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    THE MMPI-2 AND PTSD ASSESSMENT:

    MORE THAN JUST THE PK SCALE

    Jacob A. Finn, M.A. & Elana Newman, Ph.D

    The University of Tulsa

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    PRESENTATION

    OBJECTIVES

    Describe more recent MMPI-2 developments,

    including the Infrequency Psychopathology (Fp)

    Scale, the Restructured Clinical (RC) Scales, and

    the Personality Psychopathology-Five (PSY-5)

    Scales.

    Explain research regarding the utility of these

    scales for the assessment of PTSD

    Discuss limitations to the research already

    conducted and identify areas for future research

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    PERSONALITY INVENTORY 2(MMPI-2)

    The MMPI-2 is one of the most widely used and

    researched assessment instruments.

    567 True or False items

    The original MMPI was published by Hathaway and

    McKinley in 1943.

    Clinical Scales developed by contrast group empirical keying

    method

    The MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, &

    Kaemmer,1989) was published to address concerns aboutnorms, language, and item content.

    Desire to maintain as much research as possible

    Clinical Scales were kept with very limited changes

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    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)

    PERSONALITY INVENTORY 2(MMPI-2)

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    MMPI-2 AND THE PK SCALE

    PTSD was not one of the clinical syndromes the MMPI

    Clinical Scales were developed to measure.

    The PK Scale (Keane, Malloy, & Fairbank, 1984) was

    developed for the purpose of assessing PTSD by

    contrasting veterans groups with and without a diagnosis.

    The large portion of research on the PK scale has focused

    on veterans.

    The PK scale has been evaluated by several groups, with

    many concluding the construct being measured by PK is

    distress (Arbisi, McNulty, & Ben-Porath, 2004; Miller,Goldberg, & Streiner, 1995; Wetzel, Murphy, Simons,

    Lustman, North, & Yutzy, 2003).

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    DISTRESS AND THE MMPI-2

    Watson (2005) proposed a three factor model to explaininternalizing disorders: distress (negative emotionality),

    positive affect, and physiological hyperarousal.

    He acknowledges the limitations to our understanding ofwhere PTSD fits, but several large studies suggest PTSD

    loads highest on distress.

    Several studies have identified emotional distress as thefirst-factor of the MMPI-2 item pool (Graham, 2006).

    Not the only factor, but it is well-represented in item pool

    Some researchers have found evidence to suggest thatdistress may affect the interpretability of some MMPI-2

    scales.

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    DISTRESS AND THE MMPI-2

    The Infrequency (F) scale is a validity scale for over- reporting, built with items infrequently endorsed bynormal

    individuals

    Among first validity scales and based on Minnesota Normals

    Some F item content reflects sex life, substance use, level of

    functioning, sleep problems, and social support.

    The Clinical Scales were developed through contrast groupmethods, selecting items that distinguished those withpathology from those without.

    Issue with multiple elevations (lack of discriminant validity)

    Some argue this is due to distress/demoralization (Tellegen,

    Ben-Porath, McNulty, Arbisi, Graham, & Kaemmer, 2003)

    How accurate are these and similar MMPI-2 scales if

    the client is experiencing a high level of distress.

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    DEVELOPMENTS IN THE

    MMPI-2

    New MMPI-2 scales have been developed with these

    concerns in mind.

    The Infrequency Psychopathology (Fp) Scale

    The Restructured Clinical (RC) Scales

    DSM-V Workgroups acknowledge that personality traits

    add to the description of a diagnosis (Skodol, 2008, 2009)

    The Personality Psychopathology-Five (PSY-5) Scales

    The Fp, RC, and PSY-5 scales are all found on the new

    MMPI-2-RF (Ben-Porath & Tellegen, 2008) in either their

    original (RC) or a modified (Fp and PSY-5) form.

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    INFREQUENCYPSYCHOPATHOLOGY SCALE

    (FP )

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    INFREQUENCY PSYCHOPATHOLOGY

    SCALE (FP )

    PTSD is thought to be an easier disorder to fake (Resnick,

    West, & Payne, 2008).

    Media coverage including PTSD

    Emphasis of symptoms over signs

    One of the benefits to using the MMPI-2 for PTSD

    assessment is the presence of validity scales.

    Arbisi & Ben-Porath (1995) constructed the Fp scale by

    identifying items endorsed by 20% or less of individuals in

    two inpatient samples and the MMPI-2 normativesample.

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    INFREQUENCY PSYCHOPATHOLOGY

    SCALE (FP )

    Basic validation (Arbisi & Ben-Porath, 1995, 1997, 1998)

    Less correlated with measures of distress and psychopathology

    Less elevated in clinical samples and in individuals with confirmedPTSD than F and Fb

    Greater PPP and classification accuracy in an inpatient faking

    paradigm

    Compensation-seeking populations

    Produced proportion of invalid protocols comparable to the rates

    found in other compensation seeking research, 20-30% (Tolin,Maltby, Weathers, Litz, Knight, & Keane, 2004)

    Better discriminated undergraduates faking PTSD for

    compensation from non-fakers and workplace accident victims with

    confirmed PTSD, even when fakers were coached on PTSD

    symptoms and/or validity scales (Bury & Bagby, 2002).

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    Better Faker

    Groups

    Incremental contribution over other validity scales in

    identifying trained fakers from individuals with PTSD relatedto childhood sexual assault (Elhai, Naifeh, Zucker, Gold,

    Deitsch, & Frueh, 2004).

    Largest effect in differentiating individuals with PTSD from

    individuals with remitted PTSD coached and uncoached for

    faking (Efendov, Sellbom, & Bagby, 2008).

    It is important for clinicians to use actuarial data, such as

    validity scales, in evaluating self-reported symptoms andin making decisions about access to compensation and

    pension (Arbisi, Murdoch, Fortier, & McNulty, 2004)

    INFREQUENCY PSYCHOPATHOLOGY

    SCALE (FP )

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    RESTRUCTURED CLINICAL

    SCALES (RC SCALES)

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    Criticisms were raised regarding the Clinical Scales

    Long scales with item overlap, high intercorrelations, and

    questionable subtle items

    The RC Scales were developed in a 4-step process

    (Tellegen et al., 2003)

    Step 1: Develop a Demoralization Scale

    Step 2: Identify the unique core factors to the Clinical Scales

    Step 3: Build seed scales

    Step 4: Analyze item pool for convergent and discriminant

    qualities

    RCd

    Demoralization

    Developed from items in Clinical Scale 2 and 7

    Emotional discomfort, helpless, pessimistic

    RESTRUCTURED CLINICAL

    SCALES (RC SCALES)

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    RESTRUCTURED CLINICAL

    SCALES (RC SCALES)

    Watson & Tellegen, 1985, p. 221

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    RC1

    Somatic complaints

    Excessive preoccupation with physical health

    RC2

    Low positive emotions

    Withdrawn, passive, experience anhedonia

    RC3

    Cynicism

    Regard people as uncaring and untrustworthy

    RC4 Antisocial behavior

    Legal difficulties, angry, antagonistic

    RC6

    Ideas of Persecution

    Feeling targeted and mistreated

    RC7

    Dysfunctional negative emotions

    Preoccupation with negative perceptions

    RC8

    Aberrant experiences

    Impaired reality testing, psychotic symptoms

    RC9

    Hypomanic activation

    Poor impulse control, grandiose, euphoric

    RESTRUCTURED CLINICAL

    SCALES (RC SCALES)

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    RESTRUCTURED CLINICAL

    SCALES (RC SCALES)

    In two VAMC samples (one male, one female), RC scales

    relationship to PTSD symptoms and diagnosis wereexamined (Wolf, Miller, Orazem, Weierich, Castillo,Milford, et al., 2008).

    Allowed for replication and examination of gender differences

    In males, RCd (Demoralization) and RC7 (DysfunctionalNegative Emotions) were the strongest correlations with total

    PTSD symptoms and a PTSD diagnosis, respectively.

    In females, RC1 (Somatic Complaints) and RCd

    (Demoralization) were the strongest correlations with total

    PTSD symptoms, respectively.

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    RC Scale VA Men VA Women

    RCd

    Demoralization

    RC1

    Somatic Complaints

    RC2

    Low Positive Emotions

    RC3

    Cynicism

    RC4

    Antisocial Behaviors

    RC6

    Ideas of Persecution

    RC7

    Dysfunctional Negative Emotions

    RC8 Aberrant Experiences RC9 Hypomanic Activation

    WOLF ET AL. (2008) RC SCALE ELEVATIONSIN INDIVIDUALS WITH PTSD