Minnesota Multiphasic Personality Inventory

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The Minnesota Multiphasic Personality Inventory (MMPI) is one of the most frequently used personality tests in the mental health fields.^[1] This assessment, or test, was designed to help identify personal, social, and behavioral problems in psychiatric patients. The test helps provide relevant information to aid in problem identification, diagnosis, and treatment planning for the patient.

History and development

The original MMPI was at the University of Minnesota Hospitals and first published in 1942. The original authors of the MMPI were Starke R. Hathaway, PhD, and J. C. McKinley, MD. The MMPI is copyrighted by the University of Minnesota; therefore a fee is assessed for each use of the test.

The current standardized version, the MMPI-2, was released in 1989 and is for adults 18 and over. A subsequent revision of certain test elements was published in early 2001. The MMPI-2 has 567 items, or questions (all true or false format), and takes between 1 and 2 hours to complete. There is a short form of the test that comprises the first 370 items on the long-form MMPI-2. In addition, a test designed for adolescent use, the MMPI-A, was developed in 1992. A new version of the test, the MMPI-2 RF, is scheduled for release sometime in the fall of 2007.

The original MMPI was developed using a novel (at the time) approach to test construction known as empirical keying. The big difference between this approach and other test development strategies being used at the time was that it was atheoretical (not based on any particular theory) and thus the initial test was not as saturated with the prevailing psychodynamic theories of the time as were its contemporaries.

Empirical keying works by initially identifying two groups, one which possesses some key trait or outcome you wish to identify (e.g. depressed clients), and a control group. The two groups are then given the same set of questions, then any question that reliably differentiates between the groups is selected for further study, regardless of its content. Thus, if depressed clients were to respond "yes" to the statement "I like cheese pizza" significantly more often than individuals in the control group, this item would be included on a scale of depression (potentially), despite the fact that the content of the item appears to have little relevance to the phenomenon of depression.

This construction method led to the inclusion of many "subtle" items on the MMPI/MMPI-2, which were thought to make the test more difficult to fake, given the item's relative lack of face validity. Recent studies, however, have suggested that this is not in fact the case, and that the inclusion of subtle items in the inventory actually negatively affects its utility.^{[citation needed]}

More recent revisions of the MMPI have moved away from the empirical keying method towards more rational, statistically driven scale development strategies. The Content and RC Clinical scales are examples of this more recent trend. The items on these scales tend to be more face valid, and the instrument now relies more on the extensive collection of validity scales to detect inaccurate responding.

Current scale composition Clinical interpretation of the instrument centers around five general groups of scales: the validity scales, the clinical scales, the content scales, the supplemental scales, and the PSY-5 scales. Historically, the clinical scales have been used as the core of the interpretation, but recent trends have been moving away from these somewhat heterogeneous (i.e. measuring more than one thing) scales and towards a focus on the more homogeneous (i.e. measuring only one thing) content and supplemental scales. Furthermore, recent projects have produced alternate versions of the clinical scales known as the Restructured Clinical or RC scales. The RC scales are generally more homogeneous than their traditional counterparts, but are not simple reflections of the original clinical scales, as the pathology they assess is somewhat different than the original clinical scales (see Graham, 2006 for a review).

The validity scales are comprised of three basic types of measures: scales which are designed to detect overtly random or non-responding (CNS, VRIN, TRIN), scales designed to detect when clients are intentionally or unintentionally over reporting or exaggerating the prevalence or severity of psychological symptoms (F, Fb, Fp, Fs, FBS), and scales designed to detect when clients are intentionally or unintentionally underreporting or downplaying psychological symptoms (L, K, S).

The traditional clinical scales (Hy, D, Hs, Pd, Mf, Pa, Pt, Sc, Ma, Si) are designed to measure common types of pathology which were identified in the development of the test, back in 1942. As a result, some of the pathology which these scales were designed to measure is either extremely rare today (Hs), or no longer considered pathological (Mf). Additionally, as a result of the empirical keying process by which the scales were developed, many of the clinical scales appear to be measuring more than one thing (i.e. scale 7 (Pt) appears to measure symptoms common to many disorders, most notably depression, generalized anxiety disorder, and obsessive compulsive disorder). Due to the difficulty many clinicians had in trying to interpret these often ambiguous scales, attempts have been made to supplement and refine these core scales, resulting in the Content Scales, the Supplementary Scales, and most recently, the RC scales.

The content scales are composed of 15 scales which more directly address a specific area of pathology (i.e. Depression, Anxiety, Fears) or a known pattern of behavior which impacts the client in a direct and measurable way (i.e. Cynicism, Work Interference, Negative Treatment Indicators). These questions on these scales tend to assess areas of interest more directly, and as a result, the scales themselves tend to be more homogeneous.

There have been a large number of supplementary scales created for the MMPI-2 over the years, with many falling into disuse due to a lack of necessity or general psychometric problems. Among the more frequently used supplemental scales are the substance abuse scales (MAC-R, APS, AAS), designed to assess the extent to which a client admits to or is prone to abusing substances. Also frequently used are the A and R scales, developed by Welch after factor analyzing the original MMPI item pool. Welch's first factor, A, which is a measure of general maladjustment, is similar to the new RC Demoralization scale. Other commonly used supplemental scales include measures of marital distress (MDS) and social dominance (Do) (again, see Graham, 2006 for a more complete review).

Unlike the content and supplemental scales, the PSY-5 scales were not developed as a reaction to some actual or perceived shortcoming in the MMPI-2 itself, but rather as an attempt to connect the instrument with more general trend in personality psychology. The five factor model of human personality (or the OCEAN model, see also NEO-PI-R) has gained great acceptance in non-pathological populations, and the PSY-5 scales are the result of an attempt to see a similar model existed in a pathological sample. Although five scales were developed, the content of these scales differ drastically from the 5 factors identified in non-pathological populations (for a more through review, see Arnau, Handel and Archer, 2005, or see Harkness and McNulty, 1994) The five components discovered were labeled Negative Emotionality (NEGE), Psychoticism (PSYC), Introversion (INTR), Disconstraint (DISC) and Aggressiveness (AGGR).

Scoring and interpretation

Like many standardized tests, scores on the various scales of the MMPI-2 are not representative of either percentile rank or how "well" or "badly" someone has done on the test. Rather, raw scores on the scales are transformed into a standardized metric known as T-scores (mean or average equals 50, standard deviation equals 10), making interpretation easier for clinicians. Individuals who are not trained in psychological assessment and scoring should not attempt to score or interpret the MMPI-2, as accurate scoring and interpretation requires knowledge of the test itself, standardized testing theory, the various subscales in combination (test profile) and correspondence of results to diagnosis. With few exceptions, the MMPI-2 should only be scored and interpreted by individuals with graduate level training in either clinical, experimental or I/O psychology, or some closely related discipline. Test manufacturers and publishers ask test purchasers to prove they are qualified to purchase the MMPI/MMPI-2 and other tests ^[2]

The scales on the MMPI-2, are generally interpreted in the positive direction. What this means is that, while a high score on any of the Depression scales may suggest the individual is significantly more depressed than we would expect a random individual to be, a low score is not interpreted to mean the individual is significantly less depressed than the average individual. This is due in part to the wording of many of the items on the test. These items often are designed to detect the presence or absence of symptoms, and the absence of symptoms does not necessarily indicate the presence of contrarian traits. As an example, it is entirely possible for a person to be relatively free of the symptoms of depression, and not be considered a particularly happy person. Furthermore, since the test was designed as a measure of psychopathology, its predictive ability tends to be much sharper when scores are high compared to when they are low. There are some scales on the MMPI-2, most notably Clinical Scales 5 (Mf) and 0 (Si) which do not follow this pattern, and where low scores are routinely interpreted.

Test uses

• Criminal justice and corrections
• Evaluation of disorders such as post-traumatic stress disorder, clinical depression and schizophrenia
• Identification of suitable candidates for high-risk pubic safety positions such as nuclear power plant workers, police officers, airline pilots, medical and psychology students, firefighters and seminary students
• Evaluation of armed forces' officer and NCO candidates
• Assessment of medical patients and design of effective treatment strategies, including chronic pain management
• Evaluation of participants in substance abuse programs
• Support for college and career counseling
• Marriage and family counseling
• International adoption parent screening

Criticism and controversy

[[Personality test|Personality tests]] like graphology, Rorschach inkblot test, and [[Myers-Briggs Type Indicator]] have come under fire more often than the MMPI^{[citation needed]}, but critics have raised issues about the ethics and validity of administering the MMPI, especially for non-clinical uses^{[citation needed]}.^[3]  By the 1960s, the MMPI was being given by companies to employees and applicants as often as to psychiatric patients. Sociologist William H. Whyte was among many who saw the tests as helping to create and perpetuate the oppressive groupthink of mid-century corporate capitalism.

Ethical use of psychological tests means that results must be interpreted in the context of other information about the individual, i.e., personal history, reason for assessment, the intended uses of the report about the results, who made the referral for assessment (e.g., self, family, physician, lawyer). Many of the controversies have been in situations of inappropriate test use, such as deciding the results are infallible, can stand on their own in isolation from other information about the test taker.^[4]Psychological assessment requires the use of psychological tests, background information about the individual, clinical interviews such as a mental status examination, so as to put test results into appropriate context. This is called "test interpretation".

A 1990 Office of Technology Assessment report^[5] noted:

In 1965 the Senate Subcommittee on Constitutional Rights of the Committee on the Judiciary, chaired by Senator Sam Ervin, and the House Special Subcommittee on Invasion of Privacy of the Committee on Government Operations, chaired by Representative Cornelius E. Gallagher, held hearings to determine whether the questions asked on psychological tests used by the Federal Government were an unjustified invasion of the respondent’s psyche and private life. The Subcommittees also investigated the validity of these tests and the due process issues involved in test administration. The reactions of the press and public were very critical of the types of questions asked on these psychological tests.

In 1966, Senator Ervin introduced a bill to sharply curtail the government's use of the MMPI and similar tests, comparing them to McCarthyism. Ervin's bill failed.

Annie Murphy Paul, a former senior editor of Psychology Today, charges that personality tests "are often invalid, unreliable, and unfair."^[3] Others have accused that MMPI can "overpathologize" certain demographic groups, notably teenagers and non-white test takers. However, recent empirical research suggests that the modern day family of MMPI instruments does not overpathologize certain demographic groups.^[6] The MMPI is no longer offered for sale and has been replaced with the MMPI-2, which is only designed for use with individuals ages 18 and over. There is no compelling evidence that the current adolescent version of the MMPI, the MMPI-A, overpathologizes adolescents.^[7] Further, several recent peer-reviewed empirical studies have failed to find support for the hypothesis that the MMPI-2 overpathologizes members of minority groups.^[6]

Numerous successful lawsuits have argued that giving the test to job applicants is an invasion of privacy, and that there is no evidence linking test results to job performance.

There is a great amount of controversy about the extent to which third parties can publish derivitive works and scoring programs. The University of Minnesota maintains an iron grip on all intellectual property rights. Others however have argued that the MMPI is actually more of a patentable construct rather than a literary or artistic work, and should have fallen into the public domain long ago. However, copyright law will basically give the University of Minnesota indefinite control over any rights. It is quite possible that these rights could be invalidated in court, but no single entity has enough to gain from the cost associated wtih litigation, and a win for any one of them would open up the flood gates to competitors.

MMPI-2 trait scales

The ten trait scales on the MMPI-2:

Scale 1 — Hypochondriasis

Neurotic concern over bodily functioning.

Scale 2 — Depression

Poor morale, lack of hope in the future, and a general dissatisfaction with one's own life situation. High scores are clinical depression whilst lower scores are more general unhappiness with life.

Scale 3 — Hysteria

Hysterical reaction to stressful situations. Often have 'normal' facade and then go to pieces when faced with a 'trigger' level of stress. People who tend to score higher include brighter, better educated and from higher social classes. Women score higher too.

Scale 4 — Psychopathic Deviation

Measures social deviation, lack of acceptance of authority, amorality. Adolescents tend to score higher.

Scale 5 — Masculinity-Femininity

This scale was originally developed to identify homosexuals, but did not do so accurately. Instead, it is used to measure how strongly an individual identifies with the traditional (pre-1960's) masculine or feminine role. Men tend to get higher scores. It is also related to intelligence, education, and socioeconomic status.

Scale 6 — Paranoia

Paranoid symptoms such as ideas of reference, feelings of persecution, grandiose self-concepts, suspiciousness, excessive sensitivity, and rigid opinions and attitudes.

Scale 7 — Psychasthenia

Originally characterized by excessive doubts, compulsions, obsessions, and unreasonable fears, it now indicates conditions such as Obsessive Compulsive Disorder (OCD). It also shows abnormal fears, self-criticism, difficulties in concentration, and guilt feelings.

Scale 8 — Schizophrenia

Assesses a wide variety of content areas, including bizarre thought processes and peculiar perceptions, social alienation, poor familial relationships, difficulties in concentration and impulse control, lack of deep interests, disturbing questions of self-worth and self-identity, and sexual difficulties.

Scale 9 — Hypomania

Tests for elevated mood, accelerated speech and motor activity, irritability, flight of ideas, and brief periods of depression.

Scale 0 — Social Introversion

Tests for a person's tendency to withdraw from social contacts and responsibilities.

The authors also developed four Validity Scales to detect "deviant test-taking attitudes" and gauge the accuracy of the other scales.

The "Cannot Say" scale

This is the simple frequency of the number of items omitted or marked both true and false. Large numbers of missing items call the scores on all other scales into question.

The L scale

Originally called the "Lie" scale, this was an attempt to assess naive or unsophisticated attempts by people to present themselves in an overly favorable light. These items were rationally derived rather than criterion keyed.

The F scale

This is a deviant, or rare response scale. The approach was to look at items which are rarely endorsed by normal people. If less than 10 percent of the normals endorse the item, but you do, your F count goes up. For example "All laws should be eliminated."

The K scale

This scale was an attempt to assess more subtle distortion of response, particularly clinically defensive response. The K scale was constructed by comparing the responses of a groups of people who were known to be clinically deviant but who produced normal MMPI profiles with a group of normal people who produced normal MMPI profiles (no evidence of psychopathology in both). The K scale was subsequently used to alter scores on other MMPI scales. It was reasoned that high K people give scores on other scales which are too low. K is used to adjust the scores on other scales. K-corrected and uncorrected scores are available when the test results are interpreted.

There are additional validity scales developed via research and incorporated into computer scoring services (whether used in office or sent to a service for scoring).