Jacob Finn

7/30/2019 Jacob Finn

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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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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)


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


SCALES (RC SCALES)


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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


SCALES (RC SCALES)


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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


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Discriminate PTSD from other diagnoses in a college

sample (McDevitt-Murphy, Weathers, Flood, Eakin, &

Benson, 2007)

No RC scale distinguished PTSD and MDD, though RC2 and

RC4 were close to moderate effect sizes

RCd, RC1, RC2, and RC4

PTSD from Social Phobia

All RC scales

PTSD from well-adjusted individuals

Discriminate between internalizing and externalizing

subtypes of PTSD in a work-related trauma group

(Sellbom & Bagby, 2009)

Both externalizers and internalizers had high scores on RCd

and RC7.

RC3, RC4, and RC9 were higher in externalizers

RC1 and RC2 were higher in internalizers


SCALES (RC SCALES)


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Used to test the theoretical assumptions of Watsons

model of internalizing disorders (Sellbom, Ben-Porath, &

Bagby, 2008)

Large undergraduate sample and a large outpatient sample

RCd (Demoralization) loaded strongly on a distress factor

comprised of Depression, GAD, and PTSD measures

RC7 (Dysfunctional Negative Emotions) loaded strongly on a

fear factor comprised of Social Phobia, Specific Phobias, and

Agoraphobia measures

RC2 (Low Positive Emotions) loaded on Depression and on

Social Phobia


SCALES (RC SCALES)


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PERSONALITYPSYCHOPATHOLOGY-FIVE

SCALES (PSY-5)


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PERSONALITY PSYCHOPATHOLOGY-

FIVE SCALES (PSY-5)

Replicated Rational Selection (RRS) was used to identify

MMPI-2 items for the PSY-5 scales (Harkness, McNulty, &

Ben-Porath, 1995).

RRS involves educating a layperson regarding a construct of

interest and having them select relevant items.

No item overlap and highly face valid

Scales represent communication between client and clinician

Scales

Aggressiveness (AGGR)

Psychoticism (PSYC)

Disconstraint (DISC)

Negative Emotionality/Neuroticism (NEGE)

Introversion/Low Positive Emotionality (INTR)


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Aggressiveness (AGGR)

Instrumental aggression

Low scores: Interpersonally passive and submissive (Weisenburger,Harkness, McNulty, Graham, & Ben-Porath, 2008)

Psychoticism (PSYC)

Disconnection from reality

Disconstraint (DISC)

Impulsivity, rule-breaking

Low scores: Prone to structure and planning, controlled

Negative Emotionality/Neuroticism (NEGE)

Thinks negatively about self, others, world, and future

Introversion/Low Positive Emotionality (INTR)

Little interest in social activities and positive experiences

Low scores: Sociable and energetic

PERSONALITY PSYCHOPATHOLOGY- FIVE SCALES (PSY-5)


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PSY-5 scores are related to trauma-related internalizing

and externalizing symptom clusters

In a veteran sample (Miller, Kaloupek, Dillon, & Keane, 2004)

In a work-related trauma sample (Sellbom & Bagby, 2009)


FIVE SCALES (PSY-5)

PERSONALITY PATTERNS OF


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PERSONALITY PATTERNS OF

INTERNALIZING AND EXTERNALIZING

PTSD

PSY-5 Scales

Internalizing Subtype Externalizing Subtype

Veterans Work Veterans Work

AGGR Low High

PSYC High

DISC High High

NEGE

INTR High High


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PSY-5 constructs contribute to the relationship between

PTSD and substance use (Miller, Vogt, Mozley, Kaloupek,

& Keane, 2006).

Alcohol = DISC and NEGE

Illicit substances = DISC

PSY-5 scales may be used to understand how someone

copes with a future stressor (Ferrier-Auerbach, Kehle,

Erbes, Arbisi, Thuras, & Polusny, 2009)

Sample of pre-deployment National Guard soldiers

Predictors of drinking frequency = DISC and NEGE

Predictors of quantity of drinking = DISC and NEGE

Predictors of frequency of binge drinking = NEGE and DISC


FIVE SCALES (PSY-5)


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CONCLUSIONS

While the Clinical Scales may represent the core of the

MMPI-2, other scales may offer additional information.

The research suggests Fp provides important informationabout response strategies.

Currently, the research supports the continued evaluation

of the RC and PSY-5 scales for PTSD assessment, butmore research is needed to firmly establish their utility.

The scales of the MMPI-2 provide symptom-related

information, but they should not be used alone for

diagnosis.

A multi-method battery including a structured interview

and trauma-specific measures should be used with the

MMPI-2 (Penk, Rierdan, Losardo, & Robinowitz, 2006)

REFERENCES


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REFERENCES

Arbisi, P. A., & Ben-Porath, Y. S. (1995). An MMPI-2 infrequent response scale for use withpsychopathological populations: The Infrequency-Psychopathology Scale, F(p).Psychological Assessment,7(4), 424-431.

Arbisi, P. A., & Ben-Porath, Y. S. (1997). Characteristics of the MMPI-2 F(p)

scale as a function of diagnosis

in an inpatient sample of veterans.Psychological Assessment, 9(2), 102-105.

Arbisi, P. A., & Ben-Porath, Y. S. (1998). The ability of Minnesota Multiphasic Personality Inventory -2validity scales to detect fake-bad responses in psychiatric inpatients.Psychological Assessment, 10(3), 221-

228.

Arbisi, P.A., McNulty, J.L., & Ben-Porath, Y.S. (2004, July). Contribution of the MMPI-2 RestructuredClinical (RC) Scales to the Assessment of PTSD in Veterans.

Poster presented at the annual meeting of the

American Psychological Association (APA), Honolulu, HI.

Arbisi, P. A., Murdoch, M., Fortier, L., & McNulty, J. L. (2004). MMPI-2 validity and award of serviceconnection for PTSD during the VA Compensation and Pension Evaluation.Psychological Services, 1(1), 56-67.

Ben-Porath, Y. S., & Tellegen, A. (2008). MMPI-2-RF: Manual for Administration, Scoring, andInterpretation. Minneapolis: University of Minnesota Press.

Bury, A. S., & Bagby, R. M. (2002). The detection of feigned uncoached and coached Posttraumatic StressDisorder with the MMPI-2 in a sample of workplace accident victims.Psychological Assessment, 14(4), 472-484.

Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., &

Kaemmer, B. (1989). Minnesota Multiphasic

Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis: University ofMinnesota Press.

Efendov, A. A., Sellbom, M., & Bagby, R. M. (2008). The utility and comparative incremental validity of theMMPI-2 and Trauma Symptom Inventory Validity Scales in the detection of feigned PTSD.PsychologicalAssessment, 20(4), 317-326.

Elhai, J. D., Naifeh, J. A., Zucker, I. S., Gold, S. N., Deitsch, S. E., & Frueh, B. C. (2004). Discriminating

malingered from genuine civilian Posttraumatic Stress Disorder: A validation of three MMPI-2 Infrequencyscales (F, Fp, and Fptsd).Assessment, 11(2), 139-144.

Ferrier-Auerbach, A. G., Kehle, S. M., Erbes, C. R., Arbisi, P. A., Thuras, P., & Polusny, M. A. (2009).Predictors of alcohol use prior to deployment in National Guard Soldiers.Addictive Behaviors, 34, 625-631.

REFERENCES


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Graham, J. R. (2006). MMPI-2: Assessing personality and psychopathology (4th ed.). New York: Oxford

University Press.

Harkness, A. R., McNulty, J. L., & Ben-Porath, Y. S. (1995). The Personality Psychopathology Five (PSY-5):

Constructs and MMPI-2 Scales.Psychological Assessment, 7(1), 104-114.

Keane, T. M., Malloy, P. F., & Fairbank, J. A. (1984). Empirical

development of an MMPI subscale for the

assessment of combat-related post-traumatic stress disorder. Journal of Consulting and Clinical Psychology,

52, 888-891.

McDevitt-Murphy, M. E., Weathers, F. W., Flood, A. M., Eakin, D. E., & Benson, T. A. (2007). The utility ofthe PAI and the MMPI-2 for discriminating PTSD, Depression, and Social Phobia in trauma-exposed college

students.Assessment, 14(2), 181-195.

Miller, H. R., Goldberg, J. O., & Streiner, D. L. (1995). What's

in a name? The MMPI-2 PTSD scales.

Journal of Clinical Psychology, 51(5), 626-631.

Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T. M. (2004). Externalizing and internalizingsubtypes of combat-related PTSD: A replication and extension using the PSY-5 scales. Journal of Abnormal

Psychology, 113(4), 636-645.

Miller, M. W., Vogt, D. S., Mozley, S. L., Kaloupek, D. G., & Keane, T. M. (2006). PTSD and substance-

related problems: The mediating roles of Disconstraint and Negative Emotionality. Journal of Abnormal

Psychology, 115(2), 369-379.

Penk, W.E., Rierdan, J., Losardo, M., & Robinowitz, R. (2006). The MMPI-2 and Assessment of

Posttraumatic Stress Disorder (PTSD). In J.N. Butcher (Ed.), MMPI-2: A Practitioners Guide. Washington,

D.C.: American Psychological Association.

Resnick, P. J., West, S., & Payne, J. W. (2008). Malingering of Posttraumatic Disorders. In R. Rogers (Ed.),

Clinical Assessment of Malingering and Deception (3rd ed.). New York: Guilford Press.

Sellbom, M., & Bagby, R. M. (2009). Identifying PTSD personality

subtypes in a workplace trauma sample.

Journal of Traumatic Stress, 22(5), 471-475.

REFERENCES

REFERENCES


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Sellbom, M., Ben-Porath, Y. S., & Bagby, R. M. (2008). On the hierarchical structure of mood and anxiety

disorders: Confirmatory evidence and elaboration of a model of temperament markers. Journal of Abnormal

Psychology, 117(3), 576-590.

Skodol, A. E. (2008). Report of the DSM-V Personality and Personality Disorder Work Group. Arlington, VA:

American Psychiatric Association.

Skodol, A. E. (2009). Report of the DSM-V Personality and Personality Disorders Work Group. Arlington, VA:

American Psychiatric Association.

Tellegen, A., Ben-Porath, Y. S., McNulty, J. L., Arbisi, P. A., Graham, J. R., & Kaemmer, B. (2003). TheMMPI-2 Restructured Clinical scales: Development, validation, and interpretation. Minneapolis: University

of Minnesota Press.

Tolin, D. E., Maltby, N., Weathers, F. W., Litz, B. T., Knight, J., & Keane, T. M. (2004). The use of the

MMPI-2 Infrequency-Psychopathology Scale in the assessment of Posttraumatic Stress Disorder in male

veterans. Journal of Psychopathology and Behavioral Assessment, 26(1), 23-29.

Watson, D. (2005). Rethinking the Mood and Anxiety Disorders: A quantitative hierarchical model forDSM-

V. Journal of Abnormal Psychology, 114(4), 522-536.

Watson, D., & Tellegen, A. (1985). Toward a consensual structure

of mood.Psychological Bulletin, 98(2),

219-235.

Weisenburger, S., Harkness, A. R., McNulty, J. L., Graham, J. R., & Ben-Porath, Y. S. (2008). Interpreting

low Personality Psychopathology--Five Aggressiveness Scores on the MMPI-2: Graphical, robust, and

resistant data analysis. Journal of Personality Assessment, 20(4), 403-408.

Wetzel, R. D., Murphy, G. E., Simons, A., Lustman, P., North, C., & Yutzy, S. (2003). What does the Keane

PTSD Scale of the MMPI measure? Repeated measurements in a group

of patients with Major Depression.

Psychological Reports, 92, 781-786.

Wolf, E. J., Miller, M. W., Orazem, R. J., Weierich, M. R., Castillo, D. T., Milford, J., et al. (2008). TheMMPI-2 Restructured Clinical Scales in the assessment of Posttraumatic Stress Disorder and comorbid

disorders.Psychological Assessment, 20(4), 327-340.

REFERENCES


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Jacob Finn

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