Differentiating PTSD symptomatology with the MMPI-2-RF (Restructured Form) in a forensic disability sample

The current study was designed to explore models of assessing various forms of Post-Traumatic Stress Disorder (PTSD) symptomatology that incorporate both broad and more narrowly focused affective markers. We used broader markers of demoralization, negative activation, positive activation, and aberrant experiences to predict global PTSD scores, whereas more narrowly focused markers of positive and negative affect were used to differentiate between PTSD symptom clusters. A disability sample consisting of 347 individuals undergoing medico-legal psychological evaluations was used for this study. All participants completed symptom measures of PTSD and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (from which MMPI-2-RF scores were derived). The results indicated that demoralization was the best individual predictor of PTSD globally, and that more narrowly focused MMPI-2-RF Specific Problems scales provided a differential prediction of PTSD symptom clusters. Theoretical and practical implications of these findings are discussed within contemporary frameworks of internalizing personality and psychopathology.     

Reaffirming normal: The high risk of pathologizing healthy adults when interpreting the MMPI-2-RF

Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales – Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF’s multiscale composition does not contribute to high rates of elevated scores.     

Association Between the MMPI-2 Restructured Form (MMPI-2-RF) and Malingered Neurocognitive Dysfunction Among Non-Head Injury Disability Claimants

The current study examined the over-reporting Validity Scales of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008/2011) in relation to the Slick, Sherman, and Iverson (1999) criteria for the diagnosis of Malingered Neurocognitive Dysfunction in a sample of 916 consecutive non-head injury disability claimants. The classification of Malingered Neurocognitive Dysfunction was based on scores from several cognitive symptom validity tests and response bias indicators built into traditional neuropsychological tests. Higher scores on MMPI-2-RF Validity Scales, particularly the Response Bias Scale (Gervais, Ben-Porath, Wygant, & Green, 2007), were associated with probable and definite Malingered Neurocognitive Dysfunction. The MMPI-2-RF's Validity Scales classification accuracy of Malingered Neurocognitive Dysfunction improved when multiple scales were interpreted. Additionally, higher scores on MMPI-2-RF substantive scales measuring distress, internalizing dysfunction, thought dysfunction, and social avoidance were associated with probable and definite Malingered Neurocognitive Dysfunction. Implications for clinical practice and future directions are noted.     

Increased odds and predictive rates of MMPI-2-RF scale elevations in patients with psychogenic non-epileptic seizures and observed sex differences

ObjectiveThe Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a self-report instrument, previously shown to differentiate patients with epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). At present, the odds of MMPI-2-RF scale elevations in PNES patients, as well as the diagnostic predictive value of such scale elevations, remain largely unexplored. This can be of clinical utility, particularly when a diagnosis is uncertain.MethodAfter looking at mean group differences, we applied contingency table derived odds ratios to a sample of ES (n = 92) and PNES (n = 77) patients from a video EEG (vEEG) monitoring unit. We also looked at the positive and negative predictive values (PPV, NPV), as well as the false discovery rate (FDR) and false omission rate (FOR) for scales found to have increased odds of elevation in PNES patients. This was completed for the overall sample, as well as the sample stratified by sex.ResultsThe odds of elevations related to somatic concerns, negative mood, and suicidal ideation in the PNES sample ranged from 2 to 5 times more likely. Female PNES patients had 3–6 times greater odds of such scale elevations, while male PNES patients had odds of 5–15 times more likely. PPV rates ranged from 53.66% to 84.62%, while NPV rates ranged from 47.52% to 90.91%. FDR across scales ranged from 15.38% to 50%, while the FOR ranged from 9.09% to 52.47%.ConclusionsConsistent with prior research, PNES patients have greater odds of MMPI-2-RF scale elevations, particularly related to somatic concerns and mood disturbance. Female PNES patients endorsed greater emotional distress, including endorsement of suicide related items. Elevations of these scales could aid in differentiating PNES from ES patients, although caution is warranted due to the possibility of both false positives and the incorrect omissions of PNES cases.     

The detection of content-based invalid responding: a meta-analysis of the MMPI-2-Restructured Form’s (MMPI-2-RF) over-reporting validity scales

Objective: This study synthesized research evaluation of the effectiveness of the over-reporting validity scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) for detecting intentionally feigned over-endorsements of symptoms using a moderated meta-analysis. Method: After identifying experimental and quasi-experimental studies for inclusion (k = 25) in which the validity scales of the MMPI-2-RF were compared between groups of respondents, moderated meta-analyses were conducted for each of its five over-reporting scales. These meta-analyses explored the general effectiveness of each scale across studies, as well as the impact that several moderators had on scale performance, including comparison group, study type (i.e. real versus simulation), age, education, sex, and diagnosis. Results: The over-reporting scales of the MMPI-2-RF act as effective general measures for the detection of malingering and over endorsement of symptoms with individual scales ranging in effectiveness from an effect size of 1.08 (Symptom Validity; FBS-r) to 1.43 (Infrequent Pathology; Fp-r), each with different patterns of moderating influence. Conclusions: The MMPI-2-RF validity scales effectively discriminate between groups of respondents presenting in either an honest manner or with patterned exaggeration and over-endorsement of symptoms. The magnitude of difference observed between honest and malingering groups was substantially narrower than might be expected using traditional cut-scores for the validity scales, making interpretation within the evaluation context particularly important. While all over-reporting scales are effective, the FBS-r and RBS scales are those least influenced by common and context specific moderating influences, such as respondent or comparison grouping.     

Comparative prediction of nonepileptic events using MMPI-2 clinical scales,Harris Lingoes subscales,and restructured clinical scales

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a psychological testing tool used to measure psychological and personality constructs. The MMPI-2 has proven helpful in identifying individuals with nonepileptic events/nonepileptic seizures. However, the MMPI-2 has had some updates that enhanced its original scales. The aim of this article was to test the utility of updated MMPI-2 scales in predicting the likelihood of non-epileptic seizures in individuals admitted to an EEG video monitoring unit. We compared sensitivity, specificity, and likelihood ratios of traditional MMPI-2 Clinical Scales against more homogenous MMPI-2 Harris-Lingoes subscales and the newer Restructured Clinical (RC) scales. Our results showed that the Restructured Scales did not show significant improvement over the original Clinical scales. However, one Harris-Lingoes subscale (HL4 of Clinical Scale 3) did show improved predictive utility over the original Clinical scales as well as over the newer Restructured Clinical scales. Our study suggests that the predictive utility of the MMPI-2 can be improved using already existing scales. This is particularly useful for those practitioners who are not invested in switching over to the newly developed MMPI-2 Restructured Form (MMPI-2 RF).     

Dementia does not Preclude Very Reliable Responding on the MMPI-2 RF: A Case Report

The Minnesota Multiphasic Personality Inventory (MMPI) family of personality tests has long been used by psychologists, in part because it provides extensive information on the validity of patient responses. Although much of the research on MMPI validity indicators has focused on over-reporting or under-reporting symptoms, the consistency (i.e., reliability, a requirement for validity) of responding is also critical to examine. Clinicians tend to avoid using the MMPI-2 or the MMPI-2-RF (Restructured Form) in patients with dementia based on the belief that severe cognitive impairment would make reliable responding impossible given the large number of items (567 and 338, respectively). In contrast with this belief we present the case of a 65-year-old woman with severe memory impairments and executive dysfunction due to a non-specific dementia syndrome who was able to provide remarkably consistent responding on the MMPI-2-RF. Implications and future directions are discussed.     

Let's Not Get Hysterical: Comparing the MMPI-2 Validity,Clinical, and RC Scales in TBI Litigants Tested for Effort

The MMPI-2 restructured clinical (RC) scales replace the traditional clinical scales in the MMPI-2 restructured form (MMPI-2-RF). Few studies to date have examined the MMPI-2 RC scales in traumatic brain injury (TBI) litigants. We compared MMPI-2 validity, clinical, and RC scales profiles of 83 mild, complicated mild, and moderate/severe TBI litigants who were tested for effort. Past research shows that patients referred for neuropsychological evaluations with mild TBIs paradoxically have higher MMPI-2 clinical scale elevations than patients with moderate/severe TBIs. Failure on cognitive symptom validity tests (SVTs) has also been associated with elevated validity and clinical scales profiles. The “conversion V” (elevated Hs and Hy, followed by D) is the most frequent elevated profile configuration in mild TBI and/or SVT failure. We sought to determine if these patterns of symptom reporting would replicate on the RC scales profile. Archival data from independent neuropsychological examinations were used to correlate TBI severity, cognitive test effort as indicated by SVTs, and MMPI-2 profiles. Results suggest that the validity, clinical, and RC scales profiles all correlate well with indices of cognitive test effort (namely that failure on SVTs is correlated with elevated symptom reporting). In addition, the validity scales profile, but not the clinical or RC scales profiles, was significantly inversely related to TBI severity. Discriminant function analyses suggest that the MMPI-2 RC scales can aid in the diagnosis of over-reported TBI symptomatology. However, RC3—the RC equivalent of the Hy scale—no longer appears to serve as a marker of somatization and/or malingering.     

Influence of seizure content on interpreting psychopathology on the MMPI-2 in patients with epilepsy

Abstract

We investigated whether seizure content items inflate MMPI-2 scores in persons with epilepsy. A mean MMPI-2 profile was generated for 100 epilepsy patients. Two expert raters then identified MMPI-2 items reflecting seizure symptoms. When individual profiles were rescored to remove elevations caused by seizure content, some statistically significant (but not clinically significant) decreases were observed. The MMPI-2 appears to be a valid assessment instrument in epilepsy. In most cases seizure content did not alter clinical interpretation. When the interest is in detecting symptom change, assessing both statistical and clinical significance is recommended in future MMPI-2 research.     

Independent validation of the MMPI-2-RF Somatic/Cognitive and Validity scales in TBI Litigants tested for effort

The MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is replacing the MMPI-2 as the most widely used personality test in neuropsychological assessment, but additional validation studies are needed. Our study examines MMPI-2-RF Validity scales and the newly created Somatic/Cognitive scales in a recently reported sample of 82 traumatic brain injury (TBI) litigants who either passed or failed effort tests (Thomas & Youngjohn, 2009). The restructured Validity scales FBS-r (restructured symptom validity), F-r (restructured infrequent responses), and the newly created Fs (infrequent somatic responses) were not significant predictors of TBI severity. FBS-r was significantly related to passing or failing effort tests, and Fs and F-r showed non-significant trends in the same direction. Elevations on the Somatic/Cognitive scales profile (MLS-malaise, GIC-gastrointestinal complaints, HPC-head pain complaints, NUC-neurological complaints, and COG-cognitive complaints) were significant predictors of effort test failure. Additionally, HPC had the anticipated paradoxical inverse relationship with head injury severity. The Somatic/Cognitive scales as a group were better predictors of effort test failure than the RF Validity scales, which was an unexpected finding. MLS arose as the single best predictor of effort test failure of all RF Validity and Somatic/Cognitive scales. Item overlap analysis revealed that all MLS items are included in the original MMPI-2 Hy scale, making MLS essentially a subscale of Hy. This study validates the MMPI-2-RF as an effective tool for use in neuropsychological assessment of TBI litigants.     

Independent Validation of the MMPI-2-RF Somatic/Cognitive and Validity Scales in TBI Litigants Tested for Effort

The MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) is replacing the MMPI-2 as the most widely used personality test in neuropsychological assessment, but additional validation studies are needed. Our study examines MMPI-2-RF Validity scales and the newly created Somatic/Cognitive scales in a recently reported sample of 82 traumatic brain injury (TBI) litigants who either passed or failed effort tests (Thomas & Youngjohn, 2009). The restructured Validity scales FBS-r (restructured symptom validity), F-r (restructured infrequent responses), and the newly created Fs (infrequent somatic responses) were not significant predictors of TBI severity. FBS-r was significantly related to passing or failing effort tests, and Fs and F-r showed non-significant trends in the same direction. Elevations on the Somatic/Cognitive scales profile (MLS-malaise, GIC-gastrointestinal complaints, HPC-head pain complaints, NUC-neurological complaints, and COG-cognitive complaints) were significant predictors of effort test failure. Additionally, HPC had the anticipated paradoxical inverse relationship with head injury severity. The Somatic/Cognitive scales as a group were better predictors of effort test failure than the RF Validity scales, which was an unexpected finding. MLS arose as the single best predictor of effort test failure of all RF Validity and Somatic/Cognitive scales. Item overlap analysis revealed that all MLS items are included in the original MMPI-2 Hy scale, making MLS essentially a subscale of Hy. This study validates the MMPI-2-RF as an effective tool for use in neuropsychological assessment of TBI litigants.     

Initial development of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales to identify patients with psychogenic nonepileptic seizures

Long term video-EEG (electroencephalography) monitoring in an epilepsy monitoring unit (EMU) will remain the gold standard for differential diagnosis of epilepsy from psychogenic nonepileptic seizures. However, neuropsychologists are routinely part of the differential diagnosis team and utilize personality assessment measures to add supportive data for the diagnosis. The most accurate scale on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in terms of differential diagnosis appears to be RC1 (Somatic Complaints) with a classification rate of 68% (Locke et al., 2010). This is not as helpful as neuropsychologists would like. Our aim in the current study was to determine whether another set of MMPI-2-RF items could provide improved classification accuracy. Using a combination of modern psychometric techniques and clinical judgment, we developed two complementary scales based on a physical complaints factor (Psychogenic Nonepileptic Seizures Physical Complaints, PNES-pc) and an attitudes factor (Psychogenic Nonepileptic Seizures Attitudes, PNES-a). The combination of these scales classified 73% of the sample, an improvement over comparable single or combined MMPI-2-RF scales. Cross validation is needed to warrant use in clinical practice. Information on scoring, sensitivity, specificity, and likelihood ratios at various levels of endorsement is provided.     

Utility of the MMPI-2-RF in detecting non-credible somatic complaints

We examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales (infrequent responses (F-r), infrequent psychopathology responses (Fp-r), infrequent somatic responses (Fs), symptom validity (FBS-r), and response bias (RBS)) in differentiating individuals who were asked to feign physical health problems from a group of somatoform disorder patients and genuine medical patients with no history of mental health problems. A large group of undergraduate students were instructed to feign physical health problems as if they were participating in a disability evaluation for a work-related injury. Comparison groups were drawn from archival databases and consisted of non-litigating medical patients or individuals carefully diagnosed with somatoform disorder. The Fs and Fp-r scales were associated with the best differentiation between the three groups; the Fs scale was the most sensitive to somatic malingering, whereas the Fp-r scale was the most specific. Both scales were associated with high likelihood ratios in differentiating the somatic malingering group from the somatoform and medical illness groups. Although the FBS-r scale was overall the most sensitive in differentiating non-credible somatic complaints from genuine medical illness, it could not differentiate well between the somatic malingering and somatoform patient conditions. The MMPI-2-RF appears to have considerable promise in detecting individuals who feign physical health problems. Not surprisingly, differentiating somatic malingering from somatoform disorder with the MMPI-2-RF was less accurate than differentiating somatic malingering from bona-fide medical patients.     

Scores on the MMPI-2-RF scales as a function of increasing levels of failure on cognitive symptom validity tests in a military sample

This research examined associations between the full range of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales and increasing levels of cognitive symptom validity test (SVT) failure in a sample of 501 military members who completed a neuropsychological evaluation primarily for mild traumatic brain injury resulting from a closed head injury and blast exposure or heat injury. SVT failure was associated with significant linear increases in all of the over-reporting MMPI-2-RF validity scales and most of the substantive scales. For the validity scales, all over-reporting scales had large effect sizes (ESs) when comparing a group that failed no SVTs with a group that failed three SVTs. A comparison between these two groups for the substantive scales revealed the largest ESs for scales related to somatic/cognitive complaints and emotional dysfunction. RBS (Response Bias Scale) had the largest ES of all scales (d = 1.69), followed by FBS-r (Symptom Validity Scale; d = 1.34), AXY (Anxiety, d = 1.21), and COG (Cognitive Complaints, d = 1.19). The scales related to behavioral dysfunction had the smallest ESs of all of the substantive scales, and there were no significant associations between the vast majority of these scales and SVT failure. With respect to clinically significant elevations, those who did not fail SVTs had clinically significant elevations only on COG and NUC (Neurological Complaints), and MLS (Malaise) approached clinical significance. For those who failed SVTs, RBS was the only over-reporting scale that was elevated across all failure groups. Those who failed any SVT had clinically significant elevations on COG, MLS, NUC, and AXY. Those who failed three SVTs had additional elevations on scales related to emotional dysfunction.     

Personality testing and epilepsy: comparison of two MMPI-2 correction procedures

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is widely used for assessing psychopathology. However, its reliability in people with neurologic disease has been questioned. This concern is especially true for epilepsy, a disease with symptoms, i.e., seizures, that frequently include experiences likely to suggest psychopathology. Correction procedures, in which select items are removed and the test is rescored, may improve MMPI-2 specificity. The MMPI-2 was administered to 27 subjects with epilepsy, and the results were compared before and after application of three correction procedures: rational, statistical, and combined. The statistical correction resulted in clinically significant T-score changes (> or = 5 points) in two MMPI-2 clinical scales, while a combined correction procedure produced clinically significant changes in three scales. In the subgroup of patients with intractable epilepsy, two noncorrected scale T-scores > or = 65 fell to the normal range with both the statistical and combined procedures. These results suggest cautious interpretation of standard MMPI-2 scores in patients with epilepsy.     

Scores on the MMPI-2-RF Scales as a Function of Increasing Levels of Failure on Cognitive Symptom Validity Tests in a Military Sample

This research examined associations between the full range of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity and substantive scales and increasing levels of cognitive symptom validity test (SVT) failure in a sample of 501 military members who completed a neuropsychological evaluation primarily for mild traumatic brain injury resulting from a closed head injury and blast exposure or heat injury. SVT failure was associated with significant linear increases in all of the over-reporting MMPI-2-RF validity scales and most of the substantive scales. For the validity scales, all over-reporting scales had large effect sizes (ESs) when comparing a group that failed no SVTs with a group that failed three SVTs. A comparison between these two groups for the substantive scales revealed the largest ESs for scales related to somatic/cognitive complaints and emotional dysfunction. RBS (Response Bias Scale) had the largest ES of all scales (d?=?1.69), followed by FBS-r (Symptom Validity Scale; d?=?1.34), AXY (Anxiety, d?=?1.21), and COG (Cognitive Complaints, d?=?1.19). The scales related to behavioral dysfunction had the smallest ESs of all of the substantive scales, and there were no significant associations between the vast majority of these scales and SVT failure. With respect to clinically significant elevations, those who did not fail SVTs had clinically significant elevations only on COG and NUC (Neurological Complaints), and MLS (Malaise) approached clinical significance. For those who failed SVTs, RBS was the only over-reporting scale that was elevated across all failure groups. Those who failed any SVT had clinically significant elevations on COG, MLS, NUC, and AXY. Those who failed three SVTs had additional elevations on scales related to emotional dysfunction.     

MMPI-2 Restructured Form Over-Reporting Scales in First-Episode Psychosis

MMPI-2-RF over-reporting scales for physical, cognitive, or psychological symptoms were examined in 130 consecutive referrals to a first-episode psychosis (FEP) clinic. Although acutely ill upon presentation, consistent and responsive profiles were obtained in 79% of the sample. There was no indication of under-reporting on defensive scales, and anticipated elevations were observed on clinical scales sensitive to thought disorder, ideas of persecution, and aberrant experiences. The Infrequent Somatic (Fs), Symptom Validity Scale (FBS-r), and Response Bias (RBS) scales did not indicate somatic or cognitive over-reporting, but the Infrequent Psychopathology Scale (Fp-r) showed a moderate elevation that may suggest a propensity for over-reporting or an effect of clinical symptoms on the over-reporting scale. Clinician ratings of positive symptoms of psychosis were related to the Fp-r. Although the over-reporting classifications with the RBS were relatively low, RBS scores were directly related to positive and general symptoms of psychosis. The MMPI-2-RF appears to have clinical value in an acutely ill FEP sample. The sample was not prone to over-reporting pathology, but associations between both the Fp-r and the RBS with clinical symptoms will warrant further investigation.