Post-traumatic stress disorder and the MMPI-2

This study compared the MMPI-2 profiles of 27 veterans diagnosed with post-traumatic stress disorder with a non-PTSD comparison group of 27 veteran patients receiving inpatient treatment for other mental disorders. Three multivariate analyses of variance were conducted comparing the two groups on the 10 traditional clinical scales, the 12 supplemental scales and the 15 new content scales on the MMPI-2. The PTSD group obtained a mean profile with peak elevations on the F validity scale and on clinical Scales 2 (D) and 8 (Sc). The multivariate analysis of variance comparing the PTSD and non-PTSD groups across the 10 traditional clinical scales was not significant. The multivariate analyses of variance comparing the two groups on the 12 supplemental scales and the 15 content scales were significant. Significant univariate supplemental scale differences were found on the Keane PTSD scale (PK) and the Post-Traumatic Stress Disorder (PS) scale with the PTSD group scoring higher on PK and PS. Significant univariate content scale differences were found for the Anger (ANG) scale with the PTSD group scoring higher. A cut-off score of 28 on the PK scale correctly classified 76% of the overall sample, 67% of the PTSD group and 85% of the non-PTSD-comparison group.     

Relations Between Coercive Strategies and MMPI-2 Scale Elevations Among Women Survivors of Childhood Sexual Abuse

The relationship between coercion strategies used by perpetrators of childhood sexual abuse (CSA) and elevations of CSA survivors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was investigated. Participants were 151 women survivors of CSA in outpatient treatment at a university-based community mental health center. Scores on the MMPI-2 clinical scales and the Keane posttraumatic stress disorder (PTSD) scale were examined. Main effects were found for promised or received rewards on several clinical scales and the PTSD scale of the MMPI-2, independent of the presence of force. Specifically, the presence of such rewards was associated with significantly higher levels of symptomatology on Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), and PTSD (Pk). There were no main or interaction effects noted for the presence of actual or threatened force on any of the scales.     

MMPI, MMPI-2 and PTSD: Overview of Scores, Scales, and Profiles

A number of issues should be considered when applying profile interpretations and subscales derived from the original MMPI. These issues and the overall utility of the MMPI-2 for posttraumatic stress disorder (PTSD) evaluations are summarized. The Keane PTSD scale is found to be an effective tool for differential diagnosis when a cut-off score of 28 is used. The Schlenger PTSD scale warrants additional study. Various MMPI-2 validity scales are useful in detecting malingering, but concurrence regarding cut-off scores is lacking. The 2-8/8-2 MMPI PTSD profile does not emerge as consistently on the MMPI-2 as it did on the MMPI, due to the frequent elevation of scale 7 on the MMPI-2.     

MMPI-2 Scores in the Outcome Prediction of Gastric Bypass Surgery

Background: A psychological assessment is critical for morbidly obese patients seeking Roux-en-Y gastric bypass (RYGBP) surgery. The Minnesota Multiphasic Personality Inventory (MMPI) has been widely used in past psychological studies of bariatric surgery patients, but, to date, there is no published research on the more recent version of the MMPI, the Minnesota Multiphasic Personality Inventory-2 (MMPI2), and its relation to RYGBP outcome.This investigation was designed to evaluate the predictive validity of the MMPI-2 with respect to outcome of RYGBP for morbid obesity. Methods: The research involved a retrospective analysis of MMPI-2 scores of 2 groups of patients 1 year following RYGBP: 1) those who lost ≥ 50% of their excess weight and 2) those who lost <50% of their excess weight. Subjects were 52 morbidly obese patients (mean age 44 years, mean BMI 56 kg/m2).The measurement of psychological variables consisted of the MMPI-2 scores of 3 validity scales, 10 clinical scales, and 3 Content Scales, and BMI. Results: Those who lost <50% excess weight scored significantly higher than those who lost >50% excess weight on the F,Hysteria, Paranoia, and Health Concerns scales of the MMPI-2, and significantly lower on the Masculinity-femininity scale. Stepwise regression analysis found that a combination of the Health Concerns and Masculinity-femininity scales was the most accurate predictor model for 1-year post-surgery weight loss. Conclusion: A standard personality measure, the MMPI-2, appears to be associated with weight loss outcome 1 year after RYGBP. Psychological traits such as anxiety and excessive health concerns are likely to influence bariatric surgical outcome.     

Assessment of response style in combat veterans seeking compensation for posttraumatic stress disorder

This study examined response styles of veterans seeking compensation for PTSD (N = 204). Veterans were classified as having a valid or overreporting response style based on their scores on three MMPI-2 validity scales that measure overreporting F, F(p), F-K. Sixteen percent of veterans had valid scores on all three scales. The number of veterans classified as having an overreporting response style differed depending on which scale was used. This finding highlights the importance of using multiple validity scales to measure response style. Veterans who were and were not classified as overreporters were compared on measures of combat exposure, PTSD, and depression.     

The Occurence of Mood and Anxiety Disorders in Heart Transplant Recipients

Fortynine heart transplant recipients were evaluated during the first weeks after orthotopic heart transplantation. Using the ICD-10 (International Classification of Diseases–10th revision) criteria, we studied the incidence of anxiety disorders as well as 17 demographic and medical factors potentially influencing the probability of their occurrence. A smaller 36-person group was evaluated using standard psychopathologic scales for anxiety and mood disorders. Cox regression analysis was used to specify which of 11 demographic and medical factors influenced the time to occurrence of the first episode of a mental disorder. Anxiety episodes occurred in 25 patients, depressive episodes in 27, (hypo)manic in 3, and 12 manifested a slightly elevated mood. The risk of occurrence of anxiety and mood disorders was highest during the first 3 weeks after OHT. “False alarms,” namely, calls to the clinic not ending up in transplantation, and coexisting illnesses were related to higher incidences and earlier appearance of anxiety and mood disorders. The risk of occurrence of an anxiety syndrome was greater among older patients. Anxiety syndromes were manifested earlier in patients who underwent transplantation due to ischemic cardiomyopathy than in patients with heart failure caused by other factors. A greater number of false alarms, of long-lasting hospitalizations, and of low mean cyclosporine levels were risk factors for depressive episodes.     

Symptom Exaggeration and Compensation Seeking Among Combat Veterans with Posttraumatic Stress Disorder

Combat veterans seeking treatment for posttraumatic stress disorder (PTSD) tend to report high levels of psychopathology on self-report instruments. The purpose of the current archival study was to replicate research on the relationships among symptom exaggeration, attempts to obtain compensation, and treatment outcome on the Beck Depression Inventory, the Mississippi Scale for Combat-Related PTSD, and selected MMPI-2 and MCMI-II subscales. Results indicated that symptom exaggeration as defined by an MMPI-2 F-K index over 13 was related to higher scores on all scales examined. Compensation seeking was not related to assessment scores or exaggeration. Neither compensation seeking nor exaggeration was related to treatment outcome. Limitations of the study and implications for future research are discussed.     

Glasgow Coma Scores,Early Opioids,and Posttraumatic Stress Disorder Among Combat Amputees

A recent study found that combat amputees had a reduced prevalence of posttraumatic stress disorder (PTSD) compared with nonamputees with serious extremity injuries. We hypothesized that an extended period of impaired consciousness or early treatment with morphine could prevent consolidation of traumatic memory and the development of PTSD. To examine this hypothesis, we retrospectively reviewed 258 combat casualty records from the Iraq or Afghanistan conflicts from 2001–2008 in the Expeditionary Medical Encounter Database, including medications and Glasgow Coma Scale (GCS) scores recorded at in‐theater facilities within hours of the index injury. All patients sustained amputations from injuries. Psychological diagnoses were extracted from medical records for 24 months postinjury. None of 20 patients (0%) with GCS scores of 12 or lower had PTSD compared to 20% of patients with GCS scores of 12 or greater who did have PTSD. For patients with traumatic brain injury, those treated with intravenous morphine within hours of injury had a significantly lower prevalence of PTSD (6.3%) and mood disorders (15.6%) compared to patients treated with fentanyl only (prevalence of PTSD = 41.2%, prevalence of mood disorder = 47.1%). GCS scores and morphine and fentanyl treatments were not significantly associated with adjustment, anxiety, or substance abuse disorders.     

Compensation seeking status and psychometric assessment of combat veterans seeking treatment for PTSD

Examined differences between compensation seeking (CS) veterans and noncompensation seeking (NCS) veterans on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and other psychological measures in 142 combat veterans evaluated for posttraumatic stress disorder (PTSD) at an outpatient Veterans Affairs (VA) hospital PTSD clinic. Patients were grouped on the basis of their compensation seeking status, with 69% classified as CS for PTSD. The CS veterans achieved significantly more pathological scores across a wide range of psychological inventories and MMPI-2 validity indices, although they did not differ in frequency of PTSD diagnoses from NCS veterans. Implications of these findings are discussed, and clinicians are advised to be aware of the compensation seeking status of combat-veterans being evaluated for PTSD.     

对面部烧伤整形患者伴有情绪障碍人本主义心理干预的疗效评估

目的：探讨应用人本主义疗法对伴有情绪障碍的面部烧伤整形患者实施心理干预的效果。方法：将63例伴有情绪障碍的面部烧伤整形住院患者随机分为干预组31例,对照组32例。对照组给予常规心理护理,干预组在常规心理护理的基础上,给予人本主义疗法。两组患者在干预前后的心理状况分别用焦虑自评量表（SAS）、抑郁自评量表（SDS）和症状自评量表（SCL-90）进行评价。结果：干预组在干预后焦虑和抑郁情绪、思维、情感、行为、人际关系等方面较对照组有统计学意义,P〈0.01。结论：应用人本主义疗法对伴有情绪障碍的面部烧伤整形患者实施心理干预能显著地降低焦虑和抑郁情绪,改善患者的症状,在临床烧伤整形患者心理护理中效果明显,措施可行。     

Mental Disorders and Their Association With Disability Among Internally Displaced Persons and Returnees in Georgia

There remains limited evidence on comorbidity of mental disorders among conflict‐affected civilians, particularly internally displaced persons (IDPs) and former IDPs who have returned to their home areas (returnees). The study aim was to compare patterns of mental disorders and their influence on disability between IDPs and returnees in the Republic of Georgia. A cross‐sectional household survey was conducted with adult IDPs from the conflicts in the 1990s, the 2008 conflict, and returnees. Posttraumatic stress disorder (PTSD), depression, anxiety, and disability were measured using cut scores on Trauma Screening Questionnaire, Patient Health Questionnaire 9, Generalised Anxiety Disorder 7, and the WHO Disability Assessment Schedule 2.0. Among the 3,025 respondents, the probable prevalence of PTSD, depression, anxiety, and comorbidity (>1 condition) was 23.3%, 14.0%, 10.4%, 12.4%, respectively. Pearson correlation coefficients (p < .001) were .40 (PTSD with depression), .38 (PTSD with anxiety), and .52 (depression with anxiety). Characteristics associated with mental disorders in regression analyses included displacement (particularly longer‐term), cumulative trauma exposure, female gender, older age, poor community conditions, and bad household economic situation; coefficients ranged from 1.50 to 3.79. PTSD, depression, anxiety, and comorbidity were associated with increases in disability of 6.4%, 9.7%, 6.3%, and 15.9%, respectively. A high burden of psychiatric symptoms and disability persist among conflict‐affected persons in Georgia.     

Comparison of the domains of anxiety and mood of the University of Washington Head and Neck Cancer Questionnaire (UW-QOL V4) with the CES-D and HADS

BACKGROUND: Version 4 of the University of Washington Head and Neck Cancer Questionnaire (UW-QOLv4) includes items on mood and anxiety. The aim of this study was to compare the responses to these single items with the Centre for Epidemiology Studies Depression Scale (CES-D) and the Hospital Anxiety Depression Scale (HADS). METHODS: A cross-sectional postal survey was undertaken in April 2003. The survey was composed of all patients treated for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 who were alive and disease free. RESULTS: We distributed 306 questionnaires; there were 197 replies (65%) from 110 male and 87 female patients. Most patients reported relatively little depression, with 170 of 190 (89%) reporting a HADS depression score of less than 11. Similarly, most patients were not anxious, with 158 of 183 (86%) reporting a HADS anxiety score of less than 11. UW-QOL mood, UW-QOL anxiety, HADS anxiety, HADS depression, and CES-D scores were all moderately intercorrelated (Spearman correlations from 0.39-0.68 ignoring the signs, all p < .001). The UW-QOL mood correlated with the scores and "case-ness" categories of the HADS depression and CES-D scales, whereas the UW-QOL anxiety correlated with the scores and "case-ness" of the HADS anxiety. CONCLUSIONS: Questions on mood and anxiety can help identify significant psychological morbidity, taking a score of less than 75 for UW-QOL mood and less than 70 for UW-QOL anxiety. This could be used to trigger formal psychological assessment and with a view to possible therapeutic intervention.     

MMPI-2 Profiles of Bariatric Surgery Patients: A Replication and Extension

BACKGROUND: Maddi et al. (Obes Surg, 7:397-404, 1997) reported significant elevations on several MMPI-2 scales in a morbidly obese population. Since the number of patients presenting for bariatric surgery has increased significantly in the decade since this study, we replicated the original Maddi et al. study to investigate if there have been any appreciable changes in these patients' psychological profiles within the past 10 years. METHODS: First, we replicated the original Maddi et al. study using the same definition of profile elevations used by these investigators. Second, we extended these findings to include a fourth classification of extremely elevated profiles. Finally, we included several measures of different emotional states/characteristics in an attempt to further delineate what these elevated profiles may actually represent. RESULTS: Our findings generally support the results of the original Maddi et al. study. Additionally, a number of significant relationships were found between our additional measures and MMPI-2 elevations. CONCLUSIONS: Many morbidly obese patients presenting for bariatric surgery have elevated MMPI-2 profiles, some of which would be considered "invalid" profiles. We recommend procedures for obtaining more valid profiles from such patients. We also urge the use of other measures in addition to the MMPI-2 to more specifically clarify the personality traits/characteristics in these patients.     

Assessing the effects of violence on women in battering relationships with the Keane MMPI-PTSD Scale

The Minnesota Multiphasic Personality Inventory (MMPI)-Keane Posttraumatic Stress Disorder (PTSD) Scale (PK) has proven to be a reliable and valid measure of PTSD in combat veterans. However, few studies have examined the scale's validity in battered women, who often present with PTSD. Using empirically derived cutoff scores for the PK Scale, 69 battered women were assigned to PTSD-Positive and PTSD-Negative groups and then compared on measures of PTSD, distress, social support, and history of abuse in and out of the battering relationship. The PTSD-Positive group scored significantly higher across all measures of PTSD and distress, supporting the concurrent validity of the PK Scale in this population. However, the two groups differed only for the frequency of death threats, suggesting that the PK Scale is only mildly sensitive to the level of trauma exposure. Finally, lower levels of perceived social support were found in the PTSD-Positive than the PTSD-Negative group. Implications of these findings for the assessment of PTSD in battered women are discussed.     

MMPI‐2 assessed post‐traumatic stress disorder related to job stress,coping, and personality in police agencies

The PK and PS scales of the MMPI‐2 were developed to index the degree of post‐traumatic stress disorder (PTSD). These scales were applied to a sample of 254 mostly male sworn and civilian law enforcement employees from four police agencies. Participants also completed surveys measuring their perceived levels of job stress, their use of a set of coping strategies, and their performance on measures of five global personality domains. The two PTSD scales appeared to have good internal structures and relatively high reliabilities. Employees at greater risk for PTSD reported higher levels of work‐related stress, seemed to use more maladaptive coping strategies, were more neurotic, and tended to be less extraverted, agreeable, and conscientious. Copyright © 2004 John Wiley & Sons, Ltd.     

Posttraumatic stress disorder among deliberate self-poisoning patients

This study explored posttraumatic stress disorder (PTSD) among suicide attempters. Participants were 330 hospital-treated deliberate self-poisoning (DSP) patients. Twelve-month prevalence of PTSD and comorbid psychiatric disorders was determined using the Composite International Diagnostic Interview (CIDI-A). Standard disability measures and demographic information were also obtained. PTSD prevalence was 32% among women and 15% among men. The PTSD group had significantly higher levels of affective disorder, anxiety disorders other than PTSD, psychiatric disability, and service utilization than DSP patients without PTSD. Logistic regression modeling showed that PTSD was associated with the type of traumatic event, number of events, affective disorder, and anxiety disorder other than PTSD.     

The use of the MCMI in the personality assessment of head-injured adults

MCMI (Millon Clinical Multiaxial Inventory) profiles of 79 head-injured patients were compared with self-report of personality change following head injury. Mean MCMI scale scores were highest on Scales D (Dysthymia), A (Anxiety), 6 (Antisocial), H (Somatoform), 5 (Narcissistic) and 7 (Compulsive). Taking only high-point codes above an adjusted base-rate score of 75, the sample showed most frequent elevations on A (Anxiety), D (Dysthymia), H (Somatoform), 5 (Narcissistic), 6 (Antisocial-Aggressive) and 8 (Passive-Aggressive), in order of cumulative frequency. Personality trait scales and clinical scales were compared with self-report of personality change. Elevated personality trait scales correlated with self-reports of dysfunction and so did clinical scale elevations. There was no relationship between the number of elevated scales and severity of head injury, nor between the number of elevated scales and interval after head injury.     

Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors

To test the predictive power of peritraumatic dissociation for the development of psychopathology, the authors assessed symptoms of peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire; PDEQ), posttraumatic stress disorder (Clinician-Administered PTSD Scale; CAPS), anxiety and depression (Hospital Anxiety and Depression Scale; HADS) in a sample of 214 accident victims 5 days postaccident (T1). Six months later (T2), CAPS and HADS were administered again. Acute stress disorder (ASD) and PTSD symptom levels were surprisingly low. In sequential regression analyses, initial reexperiencing and hyperarousal significantly predicted PTSD symptom level (T2) over several possibly confounding variables controlled for. Peritraumatic dissociation explained less than 3% of variance. For PTSD scores, 38% overall variance explanation was obtained; the variance for HADS scores was low. Possible explanations for the low-predictive power of peritraumatic dissociation for posttraumatic psychopathology in the sample are discussed.     

MMPI-2 Data for Australian Vietnam Veterans with Combat-Related PTSD

Considerable attention has been devoted to the MM PI in the assessment of combat-related PTSD. To date, published data have focused almost exclusively on American Vietnam veterans. This study investigated MMPI-2 profiles of 100 Australian Vietnam veterans admitted to an intensive PTSD treatment program. Comparisons with United States (U.S.) data suggested strong similarities between the American and Australian populations in terms of F-scale elevations and typical 3-point code types (8-7-2). However, the American samples showed relatively higher elevations of Scales 4 and 6, suggesting social alienation and a tendency to externalize, while a subgroup of Australian veterans showed a greater propensity for somatization (Scale 1). The results provide overall support for the generalizability of American MMPI data to an alternative cultural group of combat veterans.     

Attention Bias Variability and Symptoms of Posttraumatic Stress Disorder

Cognitive theories implicate information‐processing biases in the etiology of anxiety disorders. Results of attention‐bias studies in posttraumatic stress disorder (PTSD) have been inconsistent, suggesting biases towards and away from threat. Within‐subject variability of attention biases in posttraumatic patients may be a useful marker for attentional control impairment and the development of posttrauma symptoms. This study reports 2 experiments investigating threat‐related attention biases, mood and anxiety symptoms, and attention‐bias variability following trauma. Experiment 1 included 3 groups in a cross‐sectional design: (a) PTSD, (b) trauma‐exposed without PTSD, and (c) healthy controls with no trauma or Axis I diagnoses. Greater attention‐bias variability was found in the PTSD group compared to the other 2 groups ; attention‐bias variability was significantly and positively correlated (r = .37) with PTSD symptoms. Experiment 2 evaluated combat‐exposed and nonexposed soldiers before and during deployment. Attention‐bias variability did not differentiate groups before deployment, but did differentiate groups during deployment ; increased variability was observed in groups with acute posttraumatic stress symptoms and acute depression symptoms only. Attention‐bias variability could be a useful marker for attentional impairment related to threat cues associated with mood and anxiety symptoms after trauma exposure.