Keane PTSD scale: MMPI and MMPI-2 update

This paper addresses questions regarding the use and interpretation of the Keane MMPI PTSD scale. Particular focus is placed on issues to consider when using various versions of the MMPI including Form R, the group form, and the new MMPI-2.     

MMPI Scales for Diagnosing Acute and Chronic PTSD in Civilians

To develop new Minnesota Multiphasic Personality Inventory (MMPI) scales for diagnosing acute and chronic posttraumatic stress disorder (PTSD), 237 civilians with PTSD or panic disorder (controls) completed the MMPI-R. All 399 items were submitted to chi-square analysis to select those differentiating acute or chronic PTSD from controls. The analyses yielded an MMPI Acute PTSD scale (32 items) and a MMPI Chronic PTSD scale (41 items). Discriminating between acute PTSD and controls, the MMPI Acute PTSD scale had a hit rate of 83% and the MMPI Chronic PTSD scale produced a hit rate of 75% to 80%. Cross-validation produced similar hit rates. These scales scores were not substantially influenced by gender or types of traumatic events, and only the MMPI Acute PTSD scale seemed to not be sensitive to co-morbidity.     

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.     

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.     

The Keane PTSD Scale extracted from the MMPI: Sensitivity and specificity with Vietnam veterans

A study was conducted to further investigate whether the Keane Posttraumatic Stress Disorder (PTSD) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) can be employed as a separate instrument administered outside the context of the full MMPI. A group of Vietnam combat veterans with diagnosed PTSD and two comparison groups of veterans without PTSD (Vietnam combat and era veterans) were diagnosed by clinical interviews. Over 84% of the 64 veterans in the study were accurately classified by the Keane PTSD Scale into their original diagnostic groups. Excellent test sensitivity was demonstrated, with 90% of combat veterans with PTSD being properly classified by the Keane PTSD Scale when the recommended cutoff score of 30 was utilized. The clinical and research implications are discussed.     

MMPI profiles of acute and chronic PTSD in a civilian sample

In a treatment setting, a group of 165 subjects presenting with either acute or chronic posttraumatic stress disorder (PTSD) were compared to 72 subjects presenting with panic disorder only in order to determine whether the MMPI PTSD assessment strategy developed with Vietnam veterans could be validly used with civilians. Results indicated that the MMPI profile, codetype, diagnostic decision rule, and PK scale developed with samples of Vietnam veterans did not apply well to civilians, especially those presenting with acute PTSD. It is thus recommended that specific assessment strategies be developed for these populations.     

Examining comorbidity and posttraumatic stress disorder in a vietnam veteran population using the MMPI-2

Examined the discriminant validity of the MMPI-2 in assessing comorbidity in a posttraumatic stress disorder (PTSD) Vietnam veteran population. The Structured Clinical Interview for the DSM-III-R (SCID) was used to diagnose veterans and to classify them into four groups: PTSD Only, PTSD with mood disorders, PTSD with other anxiety disorders, and PTSD with mood and anxiety disorders. All groups had clinical elevations on scales F, 1, 2, 3, 4, 6, 7, 8, 0, PK, and PS, with peak elevations on scales 8, 7, and 2. The PTSD Only group's MMPI-2 scores were not significantly lower than other groups' scores. The PTSD+Mood/Anxiety group was significantly more elevated on scales 2 and 7 than the PTSD Only and PTSD+Anxiety group but did not otherwise show significantly higher scale elevations than other groups. No significant differences existed between groups on scales F, L, K, PK, and PS. Implications of these results for PTSD and the current diagnostic system are explored.     

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.     

Multidimensional assessment of combat-related PTSD: Phenomenological,psychometric, and psychophysiological considerations

The literature on assessment of PTSD in combat veterans is discussed as it relates to several major diagnostic issues. Studies bearing on the validity of the PTSD diagnosis are presented. Additionally, a multidimensional assessment of PTSD is described in detail. The major assessment instruments currently used are discussed and the research supporting the selection of each of the assessment tools is presented.     

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.     

A study of the MMPI clinical and research scales for post-traumatic stress disorder diagnostic utility

Controversy exists as to the utility of the MMPI in diagnosing post-traumatic stress disorder (PTSD). Studies of an empirically developed PTSD Subscale for the MMPI have had conflicting results. In this study 84 MMPI clinical and research scales, including the PTSD Subscale, of 234 Vietnam War veterans (+PTSD=117, -PTSD=117) were compared to determine the clinical usefulness of the scales for differential diagnosis of PTSD. The veterans were all inpatients applying for admission to a PTSD treatment program. The MMPI clinical profile for PTSD was corroborated, though it had little statistically significant difference than the average profile of the -PTSD group. The PTSD Subscale was slightly better than chance in classifying veterans. A number of research scales were found to be as or more accurate than the PTSD Subscale in terms of true hit rates.     

Identifying Subtypes of Women Survivors of Childhood Sexual Abuse: An MMPI-2 Cluster Analysis

This paper investigated subtypes of women childhood sexual abuse (CSA) survivors through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 117 women in outpatient treatment for CSA aftereffects at a university-affiliated community mental health center. Three well-fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and MANOVAs; a 5-cluster solution was deemed optimal. Follow-up analyses demonstrated significant between-cluster differences on the Impact of Event Scale, Beck Depression Inventory, Dissociative Experiences Scale, and nearly all Symptom Checklist-90-Revised subscales. No differences emerged when comparing clusters on the Family Environment Scale and their CSA characteristics. Implications were considered for research and clinical practice, using the MMPI-2 with CSA survivors.     

MMPI Profiles of Female Candidates for Obesity Surgery: A Cluster Analytic Approach

Background: Early attempts to characterize personality in obese persons led to the conclusion that the severely obese are not homogeneous on personality measures. More recently, cluster analysis procedures have been applied to identify meaningful personality subtypes in populations of persons with severe obesity; some progress has been made in this effort, but researchers have indicated the need for replication in other settings. Methods: In the present study, the Minnesota Multiphasic Personality Inventory (MMPI) was administered to 163 female candidates for intestinal bypass surgery. Results: Eight clusters were identified. Of the MMPI profiles, 71% were in one of four normal limit clusters. The remainder were distributed across four clusters, all beyond normal limits. Conclusions: Present and previous results appear to converge on representative personality subtypes in severe obesity. Identification of such meaningful subgroups of candidates for obesity surgery may enhance the prediction of surgery outcomes, and yield a better understanding of personality in severely obese women.     

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.     

Certain psychological characteristics of soldiers injured in the 1991–1993 war in Croatia

To describe the level of neuroticism and alexithymia of traumatised soldiers and the impact of psychosocial context on the experience of traumatising injury and personality, MMPI subscales Hypochondriasis (Hs), Depression (D), Hysteria (Hy) and Alexithymia (Al), Post‐Traumatic Symptom Scale, IOES‐15 for Intrusive subset and Avoidance subset and a revised version of CIDI‐PTSD interview were used. Active non‐injured soldiers and non‐disabled soldiers scored significantly higher on Hysteria and Depression than permanently disabled soldiers and healthy controls. No significant differences between the groups were found on Hypochondriasis, Alexithymia, PTSS, Impact of Event Scale. Specific psychosocial context, apprehension of the trauma and the anticipation and fear of new trauma seem to have a stronger impact on the injured soldiers than the injury itself. Copyright © 2000 John Wiley & Sons, Ltd.     

MMPI-2 F scale elevations in adult victims of child sexual abuse

The present study assessed whether the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) F scale elevations may reflect genuine trauma-related distress and/or psychopathology, rather than malingering, in a clinical sample of adult child sexual abuse (CSA) victims. Eighty-eight women seeking outpatient treatment for CSA after-effects participated. Self-report measures of dissociation, posttraumatic stress, depression, and family environment individually correlated significantly with F, and collectively accounted for 40% of its variance. Dissociation was the strongest predictor. Findings suggest that high F elevations may reflect genuine problem areas often found among CSA victims, rather than symptom overreporting.     

Screening for PTSD in a Substance Abuse Sample: Psychometric Properties of a Modified Version of the PTSD Symptom Scale Self-Report

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSSSR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.     

Assessment of older combat veterans with the Clinician-Administered PTSD Scale

A study of the posttraumatic stress disorder (PTSD) among older combat veterans of World War II and the Korean Conflict was conducted. The Clinician-Administered PTSD Scale (CAPS) was given to 125 older combat veterans, along with a computerized variant of the Structured Clinical Interview for DSM-III-R for PTSD, the SCID-DTREE. (The SCID-DTREE was itself validated against the full SCID). Results showed the CAPS to be a good discriminator of PTSD: Out of the 125 cases, only 9 were misclassified using the SCID-DTREE as the base measure, a 93% efficiency. An alpha on the full CAPS was .95. This suggests that the CAPS is an appropriate scale for use with older combat veterans.     

MMPI profiles and post-traumatic symptomatology in former prisoners of war

Results of this study found that prisoners of war (POWs) tend to produce a basic 1, 2, 3 (Hs, D, Hy) configuration on the MMPI which has also been found in other studies. Significant differences were found for different subgroupings on specific scales, but the same basic, 1, 2, 3 configuration was maintained for all groups. Subjects were found to display considerable PTSD symptomatology as depicted by independent psychiatric interviews and performance on an Impact of Events Scale (IES). Post-Traumatic Stress Disorder (PTSD) symptoms were also found to dissipate over time. Results are discussed in reference to the possible use of somatization as a means of handling stress and how the manifestation of PTSD in this population differ from that seen in Vietnam combat veterans suffering from PTSD.     

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.