Millon Clinical Multiaxial Inventory Research Articles

Attitudes Toward Cardiovascular Disease Risk Factors Among Patients Referred to a Cardiac Rehabilitation Center: Importance of Psychological Attitudes

Background: Patients’ understanding of heart diseases and their related experiences can affect education and prevention of coronary heart diseases. As the patients’ beliefs play a crucial role in the development of effective therapeutic relationship, psychological adjustment, and compliance with treatment recommendations. Objectives: The purpose of this study was to investigate the attitudes toward psychological risk factors for cardiovascular disease among patients referred to a cardiac rehabilitation center in Imam Ali Hospital in Kermanshah, Iran. Patients and Methods: This cross-sectional study was performed on 775 patients referred to a cardiac rehabilitation unit in Imam Ali hospital in Kermanshah, Iran. Data were collected using clinical interview, patients’ medical records, and Millon clinical multiaxial inventory (MCMI-III), and analyzed by descriptive statistics, including mean, standard deviation, and chi‐square test. Statistical analyses were performed using SPSS software version 18. Results: The patients believed that the main cause of their illness is behavioral risk factors (42.0). Then, they referred to psychological (36.3), biological (4.3), and environmental (3.8) factors, respectively. 10.4 of the patients were not aware of the cause of their illness. Also, stress is the most important factor among the psychological factors (27.5). The results showed that there was a significant difference among the patients in term of four attitudes (χ2 = 820.356; P < 0.01); and behavioral and psychological attitudes (χ2= 6.025; P < 0.05). In fact, the patients identified behavioral problems as the main cause of their illness. Conclusions: According to the patients’ attitudes, after the behavioral factors, psychological factors are the second cause of heart diseases. Therefore, ignoring these factors by members of the medical teams may lead to a poor performance of the treatments. As these factors are controllable, learning to control and manage them can prevent the development of subsequent cardiovascular events. © 2015, Shiraz University of Medical Sciences.

Evolution of the Millon Clinical Multiaxial Inventory

Dr. Theodore Millon (1928–2014) was a primary architect for the personality disorders in the DSM–III, a structure that has endured into the DSM–5. His 1969 book, Modern Psychopathology, created an elegant framework into which the well-known personality prototypes could be fitted and understood. His theoretical work soon led into the creation of several psychological inventories, most notably the Millon Clinical Multiaxial Inventory (MCMI). The MCMI, now in preparation for its 4th major edition, has been a very popular instrument among clinicians. This article explores the history of the MCMI's development from its origins, through 2 distinct theoretical phases, and to its current status as the MCMI–IV is finalized.

Personality Disorders, Narcotics, and Stimulants; Relationship in Iranian Male Substance Dependents Population.

Background:Individuals with certain personality disorders, especially the antisocial and borderline personality disorders, are more prone to substance use disorders.Objectives:Regarding the importance of substance use disorders, this study aimed to explore the association between personality disorders and types of used drugs (narcotics and stimulants) in Iranian male substance users.Patients and Methods:The current study was a correlation study. We evaluated 285 male substance users and excluded 25 according to exclusion criteria. A total of 130 narcotic users and 130 stimulant users were recruited randomly in several phases from January 2013 to October 2013. All participants were referred to Substance Dependency Treatment Clinics in Tehran, Iran. Data collection process was accomplished by means of clinical interview based on DSM-V criteria for substance use disorders, Iranian version of addiction severity index (ASI), and Millon clinical multi-axial inventory-III (MCMI-III). Data were analyzed by SPSS 21 using Pearson correlation coefficient and regression, the.Results:There was a significant correlation between stimulant use and histrionic personality disorder (P < 0.001) and antisocial and narcissistic personality disorders (P < 0.05). In addition, correlation between avoidant, histrionic, and narcissistic personality disorders (P < 0.05) and depressed, antisocial, and borderline personality disorders (P < 0.001) with narcotics consumption were significant. In clusters, there was a significant correlation between cluster B personality disorders, and narcotic and stimulants consumption (P < 0.001). In addition, this association was explored between cluster C personality disorder and narcotics (P < 0.001).Conclusions:The results of this study in terms of personality disorders and types of used drugs were in accordance with the previous studies results. It is necessary to design appropriate treatment plans for medical treatment of those with personality disorders.

SENTIMIENTO Y AFECTO

Se explora la relación de la función sentimiento (Jung, 1921; Millon, 2001), con el afecto positivo y negativo (Watson et al. 1988), y las metas motivacionales expansión -preservación (Millon, 2001), en una muestra de estudiantes universitarios (n=200). La función sentimiento y la expansión - preservación se estudia a través del Inventario de Estilos de Personalidad [MIPS] (Millon, 2001) y el afecto positivo y negativo a través de la Escala de Afecto Positivo y Negativo [PANAS] (Watson, Clark &amp; Tellegen, 1988), siendo la presente investigación parte de su traducción y adaptación para Uruguay. Los resultados obtenidos muestran que existe una correlación inversa entre la función sentimiento y el afecto positivo, no encontrándose correlación con afecto negativo y tampoco con expansión y preservación.

A Preliminary Investigation of Abnormal Personality Traits in MS Using the MCMI-III

Neuropsychiatric abnormalities are frequently reported in patients with multiple sclerosis (MS). Previous studies have investigated the neurotic aspects of psychopathology, and the importance of the personality structure underlying neurotic symptoms has only recently been reconsidered. The aim of our study was to investigate the frequency and type of personality profiles in MS using the Millon Clinical Multiaxial Inventory-III (MCMI-III). We evaluated 77 nondemented patients with MS using physical disability scales and self-report questionnaires focused on mood, fatigue, and personality. In our cohort study, we found a personality scale score greater than 85 in 62.3% of enrolled participants. In particular, high scores on the Histrionic and Narcissistic scales emerged, respectively, in 20.8% and 15.6% of the sample. The presence of moderate abnormal elevation scores in MCMI personality scales in MS does not seem to be influenced by age, the Expanded Disability Status Scale score, disease course, or disease duration. Our research study focused on the importance of identifying personality maladaptation in patients with MS.

An Examination of Psychopathology Among Men who have Suspended the Use of Violence in Their Intimate Relationships

It is well established that personality pathology has been associated with the onset and continued perpetration of intimate partner violence, yet if and how this relates to the cessation of such behaviours remains unclear. The aim of this study was to determine whether personality pathology differentiated 37 intimate partner violent men who had suspended the use of violence against their intimates (‘desisters’), 50 persisters, and 49 non-violent controls using the Millon Clinical Multiaxial Inventory-III subscales. Cluster A and Cluster B disorders at a diagnostic level were more often reported in men who had used violence against intimates compared to men in the control group. The rates and percentages of clinically meaningful traits and disorders were lower for the desisters than the persisters, with the desisters more like the controls than the persisters. The findings suggest that the initial stage of the desistance process may be related to personality pathology.

Psychodiagnostic Assessment of Pathological Gamblers: A Focus on Personality Disorders, Clinical Syndromes and Alexithymia

Comorbid psychopathological syndromes are common in pathological gamblers (PGs), but the contribution of alexithymia, as a disorder of affect regulation, has not been fully explored yet. This study sought to examine the association between personality disorders, clinical syndromes and alexithymia levels in a group of PGs and to highlight a relationship between gambling behaviour and alexithymia scores, apart from the relationship between other disorders and gambling behaviour. Psychological assessment included the South Oaks Gambling Screen, Millon Clinical Multiaxial Inventory (MCMI-III) and Toronto Alexithymia Scale (TAS-20) performed on 70 treatment seeking PGs and 70 healthy controls. Statistical analysis on the results shows a greater presence of mental disorders in PGs together with alterations in emotional processing. Moreover, a significant contribution of alexithymia in predicting gambling behaviour has been revealed. In conclusion, even though the assessment of personality disorders and clinical syndromes in PGs should be considered as an essential diagnostical step, alexithymia must be regarded as a relevant psychological feature, in order to produce the most accurate diagnosis available and select the correct therapeutical choice.

Emotion Dysregulation and Psychopathology: the Case of Personality Disorders Not Otherwise Specified

Introduction Emotion dysregulation and impulsivity are considered an hallmark of personality pathology (Livesley & Jang, 2000), even though research has mainly regarded Borderline Personality Disorder (BPD; e.g., Linehan, 1993). Recently, some scholars proposed that facets of emotion dysregulation and impulsivity are likely to be associated with different PD traits across all clusters (Garofalo et al., 2014; Sarkar & Adshead, 2006), highlighting significant association with all PDs included in the DSM-5 (APA, 2013). Objectives We sought to expand extant research exploring whether also PDs not included in the DSM nosography, yet clinically relevant and suggested for future research, were associated with facets of emotion dysregulation. Aims In a community sample, we tested the unique associations between facets of emotion dysregulation and impulsivity with traits of 3 PDs Not Otherwise Specified: Sadistic PD, Depressive PD, and Passive-aggressive PD. Methods We recruited 399 community-dwelling participants (mean age= 37.91; 56.6% male). They were administered the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), the Barratt Impulsiveness Scale (BIS-11, Patton et al., 1995) and the Millon Clinical Multiaxial Inventory (MCMI-III; Millon, 2006). Results Multiple regression analyses showed that different facets of emotion dysregulation were associated with all PD traits considered. Further, impulsivity accounted for a significant amount of additional variance in Sadistic and Passive-aggressive features above and beyond emotion dysregulation. Conclusions Emotion dysregulation and impulsivity seemed to confirm their role as relevant features of personality pathology across different forms of PDs.

Examining the psychopathology of incarcerated male firesetters using the Millon Clinical Multiaxial Inventory-III

Research to date has been equivocal on the relationship between firesetting and psychopathology and has been impeded by studies lacking adequate control samples. The present study examined psychopathology in a sample of incarcerated adult male firesetters (n = 112) and prison controls (n = 113) using the Millon Clinical Multiaxial Inventory-III. Firesetters demonstrated multiple elevated scores on personality and clinical syndrome scales. Logistic regression showed that the borderline personality scale was the strongest personality scale discriminator between firesetters and controls. Major depression and drug dependence were the strongest clinical syndrome scale predictors. However, both clinical syndrome scale predictors appeared to be mediated by borderline personality scores indicating that firesetters are best characterized by responding indicative of borderline personality traits rather than other psychopathological deficits. The results suggest that, relative to other offenders, firesetters face challenges with impulse control, affect regulation, stability of interpersonal relationships, and self-image.

Analysis of Clinical Data From Cognitive Diagnosis Modeling Framework

We propose a general cognitive diagnosis model framework to diagnose mental disorders using item scores obtained from clinical measurement instruments. This framework can be used to validate the extent to which the items measure the specific disorders. The method is illustrated using data obtained with the Dutch version of Millon Clinical Multiaxial Inventory-III.

Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence.

Aim:To assess personality disorder (PD), emotional intelligence (EI), and locus of control of alcohol dependent (AD) patients and its comparison with normal controls.Materials and Methods:Based on purposive sampling technique, 33 AD patients were selected from the De-Addiction Ward of Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) and 33 matched normal subjects were selected from Ranchi and nearby places. Both the groups were matched on various sociodemographic parameters, that is, age, gender, and socioeconomic level. All participants were assessed with Millon Clinical Multiaxial Inventory-III, Mangal EI Inventory, and Locus of Control scale. Obtained responses were scored by using standard scoring procedures and subsequently statistically analyzed by using Chi-square test.Results:AD patients have more comorbid pathological personality traits and disorders in comparison to their normal counterparts. Depressive, narcissistic, and paranoid PDs were prominent among AD group; followed by schizotypal, antisocial, negativistic, dependent, schizoid, sadistic, masochistic, and borderline PD. In comparison to normal participants, AD patients were significantly deficient in almost all the areas of EI and their locus of control was externally oriented.Conclusion:Patients with AD have significantly higher PDs, low EI, and an external orientation on the locus of control. Identification and management of these comorbid conditions are likely to improve the management and outcome of AD.

Personality Disorders in Motorcycle Injuries: a Case- control Study in Tabriz

Purpose: The aim of the present study was to compare personality characteristics between injured and uninjured motorcyclists. Methods: This study as part of a larger case-control study was carried out on 130 motorcycle traumatic patients along with 91 control patients admitted to Shohada and Imam Reza university hospitals as the two referral specialty centers in East Azarbyjan Province of Iran in 2013. The Persian version of the motorcycle Riding behavior questionnaire (MRBQ) was used to assess riding behavior. Also, Millon Clinical Multiaxial Inventory-III was used to assess personality disorders and psychiatric syndromes. Multivariate binary logistic regression was used as the main analysis method to estimate the adjusted odds ratios of the subscales of Millon-III and risky behavior scales. The statistical analysis was conducted using Stata version 11 statistical software package. Results: Mean/median scores of the personality subscales of schizoid, alienated, obsessive-compulsive, self-abusing, schizotypal, paranoid, post-traumatic stress, thought disorders, major depression, delusional disorder in the injured group were higher than in the control group (P<0.05). However, histrionic personality disorder was observed less in the injured group than the control group (P <0.01). According to the logistic regression models obsessive-compulsive and paranoid disorders were considered to be risk factors in motorcycle injuries. Conclusion: According to the results of this study, obsessive-compulsive personality was a risk factor for motorcycle traffic injuries.

One of early maladaptive schemas' causal relationship through metacognitive beliefs with borderline and antisocial personality patterns.

Introduction:This study aimed at determining the causal relationship of metacognitive beliefs as a mediator between one of early maladaptive schemas including (emotional deprivation, abandonment, mistrust/abuse, social isolation/alienation and defectiveness/shame) and borderline and antisocial personality patterns.Materials and Methods:The study type has been relational and seeking causal modeling of path analysis has been used. The population used in this study included outpatients in counseling, psychological and psychiatric centers in 2012–2013. We randomly distributed 350 questionnaires in five centers out of three parts in Isfahan, and finally 230 valid questionnaires were evaluated and analyzed. Data collection tool has been Millon Clinical Multiaxial Inventory-III's (MCMI-III's) personality questionnaire, Yang's schema questionnaire (75 items), Metacognition Questionnaire-30 (30 items). Reliability of the Yang's Schema Questionnaire in this study was calculated by Cronbach's alpha (α =96%), and that of metacognition was calculated the same way (α =87%). Data analysis has been done using MCMI-III's software for Millon's personality questionnaire, and SPSS-16 and AMOS-18 software. We used path analysis method for testing each model in statistical data analysis.Result:The results of this study suggest a possible causal relationship between the number of one of the early maladaptive schemas and the patterns of anti-social and borderline personalities through some metacognitive beliefs.Conclusion:This study showed that cognitive beliefs can be activators of the early schema and continuation's coping behaviors in personality patterns.

Personality and psychiatric disorders in women affected by polycystic ovary syndrome.

Background: Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder among fertile women. Studies show reduced quality of life, anxiety, depression, body dissatisfaction, eating disorder, and sexual dysfunction, but the etiology of these disturbs remains still debated. The aim of our study is to verify whether this hyperandrogenic syndrome characterizes a strong psycho(patho)logical personality.Method: Sixty PCOS subjects (mean age 25.8 ± 4.7 years) were evaluated by anthropometric, metabolic, hormonal, clinical, and psychological parameters. After the certainty of the diagnosis of PCOS, the Rorschach test, according to Exner’s comprehensive system (CS) and the Millon Clinical Multiaxial Inventory-III (MCMI-III) were administered to each patient. The control group, on which the comparison was carried out, was composed by 40 healthy and aged compared women who were exclusively administered the Rorschach test according to CS.Results: MCMI-III evidenced axis II DSM-IV personality disorders [4.1% schizoid, depressive, sadistic, negativistic (passive–aggressive), and masochistic, 6.1% avoiding, 12.2% dependent, 20.4% histrionic, 16.3% narcissistic, 2.0% obsessive–compulsive], and axis I DSM-IV psychiatric disorders: 10.2% anxiety, 2.0% somatoform disorder and bipolar disorder, 16.3% major depressive disorder. Finally, we found 44.9% delusional disorder and 4.1% thought disorder. Rorschach test’s results show 53.1% reduced coping abilities and social skills, 55.1% depression, 30.6% perceptual distortion and cognitive slippage, 24.5% constantly alert and worry, 8.1% at risk for suicide, and finally about 50% of our patients had chronic stress.Conclusion: PCOS women have relevant personality and psychiatric disorders, when compared with normal subjects.

Personality characteristics of patients seeking cosmetic rhinoplasty.

Rhinoplasty is one of the most common cosmetic surgeries performed on the face. Cosmetic surgery is performed not only to change the appearance, level of satisfaction, and self-confidence of the patient, it may also reflect specific personality patterns. The goal of this study was to investigate the personality characteristics of individuals seeking cosmetic rhinoplasty. Thirty patients referred for rhinoplasty and 30 healthy age- and gender-matched controls were enrolled in this case-control study. All participants filled out the Millon Clinical Multiaxial Inventory 3rd edition and the data were analyzed using ANOVA and Fisher's exact test. Twenty-four (80 %) females and 6 (20 %) males were evaluated. Dependent, histrionic, and narcissistic personality disorders were seen in 2, 3, and 8 patients in the case group, respectively. The number of individuals with narcissistic personality traits was significantly higher in the case group than in the control group (p < 0.001). Narcissism is the most common psychological trait that motivates patients to seek a rhinoplasty. Personality disorders are not very common among individuals seeking rhinoplasty in Iran. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Characterising the psychiatric comorbidities among adults with ADHD who have a history of offending

The prevalence of attention deficit hyperactivity disorder (ADHD) among adult offenders is significantly higher than in the general population. Adults with ADHD often present with multiple psychiatric comorbidities. This study aims to characterise the comorbidities presented by adults with ADHD who have offended and also to investigate predictors of offending among this population. Seventy-three participants with a diagnosis of adult ADHD were divided into a group with a history of offending behaviour (n = 30) and a group of non-offenders (n = 43). Groups were compared on measures of ADHD symptoms, substance use and DSM-IV Axis I and Axis II disorders using the Millon Clinical Multiaxial Inventory – 3rd Edition. Major depression, cannabis use and childhood hyperactivity-impulsivity symptoms predicted offending. These findings indicate that adults with ADHD who have a history of offending behaviour are more likely to present with complex psychiatric needs.

Brain fluorodeoxyglucose PET in adrenoleukodystrophy.

To investigate the cerebral glucose metabolism in subjects with X-linked adrenoleukodystrophy (X-ALD) by using brain [(18)F]-fluorodeoxyglucose PET (FDG-PET). Cross-sectional study in which 12 adults with various forms of X-ALD underwent clinical evaluation and brain MRI, followed by brain FDG-PET, neuropsychological assessment, and personality and psychopathology evaluation using the Symptom Checkist-90-Revised (SCL-90-R) and the Millon Clinical Multiaxial Inventory-III (MCMI-III). When compared to healthy control subjects (n = 27) by using Statistical Parametric Mapping 8 software, the patients with X-ALD-with or without brain MRI changes-showed a pattern of increased glucose metabolism in frontal lobes and reduced glucose metabolism in cerebellum and temporal lobe areas. On single case analysis by Scenium software, we found a similar pattern, with significant (p < 0.02) correlation between the degree of hypermetabolism in the frontal lobes of each patient and the corresponding X-ALD clinical scores. With respect to personality, we found that patients with X-ALD usually present with an obsessive-compulsive personality disorder on the MCMI-III, with significant (p < 0.05) correlation between glucose uptake in ventral striatum and severity of score on the obsessive-compulsive subscale. We examined cerebral glucose metabolism using FDG-PET in a cohort of patients with X-ALD and provided definite evidence that in X-ALD the analysis of brain glucose metabolism reveals abnormalities independent from morphologic and signal changes detected by MRI and related to clinical severity. Brain FDG-PET may be a useful neuroimaging technique for the characterization of X-ALD and possibly other leukodystrophies.

Predictive effect of injunctions on personality disorders in dysfunctional Catholic priests and religious sisters: a study using Millon's model and Transactional Analysis

The purpose of this study is to investigate the preference of different sets of injunctions – as measured by the Espero Questionnaire – in the Millon Clinical Multiaxial Inventory-III (MCMI-III) psychopathology cluster subgroups in a sample of Catholic priests and religious sisters who had voluntarily sought therapy. A hierarchical agglomerative cluster analysis was employed to identify high (n = 21), moderate (n = 32), and low (n = 38) MCMI-III psychopathology cluster subgroups. Members of the low psychopathology subgroup demonstrated a significantly lower numerical set of injunctions than high and moderate psychopathology subgroups. The high psychopathology subgroup reported a greater number of negative injunctions than the moderate psychopathology subgroup. The results suggest that priests and religious sisters who present fewer negative injunctions – those belonging to the low psychopathology subgroup – are generally well adjusted and socially skilled. Those who present more negative injunctions – those belonging to the high psychopathology subgroup – are more at risk for pathological tendencies.

Profile of Addicted Patients Who Reenter Treatment Programs

ABSTRACT. Background: Clinical experience shows that some patients who suffer from drug addiction are readmitted to treatment programs multiple times because of relapses that occur after they leave these programs. Patients who reenter treatment programs repeatedly may do so because they have problems or difficulties that were not addressed or that were not satisfactorily solved during previous treatment periods. This study explored the differential profile of addicted patients who reenter treatment programs. Methods: A sample of 252 addicted patients (203 male and 49 female) who sought outpatient treatment was assessed. Data regarding sociodemographic factors, drug consumption factors (assessed using the EuropASI), psychopathological factors (assessed using the Symptom Checklist-90—Revised [SCL-90-R]), and personality variables (assessed using the Millon Clinical Multiaxial Inventory II [MCMI-II]) were collected. Results: A 65.9% (n = 166) of drug-addicted patients were readmitted into treatment programs. All of the variables for which data were collected were compared between these treatment repeaters and patients who were admitted for the first time. Significant differences between the 2 groups of patients were found for some of the variables that we examined. Treatment repeaters were generally older and had a poorer employment situation than first-time admits. Treatment repeaters were also more likely to report polyconsumption and to have sought treatment for alcohol abuse. Moreover, some of the scores for several EuropASI, SCL-90-R, and MCMI-II variables were statistically significantly different from those of the first-time admits. Conclusions: According to these results, patients who reenter treatment programs often present with more severe addiction problems. All of these data suggest that treatment programs should incorporate a detailed analysis regarding the existence and nature of prior treatments into the baseline protocols and they should offer follow-up services to patients who have completed their treatments. The implications of these results for further research and clinical practice are discussed.

An Examination of Positive Impression Management Validity Scales in the Context of Parenting Capacity Assessments

Although professionals conducting parenting capacity assessments (PCAs) frequently rely on test validity scales to measure parental efforts at social desirability, very limited data is available on their performance. The current study found strong concurrent validity between the Personality Assessment Inventory (PAI) and Millon Clinical Multiaxial Inventory-III (MCMI-III) validity scales. Results were also consistent with previous studies that suggest parents engage in some level of impression management. However, the PAI appeared to identify far fewer parents as engaging in positive impression management when compared to the MCMI-III or what has been published in previous studies on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Future directions and recommendations regarding the use of validity scales in PCAs are provided.