Restructured Clinical Research Articles

Viewing the MMPI–2–RF Structure Through the Personality Psychopathology Five (PSY–5) Lens

Ben-Porath and Tellegen (2008) recommend organizing MMPI–2–RF scale interpretive information around 3 broad topics, emotional/internalizing dysfunction, thought dysfunction, and externalizing/behavioral dysfunction, and 3 additional topics labeled somatic complaints, interpersonal functioning, and interests. That organization is based primarily on structural analyses of the Restructured Clinical (RC) scales. This study reviewed the MMPI–2–RF's scale structure when the Personality Psychopathology Five (PSY–5) scales are included. Principal axis factor analyses with oblique rotation were conducted on the Restructured Clinical, PSY–5, and Special Problem (SP) scales in 2 samples, by gender. One sample was an outpatient community health center, the other a large, metropolitan inpatient psychiatric facility. The 6-factor solution evidenced each of the PSY–5 constructs plus a general somatic concerns factor. Implications of this solution in comparison to the 3-factor organizing structure recommended by Ben-Porath and Tellegen are discussed.

The MMPI-2-Restructured Form and the Standard MMPI-2 Clinical Scales in Relation to DSM-IV

In a Dutch sample of psychiatric outpatients (N = 94), we linked the Minnesota Multiphasic Personality Inventory–2 (MMPI-2; Butcher et al., 2001) Clinical scales and MMPI-2-Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) Higher-Order (H-O) scales, Restructured Clinical (RC) scales and Specific Problem scales to the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 4th ed.; American Psychiatric Association, 1994) by First, Spitzer, Gibbon, and Williams (1995). Overall, the H-O scales, RC scales, and Specific Problem scales display meaningful relationships to Axis I and Axis II disorders conceptualized by the DSM-IV. In addition, the RC scales demonstrate a moderate improvement in validity over the standard Clinical scales. Theoretical and clinical implications are considered.

Predictive Validity of the MMPI-2 Clinical, PSY-5, and RC Scales for Therapy Disruptive Behavior

Impulsive acts, parasuicidal behavior, and other therapy disruptive incidents occur frequently in the treatment of patients with personality disorders and increase the risk that patients will drop out of treatment. This study examined the predictive validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 Restructured Clinical (RC) and Psychopathology Five (PSY-5) Scales for therapy disruptive behavior and compared them with the original clinical scales. Using an inventory, the treatment staff recorded the therapy disruptive behavior of 104 patients with personality disorders who were receiving inpatient psychotherapy. Both the RC and the PSY-5 scales predicted several categories of therapy disruptive behavior, and both scales predicted more categories of therapy disruptive behavior than the original clinical scales. Anger outbursts were predicted especially well by a combination of two of the RC scales. The information about the MMPI-2 obtained in this study may be helpful in case formulation when initiating inpatient treatment for patients with personality disorders.

The RC scales predict psychotherapy outcomes: The predictive validity of the MMPI‐2's restructured clinical scales for psychotherapeutic outcomes

ABSTRACTThis study investigated the capacity of the Minnesota Multiphasic Personality Inventory's (MMPI‐2) restructured clinical (RC) scales to predict treatment outcomes of inpatient psychotherapy concerning long‐term changes in the level of psychopathology for patients with personality disorders. The predictive capacity of the RC scales is compared with that of the clinical scales. The MMPI‐2 was administered at baseline. We followed up 179 patients for 36 months. The Brief Symptom Inventory measured the symptom changes between baseline and the end of the treatment as well as between baseline and 36 months. The RC2 (Low Positive Emotions) scale and RC8 (Aberrant Experiences) scale predicted lower levels of symptomatic improvements at 36 months. These scales did not have a significantly better performance than the original clinical scales. The RC2 and the 2(Depression) scale of the clinical scales predicted less improvement at 36 months. These findings emphasize that the RC scales should not be used alone or as a replacement for the clinical scales. Copyright © 2012 John Wiley & Sons, Ltd.

Spirituality and the MMPI-2 Restructured Clinical Scales

The present investigation examined the relation between spirituality, measured by the Expressions of Spirituality Inventory (ESI; MacDonald, 2000); and the Minnesota Multiphasic Personality Inventory-2 Restructured Clinical (MMPI-2 RC) scales (Tellegen et al., 2003) using data from a previously published study (i.e., MacDonald & Holland, 2003). Zero-order, multiple, and partial correlations were calculated to explore the association. All multiple correlations, wherein the five ESI dimensions were used collectively to predict MMPI-2 RC scales, emerged significant for all MMPI-2 RC scales. For zero-order correlations, all RC scales were found to have a significant relation with at least one ESI dimension. Existential Well-Being (EWB) was found to be significantly negatively associated with all MMPI-2 RC scales except RC9-Hypomanic Activation. When compared to correlations between the ESI and the MMPI-2 Basic Clinical Scales, the RC scales seem to produce a similar pattern of coefficients but of lower magnitude. The study concludes with a discussion of the findings, limitations, and suggestions for clinical practice and future research.

Comparability of the MMPI-2 and PAI in third party reproduction psychological evaluation

To investigate the comparability of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Personality Assessment Inventory's (PAI) validity, clinical, and personality subscales in a sample of gestational carrier (GC) applicants. Retrospective review of GC applicant psychological testing from 2009-2011. De-identified MMPI-2 and PAI subscale scores from N = 16 GC applicants. All mean scale scores on the clinical, validity, and personality scales of the measures were within normal limits. Further, no clinical scale scores were elevated above T = 64 on the Restructured Clinical (RC) Scales of the MMPI-2 or the PAI. Elevations above T = 64 on MMPI-2 Clinical Scales 1 (Hs), 3 (Hy) and 9 (Ma) were found. Scores on two matching PAI (i.e., PIM, T = 62.25; and DEF, T = 64.06) and MMPI-2 (i.e., L, T = 60.93; and K, T = 63.38) validity scales were more than one standard deviation above the mean. Large correlations were found between PIM and L (r = .65) and multiple other PAI and MMPI-2 clinical and personality scales (e.g., PAI-SOM and RC1, r = .70; PAI-MAN and Clinical Scale 9, r = .62). There was no statistical difference between the number of PAI and MMPI-2 profiles with elevated validity scale scores. Finally, of the applicants who were not accepted into the GC program for psychological reasons, all profiles had validity and/or clinical scale score elevations on both measures. The MMPI-2 and PAI are two measures often utilized independently to assess response style and psychological symptomatology in GC applicants. A comparison of the measures did not find the expected relationships among all matching scales of the PAI and MMPI-2. However, the measures appear to consistently identify invalid responding. Use of both measures could provide greater understanding of applicant response style and symptomatology; however, the increased cost and time commitment may be prohibitive. The results of this study suggest that use of either measure alone is acceptable.

Examining the Impact of Unscorable Item Responses on the Validity and Interpretability of MMPI-2/MMPI-2-RF Restructured Clinical (RC) Scale Scores

This article examined the impact of unscorable item responses on the psychometric validity and practical interpretability of scores on the Restructured Clinical (RC) Scales of the Minnesota Multiphasic Personality Inventory-2/Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2/MMPI-2-RF). In analyses conducted with five archival samples, we found that relatively large proportions of unscorable responses (defined as 10% or more of the items scored on a scale) were relatively uncommon, occurring most often in forensic samples. Simulated unscorable responses were inserted in varying proportions (10% to 90%) in place of the responses of participants in two of the archival samples for which criterion data were available. Analyses were conducted to gauge the impact of unscorable responses on the criterion validity of scores on these scales and their interpretability. Impact on validity was evaluated by examining correlations with extra-test variables as a function of increasing levels of unscorable responding. Interpretability was evaluated by examining the proportion of participants who produced clinically elevated RC Scale scores as a function of unscorable responding. Results indicate that whereas scale score validity was relatively robust up to a level of 50% unscorable responses, interpretability was substantially compromised at only 10% unscorable responding. This suggests that prorated scores may be used to correct for the impact of unscorable responses on the interpretability of RC Scale scores at levels as high as 50% unscorable responses. Classification analyses supported this possibility. Further steps needed to explore the feasibility of using prorated scores are discussed.

Empirical Correlates of Low Scores on MMPI-2/MMPI-2-RF Restructured Clinical Scales in a Sample of University Students

In the present study, the authors explored the meaning of low scores on the MMPI-2/MMPI-2-RF restructured clinical (RC) scales. Using responses of a sample of university students (N = 811), the authors examined whether low (T < 39), within-normal-limits (T = 39-64), and high (T > 65) score levels on the RC scales are differentially associated with multidimensional personality questionnaire (MPQ)-defined personality descriptions. Eleven primary MPQ scales and three higher order MPQ scales (negative emotionality, positive emotionality, and constraint) were used to yield these descriptions. MANOVAs were conducted for each RC scale and followed up by univariate ANOVAs and post hoc Dunnett T3 tests to identify reliable RC-scale-defined group differences for the individual MPQ scales. For those cases that exhibited significant differences between the low and within-normal subgroups on the Dunnett T3 tests, effect sizes were computed. The authors identified and discussed meaningful MPQ-based personality characteristics of the low scoring subjects.

The Detection of Feigned Psychiatric Disorders Using the MMPI-2-RF Overreporting Validity Scales: An Analog Investigation

Individuals who are motivated to feign psychological problems to achieve a desired outcome (e.g., insanity defense) may overreport symptoms of psychopathology, with type of pathology being dependent on the setting. In the current investigation, we examined the utility of the overreporting validity scales (infrequent responses [F-r], infrequent psychopathology responses [FP-r], infrequent somatic responses [Fs], and symptom validity [FBS-r]) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath and Tellegen 2008) to detect research participants instructed to simulate one of three mental disorders: major depressive disorder (MDD), schizophrenia (SCH), or post-traumatic stress disorder (PTSD). The restructured clinical (RC) and overreporting validity scale scores of bona fide psychiatric patients with a primary diagnosis of either MDD, SCH, or PTSD were compared to two groups of simulators—naive (i.e., undergraduate students with no training in mental disorders) and sophisticated (i.e., individuals with advanced training in psychopathology or personal experience with the disorder asked to overreport symptoms). Examination of the RC Scale profiles revealed that the sophisticated simulators produced symptom profiles more similar to the profiles of the psychiatric patients than did the naive simulators. For the overreporting validity scales, the sophisticated simulators were less likely to be detected as feigning compared to the naive simulators; overall, the validity scales were able to distinguish patients from simulators and accurately classify most of the simulators regardless of their level of “symptom” sophistication. Examination and comparison of the validity scales revealed that across disorders and level of research participant symptom sophistication, the FP-r scale best differentiated simulators from patients.

An evaluation of competing models for the structure of PTSD symptoms using external measures of comorbidity

Research on the structure of posttraumatic stress disorder (PTSD) symptoms has yielded support for two 4-factor models: the King (King, Leskin, King, & Weathers, 1998) and Simms/Watson models (Simms, Watson, & Doebbeling, 2002). This study evaluated them using data drawn from 1,128 Vietnam veterans by comparing associations with a latent internalizing comorbidity variable and five scales from the MMPI-2 Restructured Clinical (RC) Scales (Tellegen et al., 2003). The Simms/Watson dysphoria factor failed to show evidence of superior convergent or discriminant validity in association with external measures relative to the numbing or hyperarousal factors of the King model. Findings raise questions about proposals to abandon the distinction between numbing and hyperarousal symptoms in favor of a dysphoria-based model.

Relative practical utility of the Minnesota Multiphasic Personality Inventory–2 Restructured Clinical Scales versus the Clinical Scales in a chronic pain patient sample

The Minnesota Multiphasic Personality Inventory–2 (MMPI–2) Restructured Clinical (RC) Scales comprise the core of the new MMPI–2 Restructured Form. They were developed to retain the familiar clinical descriptive characteristics of the original basic scales while correcting a number of major psychometric shortcomings. The resulting scales are intended to be more unidimensional and unique, with improved convergent and discriminant validity. These improvements should be most evident in client samples where the traditional scales yield global and diffuse elevations, interpretively very challenging to the clinician. In the present study the RC Scales were compared to the traditional Clinical Scales in differentiating depressed (n = 239) versus nondepressed (n = 77) neuropsychology outpatients, all of whom experienced chronic pain, and most also reported other syndromes. Multiaxial diagnoses were assigned by practicing clinicians using a variety of data sources, including MMPI–2 Clinical Scales but not the RC Scales. Whereas both sets of scales achieved good overall classification rates of about 85%, the RC Scales did so using significantly fewer scales, yielding a more focused, efficient, and clinically useful profile. In the depressed group, 7 of the 8 basic scales (which exclude Scales 5 and 0) were clinically elevated, whereas only 2 of the 8 RC Scales were elevated (in addition to the demoralization scale RCd). These findings offer significant implications for the psychological assessment of chronic pain patients.

Development and validation of brief content scales for the psychological screening inventory‐2

This article describes the development of 21 brief content (BC) scales to supplement the existing scales of the Psychological Screening Inventory-2 (PSI-2), and three validity studies to support their use for both the PSI-2 and the original PSI. The BC scales comprise groups of four or more items that are statistically homogeneous in content and are replicated across three data sets: PSI and PSI-2 normative data and a PSI-based group of forensic respondents. Concurrent validity was shown in correlations with the following: (a) the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) basic clinical scales, Content scales, PSY-5 scales, and Restructured Clinical (RC) scales; (b) family/friend observer ratings; and (c) therapist ratings in an outpatient substance abuse treatment program. Consistent with the purpose of the PSI/PSI-2, the BC scales are intended to provide additional screening information and not a comprehensive representation of psychopathology.

Psychometric functioning of the MMPI-2-RF VRIN-r and TRIN-r scales with varying degrees of randomness, acquiescence, and counter-acquiescence.

In the present study, the authors evaluated the effects of increasing degrees of simulated non-content-based (random or fixed) responding on scores on the newly developed Variable Response Inconsistency-Revised (VRIN-r) and True Response Inconsistency-Revised (TRIN-r) scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Y. S. Ben-Porath & A. Tellegen, 2008) and compared the performance of these new scales with the existing VRIN and TRIN scales of the MMPI-2 (J. N. Butcher et al., 2001). The results support the interpretation of VRIN-r and TRIN-r scores as measures of random and fixed responding, respectively. Furthermore, the authors examined how scores on the Restructured Clinical (RC) scales (A. Tellegen et al., 2003) are affected by increasing levels of non-content-based responding and offer practical interpretive recommendations for test users. Finally, the results of the present study indicate that RC validity coefficients are relatively robust in the face of moderate degrees of non-content-based responding.

Personality Assessment from the Nineteenth to the Early Twenty-First Century: Past Achievements and Contemporary Challenges

The historical basis of personality assessment that led to the development of today's approaches and applications is described. The modern era of personality assessment began in late nineteenth-century Europe. Early twentieth-century highlights included the development of projective techniques like the Rorschach and several early self-report inventories, culminating in the development of the most widely used measure, the Minnesota Multiphasic Personality Inventory (MMPI). The most recent 30-year period showed expansions into personnel screening; clinical assessment, including wide use in forensic settings; and therapeutic assessment. However, contemporary controversies are apparent with two of the most widely used measures, the Rorschach and the MMPI instruments. These controversies are described, including concerns about the Exner Comprehensive System for the Rorschach and the last five years of changes to the MMPI-2, including the introduction of the Restructured Clinical (RC) Scales, the adoption of the Fake Bad Scale (FBS) into the instrument, and the release of the MMPI-2 Restructured Form (MMPI-2-RF). Current challenges facing psychologists in personality assessment are highlighted.

Use of the MMPI-2 Restructured Clinical (RC) Scales in Detecting Criminal Malingering

The purpose of the present study was to assess the effects of criminal malingering on the MMPI-2 Restructured Clinical (RC) scales. Sixty undergraduate students were given the MMPI-2 twice. One administration was conducted according to the MMPI-2 manual, and the other was given with a special set of malingering instructions specific to a prison setting. The two MMPI-2 profiles for each participant were scored for both the Basic and RC scales. Eight participants were eliminated from the data analysis due to validity (VRIN or TRIN) concerns. Data from the remaining 52 participants were analyzed using a 2 × 2 repeated measures ANOVA. Results showed that, as expected, the participants achieved higher MMPI-2 scores in the malingering condition. Also, participants achieved higher scores overall on the Basic scales and a significant interaction showed that participants achieved higher scores on the Basic Scales in the malingering condition than on the RC scales in that condition. These results supported prior research, indicating that malingerers produce elevated RC profiles. However, the present results also suggest that the Basic scales may be more effective in actually detecting malingerers, mainly due to the much lower ceiling on the RC scaled scores. Further implications of these findings for research and clinical work are also discussed.

Let's Not Get Hysterical: Comparing the MMPI-2 Validity, Clinical, and RC Scales in TBI Litigants Tested for Effort

The MMPI-2 restructured clinical (RC) scales replace the traditional clinical scales in the MMPI-2 restructured form (MMPI-2-RF). Few studies to date have examined the MMPI-2 RC scales in traumatic brain injury (TBI) litigants. We compared MMPI-2 validity, clinical, and RC scales profiles of 83 mild, complicated mild, and moderate/severe TBI litigants who were tested for effort. Past research shows that patients referred for neuropsychological evaluations with mild TBIs paradoxically have higher MMPI-2 clinical scale elevations than patients with moderate/severe TBIs. Failure on cognitive symptom validity tests (SVTs) has also been associated with elevated validity and clinical scales profiles. The “conversion V” (elevated Hs and Hy, followed by D) is the most frequent elevated profile configuration in mild TBI and/or SVT failure. We sought to determine if these patterns of symptom reporting would replicate on the RC scales profile. Archival data from independent neuropsychological examinations were used to correlate TBI severity, cognitive test effort as indicated by SVTs, and MMPI-2 profiles. Results suggest that the validity, clinical, and RC scales profiles all correlate well with indices of cognitive test effort (namely that failure on SVTs is correlated with elevated symptom reporting). In addition, the validity scales profile, but not the clinical or RC scales profiles, was significantly inversely related to TBI severity. Discriminant function analyses suggest that the MMPI-2 RC scales can aid in the diagnosis of over-reported TBI symptomatology. However, RC3—the RC equivalent of the Hy scale—no longer appears to serve as a marker of somatization and/or malingering.

Racial bias in personality assessment: Using the MMPI-2 to predict psychiatric diagnoses of African American and Caucasian chemical dependency inpatients.

An assessment of predictive bias was conducted on numerous scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989), including the Restructured Clinical (RC) scales, in the prediction of clinical diagnostic status for African American and Caucasian male veterans seeking substance abuse treatment. Patients completed a battery of self-report instruments and were administered structured diagnostic interviews. African American patients obtained higher scores across most MMPI-2 scales compared with Caucasians with clinically meaningful elevations (T scores > 5 points) on 3 scales. The RC scales demonstrated strong correlations with diagnoses, however, like other MMPI-2 scales examined in this study, they displayed a general trend of predictive bias. Step-down hierarchical regression procedures (G. J. Lautenschlager & J. L. Mendoza, 1986) indicated the presence of predictive bias for a majority of the scales examined; however, most of these effects were small to modest (accounting for 3%-5% of variance). The pattern of slope and intercept biases across types of MMPI-2 scales differs from prior research and indicates the importance of evaluating bias in various populations and settings.

The MMPI–2 Restructured Clinical (RC) Scales and Redundancy: Response to Tellegen, Ben-Porath, and Sellbom

In this article, we examine 5 criticisms of Tellegen, Ben-Porath, and Sellbom (2009/this issue) about our study demonstrating the redundant relationships of the Restructured Clinical (RC) scales with extant MMPI–2 scales. We discuss differences in univariate versus multivariate comparisons of the RC scales and our “proxy” scales using their data. We show that (a) both the RC and extant proxy scales identified in our analyses account for most of the variance in the Clinical scales; (b) the proxy scales are redundant with the RC scales; (c) the proxy scales matched the 6 RC scales in accounting for variance in the Clinical scales exactly in three cases, differed by ≤.02 in 2 cases, and reached a maximum of .11 in one case; (d) the item overlap between RC1 and HEA is not at issue but rather their correlation with Scale 1; and (e) the evidence for the construct validity of the RC scales is weak using findings on the incremental validity of RC4 as illustrative.

Construct Validity of the MMPI–2 Restructured Clinical (RC) Scales: Reply to Rouse, Greene, Butcher, Nichols, and Williams

Rouse, Greene, Butcher, Nichols, and Williams (2008) repeat two claims about the MMPI–2 Restructured (RC) scales. One asserts that the correlations of RC scales with parent Clinical scales are modest compared to the correlations with other existing MMPI–2 scales. In response, we reiterate that the RC scales were not meant to emulate the divergent and overlapping content of the Clinical scales. Instead, each represents a distinctive Clinical scale component. Although individually focused, the RC scales span collectively a wide range of content and used as multivariate predictors, account for most of the variance of each Clinical scale. Rouse et al. also claim that most RC scales are redundant with existing MMPI–2 scales, which they propose as substitutes (“proxies”). However, our analyses of Rouse et al.'s database and of our own data show that several of their proposed proxies are far less mutually distinguishable than are the RC scale counterparts. Furthermore, several Clinical scales are more successfully, and none are less successfully, accounted for by RC scales than by proxies. In response to Rouse et al.'s neglect of a body of empirical findings supporting the construct validity of the RC scales, we also review the relevant research literature.

Psychometric Evaluation of the MMPI–2 Restructured Clinical Scales in Two Dutch Samples

In this article, we evaluate internal validity, internal consistency, and test–retest reliability of the MMPI–2 Restructured Clinical (RC) scales in the Dutch MMPI–2 normative sample (N = 1,244) and a Dutch outpatient psychiatric sample (N = 1,066). We pay special attention to a critique regarding construct drift of RC3 and the redundancy of the RC scales with existing MMPI–2 scales. The results indicate that the RC scales in both samples show comparable or better internal consistencies than the Clinical scales. Also, in both samples, the RC scales demonstrate lower scale-level intercorrelations than the Clinical scales. As to the structural characteristics, principal component analysis of the RC scales provided a clearer pattern than an analysis of the Clinical scales. Furthermore, mean raw scores on the RC scales for men in the Dutch normative sample corresponded highly with those in the U.S. normative sample except for RC2 and RC4. Less correspondence was found for women. Overall, we conclude that the RC scales show satisfactory reliability and promising internal validity in our Dutch samples. We suggest that U.S. validation studies on the RC scales may be generalized to the Dutch-language version of the MMPI–2 RC scales.