MCMI comparisons of cocaine abusers and heroin addicts

Cocaine addicts (N = 107) and opiate addicts (N = 86) in treatment for drug abuse were compared on the MCMI. Univariate analyses revealed that cocaine abusers showed more traits of the antisocial personality style, whereas heroin addicts evinced more problems with anxiety and somatic distress, probably related to residual problems of withdrawal, and alcohol abuse. Multivariate analyses revealed four distinct clusters (MCMI patterns 456', 865', 56', and 8') that aligned by underlying personality style and clinical syndrome expression rather than by drug of choice. Ideographic analyses further demonstrated consistencies in prevalence rates of DSM-III-R personality disorders. Results do not support the pharmacodynamic theory of drug abuse. It was concluded that the similarities in personality between these two groups are greater than their differences.     

The Millon Clinical Multiaxial Inventory (MCMI) as a treatment outcome measure for psychiatric inpatients

The Millon Clinical Multiaxial Inventory (MCMI) is a 175-item inventory designed to assess both clinical symptomatology and underlying, more enduring personality traits and syndromes. The purpose of this study was to determine whether the MCMI personality scales evidenced greater stability over time than did the MCMI symptom scales. The MCMI was administered to 151 consecutively admitted inpatients at an acute care, private psychiatric hospital. Patients were administered the MCMI shortly after admission and shortly before discharge. Results indicated that the personality scales evidenced greater stability than the symptomatology scales, although statistically significant changes between admission and discharge scores also occurred for the personality scales. Implications are discussed.     

Treatment outcomes of Vietnam veterans with PTSD and the consistency of the MCMI

This study addresses two issues: treatment changes on the MCMI of Vietnam veterans with PTSD and test-retest reliability of the Millon Clinical Multiaxial Inventory (MCMI). Fifty Vietnam veterans carefully were identified for the diagnosis Post-Traumatic Stress Disorder (PTSD). They were admitted to a Special PTSD Treatment Unit that consisted of an intense 5-week period with focus on the revivified Vietnam experience. They also were given the MCMI at two points in time, treatment inception and 35 days later at discharge. Results show that 17 of 20 scales on the MCMI changed in the negative direction as a result of treatment. Also, the MCMI has adequate test-retest reliability, and the personality scales (with the exception of Borderline) have higher reliability coefficients than do symptom scales. The use of the MCMI is encourged both as a monitor of treatment for these veterans and for its stability.     

Validity of the MCMI Drug Abuse Scale with drug abusing and psychiatric samples

The validity of the Drug Abuse Scale (T) from the Millon Clinical Multiaxial Inventory (MCMI) was studied by administering the MCMI to 75 White male veterans who were seeking treatment for opioid or cocaine dependence and 60 White male veterans without diagnoses of drug dependence who were receiving psychiatric care. Only (39.4%) of the drug-abusing sample was classified correctly by obtaining base rate (BR) scores above the clinical relevant cut-off of 74, whereas, only 12% of the psychiatric sample was misclassified by having obtained a BR above 74. The results suggest that the MCMI T Scale is limited in its ability to identify drug users, but is also unlikely to misclassify psychiatric patients as drug abusers when they are not. The authors urge caution in using the Drug Abuse Scale for the purpose of identifying drug abusers.     

Age differences among psychiatric inpatients on the MCMI

A 2 x 2 x 3 MANOVA was applied to MCMI BR scores obtained from 310 newly admitted psychiatric inpatients. The study's purpose was to test the effect of patients' age (age less than 36 vs. age greater than = 36), race (White/Black), and diagnosis (paranoid schizophrenic/nonparanoid schizophrenic/non-psychotic, nonaffectively disturbed) across MCMI personality and clinical syndrome scales. On the MCMI personality syndrome scales, age, race, and diagnosis were significant. Racial differences were consistent with recently reported research (Davis, Greenblatt, & Pochyly, 1990), but the significant differences in diagnosis were opposite the direction that might be predicted from the MCMI manual. Older patients tended to produce lower symptom scale scores than younger patients, with the most meaningful difference found on the Drug Abuse scale.     

Factor-based special scales for the MCMI

Factor analytic work with the Million Clinical Multiaxial Inventory (MCMI) has shown a remarkably stable factor structure. The eight Basic Personality scales have a three-factor structure: Aloof/Social, Submissive/Aggressive, and Labile/Restrained. These dimensions appear to be the same as those suggested by the DSM-III-R advisory committee on personality disorders. The MCMI as a whole has a five-factor structure: Detached, Submissive, Suspicious, High Social Energy, and General Distress. The present work operationalizes these two sets of factors into scales for use by clinicians and researchers. The resultant scales show excellent reliabilities across three subject samples (N = 253, N = 185, N = 184) and demonstrate appropriate convergent and divergent validity estimates against the MCMI itself.     

Use of the Millon Clinical Multiaxial Inventory (MCMI) as a screening instrument at a community mental health center

Comparison of the Millon Clinical Multiaxial Inventory (MCMI) and clinician-generated DSM-III diagnoses for a sample of psychiatric outpatients (N = 72) indicated only chance agreement. The MCMI was of limited use as a screening device because of overdiagnosis and failure to identify individuals who prematurely terminated treatment. Other potential problems with the instrument included substantial intercorrelation among scales and possible pathologizing of stereotypic feminine traits. The characteristic structure of the MCMI appeared stable across patient samples; there was evidence for identification of a mean profile for psychiatric patients who voluntarily seek treatment for subjective distress.     

The relationship between the Millon Clinical Multiaxial Inventory and the MMPI in a private outpatient mental health clinic population

The concurrent validity of the MCMI as compared to the MMPI was assessed by administering both tests to 106 newly admitted outpatients and calculating the intercorrelations between these two tests. Of the 20 MCMI scales, 12 were found to correlate with the MMPI in a manner that suggested that they do measure some degree of personality dysfunction, emotional disturbance, or specific psychological symptomatology. Eight of the MCMI scales failed to show correlations that would indicate that they effectively measure any of the pathological personality characteristics or clinically significant symptom patterns known to be measured by the MMPI.     

Factor structure of the MCMI among personality disordered outpatients and in other populations

This study examined the factor structure of the Millon Clinical Multiaxial Inventory (MCMI) for a sample (N = 60), which consisted largely of personality disordered outpatients. Results are integrated with previous studies to identify the underlying MCMI dimensions across differing psychiatric populations. Three principal axis Varimax rotated factors emerged from the current study: affectively charged general maladjustment; impulsive acting-out style; and psychotically tinged isolation. Comparison with results of previous studies that involved four diverse samples indicated a large amount of stability for scales that load on the first factor. Factor two shows much less consistency across the five studies, but frequent reappearance of the drug abuse and other acting-out scales suggests a general dimension that reflects acting-out substance abuse. Across studies the third factor shows even more inconsistency, although there is some evidence for a social detachment pattern.     

Concurrent validity of the clinical symptom syndrome scales of the millon clinical multiaxial inventory

This study examined relationships between the clinical symptom syndrome scales of the Millon Clinical Multiaxial Inventory (MCMI) and the various clinically meaningful mood or symptom states measured by the six Profile of Mood States (POMS) scales (N = 243). The MCMI symptom scale—POMS symptom/mood scale relationships found in this study were compared with MCMI symptom scale—MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual (Millon, 1983). Results of the present investigation, when combined with results of the previous analyses reported in the MCMI manual, reveal a number of consistent associations of moderate strength between MCMI symptom scales and selected mood or symptom scales from the MMPI and Symptom Checklist-90 as well as from the POMS. Although most relationships between the MCMI symptom scales and the symptom/mood scales of the POMS, MMPI and SCL-90 were consistent with expectation, the Anxiety, Dsythymia and Psychotic Depression scales of the MCMI show limited ability to discriminate appropriately between anxiety and depression in several of the concurrent validity analyses considered herein.     

Validity of the Narcissistic Personality Inventory (NPI) in a psychiatric sample

Investigated the validity of the Narcissistic Personality Inventory (NPI) in a psychiatric sample. Fifty psychiatric patients were given the NPI as part of a routine psychological evaluation. Correlations between the NPI and the basic personality style scales of the Millon Clinical Multiaxial Inventory (MCMI) were obtained; the largest correlation was between the NPI and the narcissism scale of the MCMI (r = .66, p less than .001). When classified into the low and high narcissistic groups, there was 74% agreement between the NPI and narcissistic scale of the MCMI. These results provide further support for the construct validity of the NPI.     

Development of psychiatric illness in drug abusers. Possible role of drug preference.

The origin of the psychiatric illnesses observed in drug abusers is often unclear. This study examines the causal relation between drug abuse and specific psychiatric disorders. Fifty-one male veterans first seen in 1972, who were admitted at least once per year for six consecutive years for inpatient drug-abuse treatment, underwent psychiatric assessments at each admission. Eleven men mainly used stimulants, 14 depressants, and 26 opiates. Initial psychiatric examinations showed low symptom levels in all groups but no statistically significant differences among them. By the end of six years, five of the stimulant users had psychoses, and eight of the depressant users had serious depression. The narcotics users showed no change in psychopathology. Differences between the groups were significant at the 0.01 level. These changes were not due to acute toxic reactions, but our data suggest that abuse of particular drugs has a major role in the development of specific psychiatric illnesses. The possibility that different preexisting personality disorders lead to different kinds of drug abuse cannot be excluded.     

Key 15-item memorization and dot counting scores in a “stress” claim worker's compensation population: Relationship to personality (MCMI) scores

The relationship between apparent faking of cognitive impairment (as detected by such “malingering” tests as 15-item Memorization and Dot Counting) and faking of psychiatric symptoms has not been investigated formally. In addition, no empirical literature is available on the relationship between personality traits and faking of cognitive symptoms. Of 154 subjects who claimed “stress” psychiatric injury, 12% appeared to be faking cognitive impairment; 4.5% failed the 15-item Memorization Test, and 10% failed the Dot Counting task. Faking of cognitive symptoms occurred in only 23% of subjects who were faking/exaggerating psychological symptoms on the MCMI. Malingering test failure was associated with significant elevations on MCMI personality scales, although this appeared to be an artifact of attempts to fake/exaggerate on the MCMI, rather than a reflection of “true” personality traits.     

Millon Clinical Multiaxial Inventory (MCMI) findings among breast clinic patients after initial evaluation and at 4- or 8-month follow-up

Twenty-seven patients who subsequently underwent benign biopsy and 41 patients diagnosed to have breast cancer completed the Millon Clinical Multiaxial Inventory (MCMI) after initial examination in a breast problem clinic and again after 4 months or, for CA patients who were completing a course of chemo/radio-therapy, after 8 months. At initial testing, the trend toward fewer moderate-severe disorders among the benign biopsy (BB) group did not reach statistical significance. However, at follow-up, the difference was significant; the BB group showed fewer moderate-severe disorders (7.5%) than the cancer (CA) group (29%). Concordance of two-point peak elevations on scales 1-8, S, C, and P was examined. For the BB group, 56% had the same two high points on both testings, compared to only 27% of the CA group. Test-retest correlations on personality scales were generally lower for the CA group than for the BB group. We concluded that (1) approximately 30% of breast CA patients showed a disruption of psychological adjustment clearly severe enough to merit consideration of a mental health referral; (2) despite the frequency of significant distress, major affective and thought disorders were infrequent among this group; (3) distress associated with breast CA may interfere with the reliable assessment of long-standing personality traits.     

Effectiveness of abstinence-based incentives: interaction with intake stimulant test results

Intake urinalysis test result (drug positive vs. negative) has been previously identified as a strong predictor of drug abuse treatment outcome, but there is little information about how this prognostic factor may interact with the type of treatment delivered. The authors used data from a multisite study of abstinence incentives for stimulant abusers enrolled in outpatient counseling treatment (N. M. Petry, J. M. Peirce, et al., 2005) to examine this question. The first study urine was used to stratify participants into stimulant negative (n = 306) versus positive (n = 108) subgroups. Abstinence incentives significantly improved retention in those testing negative but not in those testing positive. Findings suggest that stimulant abusers presenting to treatment with a stimulant-negative urine benefit from abstinence incentives, but alternative treatment approaches are needed for those who test stimulant positive at intake.     

Personality disorder correspondence among the MMPI,MBHI, and MCMI

MMPI, MBHI, and MCMI personality disorder scales were analyzed for convergent and discriminant validity. Friedman's ANOVA indicated that there were no significant differences among the sample's averaged scale scores. Further analyses of these data, however, demonstrated that the Millon instruments classified significantly more of the sample as personality disordered when compared to Morey's MMPI personality disorder scales. In addition, codetype correspondence among the three instruments was only 4 to 6%. When the instruments were analyzed in a pair-wise fashion, codetype correspondence increased to approximately 10 to 20%. These data indicate that these personality disorder scales do not demonstrate construct equivalence, particularly at the level of the individual profile.     

Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist NHS psychodynamic psychotherapy services: Results from a multi‐centre study

Objective. Little is known about socio‐demographic, diagnostic, and clinical characteristics of patients referred for assessment to psychodynamic psychotherapy services. The aim of this study was to remedy this by prospectively collecting comprehensive and systematic demographic and clinical information on a large number of patients referred to NHS psychodynamic psychotherapy services. Design. Fourteen psychotherapy services operating within a National Health Service joined the study and contributed data for 1,136 patients referred from primary and secondary care clinics. Method. Patients were assessed using questionnaires and self‐rated measures, which included the clinician‐based version of the diagnostic form of the Millon clinical multi‐axial inventory‐III‐revised edition (MCMI‐III‐R), the brief symptom inventory (BSI), the inventory of interpersonal problems (IIP), and the clinical outcome in routine evaluation (CORE). The pathway from assessment through to treatment and variables associated with treatment uptake and exclusion are described and examined. Results. Most patients were in the moderate to severe range of psychiatric severity at the time of presentation. Ninety‐five percent met clinically based criteria for a psychiatric disorder (mostly anxiety and mood disorders) and/or personality disorder. Although the majority of patients were found suitable for treatment (N=935, 82%), analysis of uptake showed relatively high rates of treatment rejection by patients and treatment drop‐out. Partial outcome data at 6‐month follow‐up after intake into treatment revealed significant change but modest effect size (d=0.35). Conclusion. Systematic collection of baseline and outcome data would provide a national database of the performance of psychotherapy services that would be invaluable in facilitating comparative studies.     

MMPI personality disorder scales and the MCMI: concurrent validity

A set of DSM-III personality disorder scales recently were developed for the MMPI. The purpose of the present investigation was to provide data on the concurrent validity of these scales. Scores from both the overlapping and nonoverlapping MMPI personality disorder scales were compared against the criterion of the personality disorder scales of the MCMI in 47 psychiatric patients. In general, the MMPI personality scales correlated significantly with the corresponding MCMI scales. However, the antisocial (ANT), compulsive (CPS), and paranoid (PAR) scales of the MMPI failed to achieve adequate concurrent validity. For the ANT scale, this probably reflects conceptual differences between the Millon (1981) typology that underlies the MCMI and the DSM-III. The PAR scale appears to show some bias toward the assessment of paranoid and suspicious ideation, rather than paranoid personality characteristics.     

Clinical applications of the MCMI: the 1-2-3-8 codetype

The MCMI profiles of 131 psychiatric inpatients were examined to identify 1-2-3-8 codetypes on the basic personality scales, which reflect a schizoid, avoidant, dependent, and passive-aggressive blend of personality traits. Approximately 25% of the inpatient sample obtained the 1-2-3-8 codetype. Analyses of the diagnoses and clinical records of these patients suggest that this profile reflects an affect/mood disturbance with prominent depressive features and suicidal ideation/attempt prior to admission. This investigation serves mainly as a stimulus for research questions that should be addressed in order to increase the range of clinical applications of the MCMI and the body of empirical literature that can support the utility of this assessment device.