Elevated Minnesota Multiphasic Personality Inventory Research Articles

Reassessing the "traditional background hypothesis" for elevated MMPI and MMPI-2 Lie-scale scores.

The Lie (L) scale of the Minnesota Multiphasic Personality Inventory (MMPI) is widely regarded as a measure of conscious attempts to deny common human foibles and to present oneself in an unrealistically positive light. At the same time, the current MMPI-2 manual states that "traditional" and religious backgrounds can account for elevated L scale scores as high as 65T-79T, thereby tempering impression management interpretations for faith-based individuals. To assess the validity of the traditional background hypothesis, we reviewed 11 published studies that employed the original MMPI with religious samples and found that only 1 obtained an elevated mean L score. We then conducted a meta-analysis of 12 published MMPI-2 studies in which we compared L scores of religious samples to the test normative group. The meta-analysis revealed large between-study heterogeneity (I2 = 87.1), L scale scores for religious samples that were somewhat higher but did not approach the upper limits specified in the MMPI-2 manual, and an overall moderate effect size (d¯ = 0.54, p < .001; 95% confidence interval [0.37, 0.70]). Our analyses indicated that religious-group membership accounts, on average, for elevations on L of about 5 t-score points. Whether these scores reflect conscious "fake good" impression management or religious-based virtuousness remains unanswered. (PsycINFO Database Record

Enhanced screening of prospective oocyte donors: a ten-year review

OBJECTIVE: To report on our results using enhanced oocyte screening methods and to assess the value of such measures in a large oocyte donation program. DESIGN: Retrospective analysis at a university-based IVF center from 1997-2006. MATERIALS AND METHODS: After passing initial questionnaire screening, donor candidates were examined in accordance with ASRM guidelines, which included a health status questionnaire, on-site consultation and examination with a physician and psychologist, and the mandatory tests for infectious disease, drug use, and cystic fibrosis. Enhanced screening included: face to face consultations with a genetic counselor, the Minnesota Multiphasic Personality Inventory (MMPI), universal screening for Tay Sachs, Fragile X (as of 2005), and karyotypic abnormalities. Recipient husbands were tested in the case of Ashkanazi matches. RESULTS: Of 1,071 candidates presenting for on-site evaluation, 511 (48%) passed the screening process, of whom 474 (93%) donated. Twenty percent (n=212) of candidates withdrew their applications, and 560 (32%) failed screening. Candidates failed due to genetic factors (11%), psychological factors (10%), medical conditions (6%), infectious diseases (3%), and positive drug screens (2%). Of the 121 candidates rejected for genetic factors, 68 were for abnormal genetic testing and 53 for a personal/family history suggestive of a transmissible genetic trait, such as dyslexia, early cardiac disease, and aggressive cancers. There were 29 cystic fibrosis mutation carriers, and 12 abnormal hemoglobin electrophoresis patterns. Enhanced screening accounted for 21% of the genetic exclusions, with 9 Tay Sachs carriers, 6 inconclusive Tay Sachs results, 8 abnormal karyotypes, and 2 Fragile X carriers (intermediate range). Of the 112 candidates excluded for psychological factors, 24 had a personal history of a psychological disorder, 28 with unacceptable behavioral traits, and 44 with a family history of psychological disorders. Enhanced screening accounted for 14% of the psychological exclusions, as 16 had an elevated MMPI score. CONCLUSIONS: While enhanced oocyte donor screening uncovers a significant number of donors with potential problems, it also reduces the numbers of available donors. Programs may want to use the information presented here to determine if some or all of the elements of enhanced donor screening should be incorporated into their protocols.

DSM‐IV‐TR “Pain Disorder Associated with Psychological Factors” as a Nonhysterical Form of Somatization

Elevated Minnesota Multiphasic Personality Inventory (MMPI) scores on the hysteria (Hy) scale are reported in several forms of pain. Previous results were possibly biased by diagnostic heterogeneity (psychogenic, somatic and mixed pain syndromes included in the same index sample) or Hy heterogeneity (failure to differentiate Hy scores into clinically meaningful subscales, such as admission of symptoms [Ad] and denial of symptoms [Dn]). To overcome this drawback, 48 patients diagnosed as having a Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR) diagnosis of "pain disorder associated with psychological factors" were compared with 48 patients experiencing somatic pain excluding psychological factors, and 42 somatic controls without pain. MMPI Hy and hypochondriasis (Hs) scores were significantly higher in the pain disorder group than in control groups, who scored similarly. MMPI correction (K) scores and Dn scores were similar in the three groups, whereas Ad was significantly higher in the pain disorder group and lower and similar in the two control groups, respectively. In the pain disorder group, Ad and Dn were negatively correlated, whereas in control groups they were unrelated. These findings suggest that whereas a pattern of high Hs and Hy scores together with a normal K score might characterize patients with a pain disorder associated with psychological factors, elevated Hy scores per se do not indicate hysterical traits. In the pain disorder group, elevated Hy scores reflected the Ad subscale alone, indicating a strikingly high frequency of distressing somatic symptoms. They tend not to repress or deny the emotional malaise linked to symptoms, as the hysterical construct expects. The pain disorder designation should be considered a nonhysterical form of somatization.

Iron Status and Depression in Premenopausal Women: An MMPI Study

To test the hypothesis that low iron status or other nutritional deficiencies are associated with symptoms of depression in premenopausal women, the authors related blood indices of iron status to scores on the Minnesota Multiphasic Personality Inventory (MMPI) and responses to a mood adjective checklist. Participants recruited locally provided fasting blood samples and completed the MMPI during the follicular phase of the menstrual cycle. Of 365 apparently healthy participants, 4% had hemoglobin < 120 g/L, 6% had transferrin saturation < 16%, 20% had ferritin < 12 μg/L, and 8% had clinically elevated scores (T ≥ 70) on the Depression scale of the MMPI. The frequency of elevated MMPI Depression scores was unrelated to the frequency of low hemoglobin, transferrin saturation, or ferritin. The results do not support the hypothesis that low iron status contributes to symptoms of depression in women.

Discographic pain report. Influence of psychological factors.

The possibility of a relationship between discographic pain responses and Minnesota Multiphasic Personality inventory scores was investigated. To determine if patients with elevated Minnesota Multiphasic Personality Inventory scale scores were more likely to report pain on the injection of a nondisrupted disc than were patients without such high scores. In general, injection into disrupted discs provokes pain, whereas injection into nondisrupted discs does not. However, discordant results are sometimes obtained and create a more difficult diagnostic challenge. The primary study group was composed of 72 patients who underwent computed tomography/discography at the three lowest lumbar levels for diagnostic purposes and completed the Minnesota Multiphasic Personality Inventory. The mean scores on the Minnesota Multiphasic Personality Inventory hypochondriasis and hysteria scales were significantly greater for patients reporting reproduction of clinical pain than for patients not reporting pain on injection of a nondisrupted disc (hypochondriasis: 77.2 vs. 68.6, P < 0.01; hysteria: 74.5 vs. 68.3, P < 0.05). The scores on the depression scale followed a similar trend (68.6 vs. 63.6, P < 0.15). Multivariate analysis, adjusting the means for possible confounding effects of age, symptom duration, and sex, did not alter the results. Discographic pain reports are not only related to anatomic abnormalities, but are influenced by personality as assessed by the Minnesota Multiphasic Personality Inventory. Patients with elevated scores on the hypochondriasis, hysteria, and depression scales may tend to overreport pain during discographic injection. Among such patients, even those with a concordant computed tomography/discographic image, selection of therapeutic modalities should be made with caution.

Psychological assessment of aviators captured in World War II.

Psychological assessments, including administration of the Minnesota Multiphasic Personality Inventory (MMPI) and structured interviews for Axis I mental disorders and posttraumatic stress disorder (PTSD) specifically, were used to describe 33 World War II (WWII) aviators who were held as prisoners of war (POWs) for an average of 14 months. Results showed more elevated MMPI profile patterns than expected given previous research with pilots (Butcher, 1994) and rates of current and lifetime PTSD at 33%, reasoned to derive from POW trauma. Despite this level of psychopathology, WWII aviator POW survivors were found to be more resilient to captivity effects than age-similar nonaviator WWII POW survivors characterized generally by less advantages in education, military rank, and other personal resources. Compared with aviator former POWs of the Vietnam War studied in their mid-life years (Ursano, Boydstun, & Wheatley, 1981), the present sample appeared to be less psychologically robust. Studies of former prisoners of war (POWs) have revealed that war captivity is associated with increased vulnerability to physical and psychological illnesses. Yet, some POW survivors do not exhibit psychological distress or mental disorders following trauma cessation (Kluznik, Speed, Van Valkenburg, & Magraw, 1986; Sutker, Allain, & Winstead, 1993; Ursano, Boydstun, & Wheatley, 1981). Of interest are studies of American servicemen, primarily aviators, held as prisoners in North Vietnam for periods extending up to 7 or 8 years. The Ursano et al. (1981) follow-up of 253 former POW aviators revealed that, in addition to the potent impact of stressor severity, such characteristics as rank at shoot down, college education, and status as pilots and navigators were associated with lessened risk for psychiatric morbidity, although 25% of these men were labeled with mental disorders. Ursano et al. (1981) described aviators as a well-educated, intelligent military subset, homogeneous in achievement needs and potentially resistant to mental disorders. Butcher (1994) published Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2 profile patterns of applicants for flight crew positions with a major airline. Results showed that airline pilots, many of whom had served military duty, minimized problems on psychological tests and presented themselves as psychologically robust. These studies shed light on the resilience of pilots generally and survivors of Vietnam POW captivity specifically, but little attention has been directed toward study of

Prevalence of depression among electrical workers

To address the possible association between electric and magnetic field exposure and depression, we analyzed data from the Vietnam Experience Study. In order to compare the risk of diagnosed depression, depressive symptoms, and elevations in personality scales indicative of depression, we classified employed participants as electrical workers (N = 183) and nonelectrical workers (N = 3,861) and compared their scores on the Diagnostic Interview Survey (DIS) and the Minnesota Multiphasic Personality Inventory (MMPI). Electrical workers in the aggregate showed little evidence of increased risk, with the possible exception of an increase in elevated MMPI depression scores among short-term workers. Data on electricians yielded indications of increased risk for several markers of depression. Despite the limited number of electrical workers, uncertainty regarding exposure, and our inability to address other workplace exposures, these results suggest that electrical workers in general are not at increased risk for depression. However, our results encourage further evaluation of depression among electricians.

Sexual abuse, family environment, and psychological symptoms: On the validity of statistical control.

M. R. Nash, T. L. Hulsey, M. C. Sexton, T. L. Harralson, and W. Lambert (1993) reported on the effects of controlling for family environment when studying sexual abuse sequelae. Sexual abuse history was associated with elevated Minnesota Multiphasic Personality Inventory and Rorschach scores in a sample of 105 women, but many of the reported differences disappeared when a Family Functioning Scale score was used as a covariate. The present article considers the findings of Nash et al. in terms of the theoretical and statistical constraints placed on analysis of covariance and other partializing procedures. Because family dysfunction is not always causally antecedent to sexual abuse, and given the quasi-experimental quality of most abuse research, the use of covariate techniques to test hypotheses about the causal role of family environment in the impacts of sexual abuse may be ill advised. Analyses of a 2,964-subject data set illustrate these concerns.

Seminary Drop-Outs: A Study of Predictability

Why do some students remain in seminary and others drop out? A study of 552 MDiv students at a mainline Protestant seminary from the years of 1973 to 1986 was performed to attempt to answer that question. The Minnesota Multiphasic Personality Inventory (MMPI) and the Theological School Inventory (TSI) were used to differentiate between persisters and seminary leavers. Of students in an elevated MMPI group, 47% did not graduate from seminary, compared to 26% in a low MMPI group and 29% in a moderate MMPI group. A discriminant analysis was used with TSI scales and the MMPI score and 68% of the students were correctly classified as persisters or leavers. The MMPI score and the Definiteness and Flexibility scales of the TSI provided the strongest discrimination.

Outcome Prediction by MMPI in Subtypes of Anorexia Nervosa

Sixty-seven discharged, chronically anorectic inpatients were followed eight to 60 months after discharge at normal weight: 39 with anorexia nervosa, restricting subtype (ANR), and 27 with anorexia nervosa, bulimic subtype (ANB). The groups did not differ demographically. ANB patients produced more elevated MMPI profiles; they were distinguished by profile type as well as by discriminant function analysis, which identified ANB patients as higher in both depression and impulsivity. Outcome criteria, i.e., follow-up weight, bulimic behavior, social functioning, revealed that 39% of all patients maintained treatment gains while 61% relapsed. Forty-nine percent of ANR patients maintained improvement, compared with only 22% of ANB. Minnesota Multiphasic Personality Inventory (MMPI) profiles did not predict outcome across all patients, but did within each subtype. Successful ANR patients were more distressed and dramatic, while greater distress and impulsivity predicted failure among ANB. Prediction of ability to maintain improvement after inpatient treatment was markedly enhanced by first classifying anorectics into clinical subtypes. Higher subjective distress predicted negative outcome in one group and positive outcome in the other. These results may clarify apparent contradictions in the literature and contribute to more focused treatment.

Chronic Pain and Crohnʼs Disease: Treatment Difficulties

Formal observation of the interactions between chronic pain patients and their treating physicians has been infrequently reported. Four chronic pain patients with Crohn's disease are reviewed during their course of treatment with the Mount Sinai Pain Management Service. Clinically and behaviorally descriptive findings, supplemented by markedly elevated Minnesota Multiphasic Personality Inventory (MMPl) profiles, indicate a noncompliant, manipulative, and acting-out mode of interaction between the patients and their doctors. Results are discussed in light of prior research and treatment implications for the pain specialist. Identification of and sensitivity to such potentially dysfunctional doctor–patient relationships are important in the evaluation and treatment of chronic pain itself.

Elevated MMPI scores for hypochondriasis, depression, and hysteria in patients with rheumatoid arthritis reflect disease rather than psychological status.

The Minnesota Multiphasic Personality Inventory (MMPI) scales for Hypochondriasis, Depression, and Hysteria were studied in patients with rheumatoid arthritis (RA). The RA patients showed elevated scores on these scales, and these results are similar to those reported in each of 6 published studies. The elevated MMPI scale scores can be explained largely by 5 "disease-related" MMPI statements which met 2 criteria: they were among 11 of the 117 MMPI statements that two-thirds of rheumatologists predicted would be RA-associated; and RA patients and normal subjects differed significantly in their responses to these statements. The responses of RA patients and normal subjects to most other statements in the MMPI Hypochondriasis, Depression, and Hysteria scales were quite similar. In RA patients, responses to "disease-related" statements were correlated with results of measures of disease activity, which indicates that responses to these MMPI items reflect the severity, as well as the presence, of RA. These findings suggest that new criteria are needed for validation of the MMPI as a clinical tool for the recognition of hypochondriasis, depression, and hysteria in a patient who has RA.

Comparative Polysomnographic Study of Narcolepsy and Idiopathic Central Nervous System Hypersomnia

Patients with a primary diagnosis of narcolepsy or idiopathic CNS hypersomnia seen at Stanford University Sleep Disorders Clinic over a 5-year period were studied retrospectively. The two patient groups were compared with respect to blood pressure, Minnesota Multiphasic Personality Inventory (MMPI) psychological profile, nocturnal sleep structure, prevalence and severity of sleep apnea and periodic leg movements in sleep, and daytime sleep tendency. Narcoleptic patients tended to have higher blood pressure, higher prevalence of abnormally elevated MMPI scores, more abbreviated and more disrupted sleep at night, and greater daytime sleep tendency. Sleep apnea and periodic leg movements were more prevalent in narcoleptic patients, but only periodic leg movements in sleep were more prevalent in narcoleptic patients than in the general population. Periodic leg movements during REM sleep were observed in more than one-third of narcoleptic patients, which may be an important pathophysiologic feature of this disorder.

Personality resemblances between unwed mothers and their adopted-away offspring.

In a sample of 300 adoptive families there was a tendency for adopted children to be more extraverted and emotionally stable than biological children. For extraversion there was a low statistically significant resemblance between unwed mothers and their adopted-away children. Paradoxically, however, children of mothers with elevated Minnesota Multiphasic Personality Inventory (MMPI) scores tended to be rated as more emotionally stable than children of mothers with better adjustment on the MMPI. This latter finding was interpreted as suggested an interaction between emotional sensitivity and the early environment. According to this hypothesis, individuals with genotypes making them vulnerable to their environments could thrive in the warm climate of the adoptive families, but turn out relatively badly in the presumably less benign families in which the unwed mothers were reared.

Drug and alcohol abuse among psychiatric admissions. A multidrug clinical-tosicologic study.

Over one third of the adults in a psychiatric hospital had drug abuse (including alcohol) problems. The patients had fewer psychotic diagnoses, briefer hospitalizations, and less elevated Minnesota Multiphasic Personality Inventory scores than other inpatients. Toxicologic examinations, at admission, revealed psychoactive drugs in nearly half of the patients; many test results were positive for drugs that the patients denied using. Alcohol or sedative physical dependence was not uncommon. Alcohol contributed to one fourth of the admissions, but many patients also took other drugs. Younger and older patients drank alcohol in equal proportions. There was no current, and very little past, narcotic physical dependence, but one fifth of patients had abused narcotics. Nonaddicting narcotic abuse was especially common among young psychedelic users. Salicylates were abused frequently. The high incidence and complex patterns of drug abuse among psychiatric inpatients demand better diagnosis, more focused treatment, and altered public and private funding policies.

Anorexia nervosa--long-term follow up and effects of treatment.

Sixty-seven discharged, chronically anorectic inpatients were followed eight to 60 months after discharge at normal weight: 39 with anorexia nervosa, restricting subtype (ANR), and 27 with anorexia nervosa, bulimic subtype (ANB). The groups did not differ demographically. ANB patients produced more elevated MMPI profiles; they were distinguished by profile type as well as by discriminant function analysis, which identified ANB patients as higher in both depression and impulsivity. Outcome criteria, i.e., follow-up weight, bulimic behavior, social functioning, revealed that 39% of all patients maintained treatment gains while 61% relapsed. Forty-nine percent of ANR patients maintained improvement, compared with only 22% of ANB. Minnesota Multiphasic Personality Inventory (MMPI) profiles did not predict outcome across all patients, but did within each subtype. Successful ANR patients were more distressed and dramatic, while greater distress and impulsivity predicted failure among ANB. Prediction of ability to maintain improvement after inpatient treatment was markedly enhanced by first classifying anorectics into clinical subtypes. Higher subjective distress predicted negative outcome in one group and positive outcome in the other. These results may clarify apparent contradictions in the literature and contribute to more focused treatment.