Millon Clinical Multiaxial Inventory-II Research Articles

Personality patterns of people with medically refractory epilepsy – Does the epileptogenic zone matter?

ObjectivesThe aims of this study were to determine the rate of dysfunctional personality patterns before and after epilepsy surgery, their types, and the importance of the epileptogenic zone in a sample of people with refractory epilepsy. MethodsWe conducted an ambispective observational study, including refractory epilepsy surgery candidates. Demographic, psychiatric, and neurological data were recorded. Evaluation of personality was made using the Millon Clinical Multiaxial Inventory-II (MCMI-II). Presurgical predictors of personality patterns were determined using a linear regression model. The proportion of patients with dysfunctional personality patterns, before and after surgery, was compared using the Mcnemar's test. Then a generalized estimating equation model was performed to include predictors of changes in this rate. ResultsOne hundred and ninety-nine participants were included. Seventy percent had a dysfunctional personality pattern before surgery. After surgery, this percentage dropped to 58%. The difference was statistically significant after adjusting for potential confounders (p = 0.013). The most common types were Cluster C personality patterns. Temporal epileptogenic zone was a significant predictor of higher scores of the Avoidant (Coef. 11.8; Confidence Interval (CI) −0.59 23.7; p = 0.051) and Compulsive (Coef. 9.55; CI 2.48 16.6; p = 0.008) personality patterns and lower scores of Histrionic (Coef. −11.4; CI −21.2 −1.55; p = 0.024) and Antisocial (Coef. −8.4; CI −15.6 −1.25; p = 0.022) personality patterns, compared to extratemporal epileptogenic zone. ConclusionPeople with refractory epilepsy have high rates of dysfunctional personality patterns. These patterns differ according to the epileptogenic zone.

Attraction Versus Action in Pedophilic Desire: The Role of Personality Traits and Childhood Experience.

Comparison of pedophilic individuals who do and do not refrain from sexually engaging with children may offer critically important information regarding the differential contributors to pedophilic attraction versus behavior. This study compared 5 traits that are potentially contributory to pedophilic attraction or behavior in both minor-attracted persons (MAPs) who refrain from sexually engaging with minors (nonacting MAPs) and those who have acted on pedophilic attractions and subsequently entered the criminal justice system (forensic MAPs). Subjects included 195 nonacting MAPs, 50 forensic MAPs, and 60 healthy controls. Data on nonacting MAPs were drawn from an online survey, and data on the other 2 groups were based on prior in-person evaluations. Measures included the Millon Clinical Multiaxial Inventory-II (MCMI-II), Barratt Impulsiveness Scale (BIS-11), the MAP Questionnaire, and the Sexual History Questionnaire (SHQ). Both MAP groups scored higher than healthy controls on the domains of socially inhibited personality traits, propensity toward cognitive distortions, and subjects' own childhood sexual abuse (CSA). Forensic MAPs scored higher than nonacting MAPs on the CSA domain, but the 2 MAP groups differed little on the other 2 domains. Forensic MAPs also scored higher than the other 2 groups on the antisocial domain, whereas nonacting MAPs did not differ from controls on this measure. Nonacting MAPs scored higher than controls on impulsivity. Antisocial personality traits may be a primary driver of pedophilic behavior that is unrelated to pedophilic attraction. Socially inhibited personality traits and propensity toward cognitive distortions are associated with pedophilic attraction, although the direction of causation is not clear. CSA seems to increase the risk of both attraction and behavior.

Trastornos de personalidad y juego patológico en adolescentes y jóvenes con dependencia de las máquinas tragamonedas

The object of this study was to explore the relationship between patterns of maladaptive personality and pathological gambling in a group of gamblers addicted to slot machines. The sample consisted of 120 male and female subjects divided into two groups: a group of 60 pathological gamblers aged 18 to 24 who attended the Pathological Gambling Recovery Program at the Instituto de Psicologia Integral del Peru (IPIP), and a group of 60 non-gamblers aged 18 to 24 who were psychology students of a private university in Lima. Data was obtained using the Millon Clinical Multiaxial Inventory II (MCMI-II), the Pathological Gambling Brief Questionnaire (PGBQ), and the Structured Clinical Interview for Pathological Gambling (SCI-PG). The results showed that 81,7 % of the pathological gamblers addicted to slot machines had at least one personality disorder, in comparison with the other group which yielded 40%. The most prevalent personality disorder was the self-defeating disorder, followed by the passive-aggressive, narcissistic and borderline disorders. Moreover, there are significant differences in maladaptive personality patterns between gamblers and non-gamblers according to Millon’s theory.

Personality Disorders among Individuals Sentenced to Prison: Psychiatric Comorbidity

DOI: 10.20286/ajlsr-040290 The present study aimed to comprise personality characteristics among individuals sentenced to prison and normal people. The design of study was causal- comparative. The sample included 100 men (100 prisoners, and 100 normal who were living in Tabriz city) that by considering of entry criteria’s selected by convenience sampling. Both groups matched on age, gender, marital status, social- economic status, residential area. Data were gathered by Millon Clinical Multiaxial Inventory-II (MCMI-II) and Structured Clinical Interview for DSM–IV axis II personality Disorders (SCID-II), that administered among selected samples. The results showed the clinical scale figure in both groups there was a significant difference, so that the scale of schizoid (23.85), avoidant (22.72), dependent (24.55), antisocial (36.74), aggressive-sadistic (31.74), borderline (31.86) and paranoid (26.03) significant differences were observed between the two groups. Also, the highest score in individuals sentenced to prison allocated to antisocial personality disorder. These findings have some implications; according to the results it seems considering of Antisocial Personality cues can be useful in preventive programs of crime.

A 10-year Prospective Study of Mortality among Norwegian Drug Abusers after Seeking Treatment

Background: Injecting drug users have a mortality risk between 10 and 20 times higher than the general population, and the persistent high mortality rate in most Western countries, and especially in Norway, is a major public health concern. Naturalistic, prospective studies following drug abusers over many years are needed in order to investigate the most important predictors of mortality and for planning strategic preventive measures. Methods: Four hundred and eighty-one drug abusers were followed prospectively for 10 years after admission to treatment during the period 1998-2009. Following instruments were used: the European Addiction Severity Index, Symptom Checklist-25 and Millon Clinical Multiaxial Inventory-II. Information on deaths and causes of death were obtained from the National Death Register. Cox regression analysis was used to analyze factors hypothesized to be associated with the risk of death. Results: A total of 74 deaths were registered during the observation period, which represents a mortality rate of 1.5 per 100 person-years. The main cause of death was overdose, and the relative risk of mortality among males was twice that of females. Conclusions: Fifteen percent of the drug users in the study died during the 10 years after admission to index treatment. This represents an annual mortality rate of 1.5; which is in line with most similar studies from Europe, showing a mortality rates in the range of 1-2% per year. The main cause of death was overdose (68%). Preventive strategies aiming to reduce mortality among drug users have to be manifold and gender specific, taking into account drug abusers’ life conditions, their modes of thought and how they go about living their lives.

Psychological, physical, and sexual abuse in addicted patients who undergo treatment.

This study explored the prevalence of a history as victims of abuse among patients who sought outpatient treatment for drug addiction. A sample of 252 addicted patients was assessed. Information was collected on the patients' lifetime history of abuse (psychological, physical, and/or sexual abuse), sociodemographic factors, consumption factors, psychopathological factors, and personality variables. Drug-addicted patients who present a lifelong history of abuse were compared with patients who were not abused. Of the total sample, 46% of the patients (n = 115) who were addicted to drugs had been victims of abuse. There was a statistically significant difference between the victimization rates of men (37.8%) and women (79.6%). Moreover, for some variables, significant differences were observed between patients who had been abused and those who had not. Compared with patients who had not been abused, the addicted patients with a history of victimization scored significantly higher on several European Addiction Severity Index, Millon Clinical Multiaxial Inventory-II, and maladjustment variables but not on the Symptom Checklist-90-Revised. The current results indicate that patients who present a lifelong history of abuse exhibit both a more severe addiction than patients who were not abused and several comorbidities. The implications of these results for further research and clinical practice are discussed.

Drop-out from a psychodynamic group psychotherapy outpatient unit

Background. Drop-out from psychotherapy is common and represents a considerable problem in clinical practice and research. Aim. To explore pre-treatment predictors of early and late drop-out from psychodynamic group therapy in a public outpatient unit for non-psychotic disorders in Denmark. Methods. Naturalistic design including 329 patients, the majority with mood, neurotic and personality disorders referred to 39-session group therapy. Predictors were socio-demographic and clinical variables, self-reported symptoms (Symptom Check List-90-Revised) and personality style (Millon Clinical Multiaxial Inventory-II). Drop-out was classified into early and late premature termination excluding patients who dropped out for external reasons. Results. Drop-out comprised 20.6% (68 patients) of the sample. Logistic regression revealed social functioning, vocational training, alcohol problems and antisocial behavior to be related to drop-out. However, early drop-outs had prominent agoraphobic symptoms, lower interpersonal sensitivity and compulsive personality features, and late drop-outs cognitive and somatic anxiety symptoms and antisocial personality features. Clinical and psychological variables accounted for the major part of variance in predictions of drop-out, which ranged from 15.6% to 19.5% (Nagelkerke Pseudo R-Square). Conclusion. Social functioning was consistently associated with drop-out, but personality characteristics and anxiety symptoms differentiated between early and late drop-out. Failure to discriminate between stages of premature termination may explain some of the inconsistencies in the drop-out literature. Clinical implications. Before selection of patients to time-limited psychodynamic groups, self-reported symptoms should be thoroughly considered. Patients with agoraphobic symptoms should be offered alternative treatment. Awareness of and motivation to work with interpersonal issues may be essential for compliance with group therapy.

Personality disorders and treatment drop out in the homeless.

The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist — homelessness and personality disorders — the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment.

Sintomatología prefrontal y trastornos de la personalidad en adictos a sustancias

Neuroimaging findings associate personality traits and their disorders with an altered functioning of certain areas of the brain, especially in the frontal lobe. There is a need for instruments that can be applied in clinical practice to explore these relations based on their behavioural manifestations. The sample was composed of 371 subjects with substance abuse/dependence. The Prefrontal Symptoms Inventory (PSI) and the Millon Clinical Multiaxial Inventory II (MCMI-II) were administered and diagnostic interviews were carried out to determine the existence of disorders affecting axis II (personality disorders). Criteria satisfying a diagnosis of some personality disorder were present in 43.9% of the sample. The results show a broad correlational pattern between the prefrontal symptoms scales and those of personality disorders. The variance in up to eight of the 13 scales of the MCMI-II is predicted in over 20%, based on the combination of scales from the PSI. The personality disorders diagnosed by means of a clinical interview present differential prefrontal symptomatological profiles that were consistent with what was expected. The results support the hypothesis of a relationship between the diagnosis of personality disorders and frontal malfunctioning, thus suggesting new lines for studying and approaching them in clinical practice. Such new paths could involve the use of cognitive rehabilitation to improve day-to-day functioning and modify the neurological substrates underlying personality disorders.

Personality Profiles in Abused Women Receiving Psychotherapy According to the Existence of Childhood Abuse

This study explores the personality profiles and the influence of childhood abuse on personality profiles of a group of 142 female victims of intimate partner violence (IPV) who attended a specialized, free care, public outpatient psychological care service in Spain. Characteristics of the abuse were obtained through a semi-structured interview, and personality profiles were assessed using the Millon Clinical Multiaxial Inventory-II (Millon, 1983/1999), validated for the Spanish population. Results revealed that most of the women showed elevations on the basic personality scales, especially on the Dependent, Avoidant, Self-defeating, and Compulsive scales. Women who suffered childhood abuse presented greater elevations in Avoidant, Antisocial, Passive-Aggressive, Self-defeating, and Borderline scales. The importance of studying the effects of violence in intimate relationships in order to analyze prevention and intervention strategies is discussed.

Trastornos de la personalidad en fumadores y personas con dependencia de la cocaína que acuden a tratamiento : un estudio comparativo = Personality disorders in smokers and cocaine dependent subjects who request treatment : a comparative study

The aim of this study was to assess and compare the presence of personality disorders in smokers and in subjects with cocaine dependence at the beginning of the treatment, with the use of the Spanish version of the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1997). The sample was composed of 304 subjects, 102 of them in treatment for cocaine dependence, and 202 attending a smoking cessation treatment. The results show signifi cant differences between the two groups in all personality scales, except in the dependent and the histrionic scales. We found that cocaine-dependent patients obtain higher scores than smokers in the hypomania, alcohol abuse, drug abuse, psychotic, psychotic delusion, sincerity and alteration scales. We conclude that the personality profi le of cocaine-dependent patients is signifi cantly different from the smokers’ profile.

Personality factors explain differences in alcoholic consumption among young adults

The study addresses a possible relationship between personality factors and alcoholic consumption in an age and ethnically homogenous non-clinical population of young adults. Contrasting group design in which the total population (n = 300; 201 women, 99 men; mean age 24.5 years, SD = 4.8) was split into three different drinking groups (low-middle-high) according to percentile scores of the population's total yearly alcoholic consumption. We assessed personality factors using the Millon Clinical Multiaxial Inventory-II (MCMI-II) and the Arnett Inventory of Sensation Seeking (AISS). Multivariate analyses of variance (MANOVA). Controlling for gender in multivariate ANOVAs, we found that both low and elevated scores on the schizoid and avoidant scales, elevated scores on the histrionic, the anti-social, and the anxiety and the bipolar-manic disorders scale were all linked to increased alcoholic intake. Elevated scores on the compulsive scale were linked to less drinking. The MCMI scales assessing the probability of drug and alcohol dependence and the AISS sensation-seeking scores were associated with increased drinking. These two last MCMI scales and the AISS could be used as simple screening instruments for assessment of drinking problems. The results are relevant for designing targeted prevention and early intervention programmes for reduced drinking among young adults.

The Millon Clinical Multiaxial Inventory II: Stability over Time? A Seven-Year Follow-Up Study of Substance Abusers in Treatment

Measuring personality disorders among substance abusers may entail special problems related to the reliability and validity of the instruments. The Millon Clinical Multiaxial Inventory II (MCMI-II), a well-known self-reporting instrument, was used in a prospective study of drug abusers from 21 treatment programs in Norway (n = 481) to investigate the influence of substance abuse on the reliability and stability of the MCMI personality traits at intake to treatment and after 7 years (n = 342). As regards the drug-abusing and drug-free subgroups, the MCMI-II dimensional scores were equally reliable and stable in both groups, and were not influenced by the abusing state. Using the MCMI-II in a categorical diagnostic way did not show sufficient predictive validity. The MCMI-II dimensional scores should therefore be used to measure personality disorder traits among help-seeking and former drug abusers.

Time limited psychodynamic group therapy

We explore predictors of participation in additional treatment within one year after termination of 39 sessions of psychodynamic group therapy (n=130). The sample was biased due to a 33% dropout at the one-year follow-up of symptomatic less improved treatment completers (N=194). Outcome predictors were the Symptom Check List 90 Revised (SCL-90-R), Millon Clinical Multiaxial Inventory II (MCMI-II), non-symptomatic Psychodynamic Focus, retrospective outcome evaluations, and socio-demographic and psychiatric variables.At follow-up, 57.6% of the patients had been seeking additional treatment for psychological or psychiatric problems; the percentage was 41.6%, when further treatment was defined as participating in more than 5 sessions. The majority (94.8%) was treated within the public health services.Participation in additional treatment was predicted by improvement on the MCMI Antisocial personality disorder scale and a higher SCL-90-R Somatization end-state score. When additional treatment was defined as receiving more than 5 sessions, lack of paid work before treatment (odds ratio 8.0), lack of social network support (odds ratio 2.9), and the Antisocial pre- post difference score (odds ratio 1.6) were significant predictors explaining a total of 26.4% variance. Neither SCL-90-R Global Severity Index (GSI) reliable and clinically significant improvement, therapist recommendations of further therapy, nor socio-demographic, psychiatric and treatment outcome variables were significantly associated with seeking additional treatment.Even though we identified only a small number of predictors for participation in further treatment, our study nevertheless points to the importance of employing reliable and validated methods in the evaluation of treatment outcome and further treatment planning.

P01-159 Autoantibodies in bipolar and cluster B personality disorders

Prevalence of depression and other common psychiatric disorders in autoimmune diseases has been extensively documented. The association between subclinical autoimmunity and behavioural or psychiatric syndromes remains less studied. The best known example is raised titres of autoantibodies with high affinity for the basal ganglia in some obsessive compulsive spectrum syndromes (e.g. Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The possible role of autoimmunity in impulse control disorders remains understudied.We proposed to study the relation between autoimmunity, affective bipolarity and impulsive psicopathology.Methods:14 bipolar, 10 cluster B personality disorder inpatients. Titres for rheumatoid factor (RA), antithyroglobulin (ATG), antiperoxidase (APO) antinuclear (ANA), anti-neutrophil cytoplasmic (ANCA) and antistreptolysin (ASO) antibodies were measured in all subjects. Psychiatric assessment: non-structured psychiatric interview, MINI International Neuropsychiatric Interview and Millon Clinical Multiaxial Inventory-II.Results:21,4% of bipolar patients had positive ATG titre vs 11,1% in the cluster B personality group. 28,6% of bipolar patients had positive APO titre vs 22,2% in the cluster B personality group. 16,7% of bipolar patients had positive ASO titre vs 30,0% in the cluster B personality group. None of this differences reached significance.ASO titre correlated significantly with antisocial (rho=0,435, p=0,043) and autodestructive (rho=0,461, p=0,031) ratings and almost significantly with borderline (rho=0,420, p=0,052) ratings.Conclusions:The results obtained partly agree with the existing studies. As far as we know a possible correlation between ASOs and impulsive behaviour has not been previously described. The results obtained call for further investigation in the subject.

P03-72 Utility of personality measurement in the recovery from surgery

Objectives:The aim of this study was to asses the impact of different psychological and/or biological effects in the recovery from surgery.Methods:The sample was composed of 42 patients waiting for a surgical intervention. Patients with cognitive impairment were removed from the sample. Prior to surgical intervention (48 to 72 hours), patients were administered the Millon Clinical Multiaxial Inventory-II (Millon, 1986) and salivary cortisol were measured 24 hours before surgery. Following surgical intervention, recovery was coded as good or poor accordingly to Moix et als criteria (1995). Dietary intake, resting and sleeping hours, as well as the existence of fever, perceived pain and related surgery complications were daily registered and controlled for.Results:The cortisol values were increased in patients with high score in Histrionic Scale (t = 2.10, p = 0.043). There was a significant relation between personality, cortisol and recovery. the patients with low score in Dependent Scale (t = 2.33, p = 0.029), Histrionic Scale ( t = 2.51, p = 0.020), Alcohol Dependence Scale (t = 2.01, p = 0.049), Drug Dependence Scale (t = 2.08, p = 0.050) and cortisol show better recovery from surgery.Conclusion:The results of this study indicate that psychological factors and levels of cortisol may have a critical rol in post-operatory recovery. Taking these data into account, it seems necessary to assess psychopathology on a regular basis in all the patients waiting for surgically interventions.

Personality and Coping in Young Inmates: A Cluster Typology

Objective: Firstly, to identify groups of inmates according to personality. Secondly, to differentiate types of personality through coping strategies, psychopathology, criminal records and social factors. Method: A cross-sectional design was used to study psychosocial, correctional, personality and clinical characteristics in inmates. The group was composed of 106 male inmates. The measures used to evaluate personality, clinical and psychosocial variables were a standard protocol and three self-report questionnaires: the Millon Clinical Multiaxial Inventory-II, the Minnesota Multiphasic Personality Inventory-2 and the Coping Responses Inventory-Adult Form. A cluster analysis, ANOVA and Kruskall-Wallis test were conducted. Results: Four clusters were identified. The secondary type was characterized by an impulsive, suspicious, hostile personality, by anxiety, a low tolerance of frustration, and by the use of cognitive avoidance coping. The controlled-healthy type showed a less pathological and more self-controlled personality. The primarytype was similar to secondary, but with lower tendency to impulsivity. The inhibited-affected type was shown to have an avoidant personality, greater tendency to symptomatology and also to use acceptance-resignation and emotional discharge coping. Conclusion: The four groups of young inmates identified showed profiles with different degrees of psychopathological risk and also different coping profiles.

Substance Abuse Problems, Psychiatric Symptoms, and Post-Treatment Status in MCMI Psychopathology Subgroups of Cocaine Dependent Males

This study involved cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records of 304 cocaine dependent males and examined differences among personality-based clusters in medical, legal, employment, drug, alcohol, family, and psychiatric problem severity at treatment intake and in outcome status during the 12 months after completion of residential drug treatment. A hierarchical cluster analysis (Ward's method) was used to identify 4 cluster subgroups: antisocial, subclinical, neurotic, and high psychopathology. MANOVA revealed that membership in Neurotic and High Psychopathology Cluster subgroups was linked with more severe family and psychiatric problems at treatment intake than found in the Subclinical Cluster Subgroup (all ps <. 05). The High Psychopathology Cluster Subgroup also had more severe drug problems at intake than did the Subclinical Subgroup (p <. 05). Logistic regression analysis revealed that membership in the High Psychopathology Subgroup predicted relapse/loss to follow-up status after controlling for age, education, ethnicity, treatment program attended, and pretreatment cocaine use frequency (X2 = 21.25, df = 3, p <. 001).

Treatment of Depressive Symptoms in Adult Survivors of Childhood Trauma

ABSTRACT This study examined differences in depression symptoms between four Personality Disorder (PD) groups in 123 adult survivors of abuse who completed a 6-week inpatient program for Post-traumatic Stress Disorder (PTSD). Data were collected at admission, discharge, 3-months, and 1-year post-treatment. Participants completed self-report measures at each time point. Based on Millon Clinical Multiaxial Inventory-II scores, participants were divided into four PD groups: avoidant, borderline, dependent, and histrionic. MANOVAs and ANOVAs were calculated to examine depression symptoms over time. Depression and hopelessness symptoms decreased post-treatment, and treatment gains were maintained at 1-year. Multiple regressions were calculated to determine which PD trait was the best predictor of response to treatment for depression. High dependent PD traits were the only significant predictor of lowered depression symptoms.

Comorbidity of alcohol dependence and personality disorders: A comparative study

To describe the frequency and profile of personality disorders related to alcohol dependence, and to compare them with non-addictive disorders and with normal population. In this cross-sectional clinical-epidemiological study, using the International Personality Disorder Examination and the Millon Clinical Multiaxial Inventory-II for personality disorders, 158 consecutively recruited alcohol-dependent patients attending a psychiatric outpatient clinic were compared with 120 consecutively recruited psychiatric patients with non-addictive disorders, and 103 subjects from the general population chosen to match the patient samples for age, gender and socioeconomic level. Of the alcohol-dependent patients, 44.3%, and of the general clinical sample, 21.7% (vs 6.8% of the normative sample) showed at least one personality disorder. Obsessive-compulsive personality disorders were most prevalent (12%), followed by antisocial, paranoid and dependent personality disorders (7% each). Most of them showed only one personality disorder.