Severe Clinical Syndrome
Scales
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3.
Often several complementary scales will be
elevated together
Interpret Basic Clinical Syndrome Scales
Guidelines:
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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