9/13/2017 1 THE MMPI‐2‐RF Psychometrics, Psychopathological Convergence, and Setting‐Specific Utility 1 Agenda Introduction and Overview of the MMPI-2-RF Examination of psychometric properties Mapping the MMPI-2-RF onto pathological models Setting-specific utility 2 Overview of the MMPI-2-RF 3 Overview of the MMPI-2-RF 338-item restructured version of MMPI-2 Published in 2008 Subset of MMPI-2 item pool Approximately 6 th grade reading level Majority of the MMPI-2-RF items fall between the 5 th and 7 th grades Per reported data (Dahlstrom et al., 1994) Flesch-Kincaid Reading Level = 4.5 PAI = ~ 4.3 Flesch-Kincaid Reading Level Additional problems with likert-type responding (“Sometimes I …”) MCMI-III = ~ 5.6 Flesch-Kincaid Reading Level 73% of items have a reading level of 7 th grade or above (Akeson & Mattson, in process) Norms based on MMPI-2 sample MMPI-3? 4
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THE MMPI‐2‐RF
Psychometrics,
Psychopathological Convergence,
and
Setting‐Specific Utility
1
Agenda
Introduction and Overview of the MMPI-2-RF
Examination of psychometric properties
Mapping the MMPI-2-RF onto pathological models
Setting-specific utility
2
Overview of the MMPI-2-RF3
Overview of the MMPI-2-RF
338-item restructured version of MMPI-2 Published in 2008 Subset of MMPI-2 item pool
Approximately 6th grade reading level Majority of the MMPI-2-RF items fall between the 5th and 7th
Additional problems with likert-type responding (“Sometimes I …”)
MCMI-III = ~ 5.6 Flesch-Kincaid Reading Level 73% of items have a reading level of 7th grade or above (Akeson &
Mattson, in process)
Norms based on MMPI-2 sample MMPI-3?
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Overview of the MMPI-2-RF
35-50 minutes for booklet administration Less time needed for computer administration Audio Administration (Computer or CD)
No K correction offered Lack of empirical support
Only uses NON-GENDERED scores Why?
Linear T Scores Validity Scales and the 2 Interest Scales
Uniform T Scores All other substantive scales
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9 10
Psychometric Rationale & Properties12
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Why Restructure the Clinical Scales?
Although it has long been recognized that the Clinical Scales (CSs) contain compelling and interpretively meaningful information, they are not psychometrically optimal when used as aggregate measures of psychopathology. (Ben-Porath, 2012)
Why? Higher than expected intercorrelations
Substantial item overlap between scales
Heterogeneous item content
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Why Restructure the Clinical Scales?
Intercorrelations Clinical Scale (CS) 7, a measure of emotional dysfunction,
and CS 8 (disordered thinking) correlate, on average, around .90 While these two constructs DO co-occur – they do not, and should
not, do so at this rate
Item Overlap CS 7 and CS 8 share 17 items MMPI-2 Item 31 is keyed “True” on five of the eight original
CSs Heterogeneous Item Content
Ambiguous scale interpretation The problem of the subtle items … AND criterion keying
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Development of the RC Scales(Ben-Porath, 2012)
Capture Demoralization Demoralization is characterized by an unhappy,
dysphoric mood, a sense of helplessness and inability to cope with one’s current circumstances, and general dissatisfaction with one’s condition (Sellbom et al., 2008)
Isolate the construct and measure once A demoralization-like construct had previously been thought
to be the elusive “MMPI 1st Factor”
Thought to be the cause of the intercorrelations between the CSs
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Tellegen (1985) – Affective Circumplex16
Development of the RC Scales(Ben-Porath, 2012)
Factor Analyze MMPI-2 Clinical Scales Identify distinctive “core components” In general, the RC Scales directly relate to the
corresponding Clinical Scales; however, this is not always the case
Construct “Seed Scales” for each core component Based on factor analytic and correlational data
Deriving Final RC Scales Entire MMPI-2 item pool utilized, internal reliability
examined, aimed at providing non-overlapping items
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Internal Consistency of the Clinical and Restructured Clinical Scales of the MMPI-2/MMPI-2-RF (Normative Sample) (Graham, 2012)
Internal Consistency Coefficients (Alpha)
Scale Men Women
MMPI-2(n = 82)
MMPI-2-RF(n = 1138)
MMPI-2(n = 111)
MMPI-2-RF(n = 1462)
--- / RCd (dem) -- .87 -- .89
Hs / RC1 (som) .77 .73 .81 .78
D / RC2 (lpe) .59 .68 .64 .62
Hy / RC3 (cyn) .58 .80 .56 .79
Pd / RC4 (asb) .60 .76 .62 .74
Mf / --- .58 -- .37 --
Pa / RC6 (per) .34 .63 .39 .65
Pt / RC7 (dne) .85 .81 .87 .83
Sc / RC8 (abx) .85 .70 .86 .71
Ma / RC9 (hpm) .58 .79 .61 .76
Si / --- .82 .84
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Reliability and Validity
Comparisons between several varying clinical samples provide data that the RC Scales show: Comparable or improved reliability Substantially reduced saturation with Demoralization Substantially reduced inter-correlations Comparable or improved convergent validity Substantially improved discriminant validity
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Reliability and Validity
Subsequent studies have provided additional evidence supporting the use of the RC Scales Replicated in: College counseling settings (Sellbom, Ben-Porath, & Graham, 2006)
Community-dwelling veterans (Simms et al., 2005)
Outpatient sample (Wallace, A., & Liljequist, L., 2005)
Private practice (Sellbom, Graham, & Schenck, 2006)
medical patient populationsFBS-r: Symptom Validity – Somatic and cognitive complaints associated at
high levels with over-reportingRBS: Response Bias Scale – Exaggerated memory complaintsL-r: Uncommon Virtues – Rarely claimed moral attributes or activitiesK-r: Adjustment Validity – Avowals of good psychological adjustment
associated at high levels with under-reporting
MMPI-2-RF: Higher-Order Scales
EID – Emotional/Internalizing Dysfunction –Problems associated with mood and affect
THD – Thought Dysfunction – Problems associated with disordered thinking
BXD – Behavioral/Externalizing Dysfunction –Problems associated with under-controlled behavior
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Identical to MMPI-2 RC Scales
RCd: Demoralization – General unhappiness and dissatisfaction
RC1: Somatic Complaints – Diffuse physical health complaints
RC2: Low Positive Emotions – Lack of positive emotional responsiveness
RC3: Cynicism – Non-self-referential beliefs expressing distrust and a generally low opinion of others
RC4: Antisocial Behavior – Rule breaking and irresponsible behavior
MMPI-2-RF: RC Scales
RC6: Ideas of Persecution – Self-referential beliefs that others pose a threat
Using samples of: 21,836 men in correctional settings 1,065 men and women in forensic contexts 402 male and female college students
Found: Variance on the externalizing domain corresponds with the
hierarchical framework of the MMPI-2-RF BXD associated with a broad range of externalizing facets
Best marker of general impulsivity/disinhibition RC scales show a more distinct pattern
Specific facet information and specific markers (e.g., RC9 & Narcissism) SP scales show unique differential pattern of associations
JCP – juvenile delinquency; SUB – alcohol and drug dependence; AGG – trait aggression; ACT – trait activation
Interpretive Strategy47
MMPI-2-RF Interpretation
Substantive Scale InterpretationBegin with Higher-Order Scales If only one is elevated, use it as starting point then
interpret all RC, Specific Problems, PSY-5 scales in that area When interpreting RC Scales:
proceed in order of elevation incorporate relevant SP Scales and PSY-5
If more than one H-O Scale is elevated, use highest as starting point, then proceed to next highest
If no H-O Scale is elevated, proceed to RC Scales and interpret by domain, in order of elevation, incorporating relevant SP and PSY-5 scales
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MMPI-2-RF Interpretation
Substantive Scale InterpretationOnce all H-O and RC Scales are covered: Interpret any remaining elevated SP Scales
Interpret Interpersonal and Interest scales
If relevant, add diagnostic and treatment considerations along the way
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Medical Settings
Setting-Specific Utility55
Medical Settings56
The technical manual (Tellegen & Ben-Porath, 2008) contains: Empirical correlates
Medical comparison groups
In addition, you can select appropriate comparison groups when using the MMPI-2-RF in medical settings Bariatric Surgery Candidates
Spine Surgery/Spinal Cord Stimulator Candidates
Bariatric Surgery Candidates57
Factors associated with poor outcome, including ability to maintain focus on self-care when faced with adversity: Maladaptive (acting out) behavior (BXD, RC4, AGG)
Affective instability (RCd, RC7, SUI, AXY)
Depression (RC2, SFD)
Low Stress tolerance (MLS, STW, AXY, SUB) Increased risk for suicidal ideation/intent and lifetime
substance abuse problems (Tarescavage et al., 2013)
MMPI-2-RF Somatic / Cognitive and Internalizing Scales
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D S F AE S M E C
JCP S U B AGG ACT FM L IP P S AV S H Y DSF AES MEC
Mean 54 62 52 55 67 50 59 56 56 60 50
Ms. G - Chronic Pain
20
30
40
50
60
70
80
90
100
110
120
JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC
MMPI-2-RF Externalizing, Interpersonal, and Interest Scales
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AGGR -r P S Y C-r D IS C-r N E GE -r IN T R -rAGGR-r PSYC-r DISC-r NEGE-r INTR-r
Mean 47 50 56 71 77
Ms. G - Chronic Pain
20
30
40
50
60
70
80
90
100
110
120
AGGR-r PSYC-r DISC-r NEGE-r INTR-r
MMPI-2-RF Personality Psychopathology Five (PSY-5)
Ms. P – Pre-surgical Spine Evaluation65
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67 68
69 70
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Ms. F - Somatization72
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73 74
75 76
77 78
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Ms. KPsychogenic Non-Epileptic Seizures
79
80
81 82
83 84
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85
Ms. W - Conversion86
87 88
89 90
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91 92
Forensic Settings
Setting-Specific Utility93
Forensic Settings94
Challenges New tests typically provide some material for attorneys
to attack
Admissibility of a test – especially a “new” test
Weight of the evidence/opinion based on the results See Ben-Porath (2012) for responses to specific challenges
based on the MMPI-2-RF
Daubert Criteria95
Has the MMPI-2-RF been tested?
Has it been subjected to peer review?
What is the MMPI-2-RF’s known or potential error rate?
Are there standards for controlling the MMPI-2-RF?
Is the MMPI-2-RF generally accepted?
Has the MMPI-2-RF been tested?96
Empirical data available in the Technical Manual Intercorrelations between the scales Correlations between the RF and the existing MMPI-2 Empirical correlates are available for both criminal and
civil forensic settings Comparison groups to aid in interpretation and report
There are over 260 peer-reviewed publications on the MMPI-2-RF Topics Include:General Assessment and Diagnostic Utility
Validity
Correctional Settings
Forensic Settings
Mental Health Settings
Medical Settings
Other Non-Clinical Settings
The MMPI-2-RF’s error rate?98
Data on reliability and standard error of measurement (SEM) of MMPI-2-RF scale scores address this question directly Available in Technical Manual Chapter 3 Available for both Normative and Clinical samples
Classification accuracy statistics Sensitivity, Specificity, Positive and Negative Predictive
Powers Available in peer reviewed classification studies (e.g.,
malingering detection research)
Are there standards for controlling the MMPI-2-RF?
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YES! Standardized administration and scoring guidelines
Standardized interpretive approach Reliability of interpretation between raters is higher
Is the MMPI-2-RF generally accepted?100
Increasingly so … Basis in the Frye StandardMMPI-2-RF is increasingly being used in:
Forensic Contexts
Medical Evaluations
Public Safety (Law Enforcement) Screenings
The MMPI-2-RF has also been included in several recent book publications by experts in personality assessment
Use of the MMPI-2-RF:Forensic and Correctional Contexts
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Assessment of Psychopathy (Wygant, Applegate, &Wall, 2014)
MMPI-2-RF substantive scales associate with specific indices from the Psychopathic Personality Inventory (PPI) BXD Hierarchy
As well as …
STW, BRF, MSF, IPP, SAV, SHY, DSF
Risk Assessments (Wygant, Applegate, &Wall, 2014)
State vs. trait violence proclivities (or both)
Fearlessness, interpersonal dominance, criminal history, severe mental health symptoms, substance abuse
Mr. P
49 year old, single male
Long-standing Dx of Schizophrenia, Paranoid type
Diagnosed late teens; lived with parents throughout adult life
Father passed away when Mr. P was in his 20s; Mother now in her 70s
Received case management services in community
Periodic employment as unskilled laborer
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Mr. P
Several weeks prior to hospitalization Mr. P became embroiled in conflict with co-worker
Employment suspended as a consequence of physical altercation
Discontinued medication and decompensated into acute psychotic episode marked by belief that job loss is the result of gov’t conspiracy to take away his disability benefits as well
Mother informed case worker that Mr. P was threatening retaliation against co-worker
Although no history of violent behavior, psychiatrist determined significant risk – referred for evaluation.