Millon Clinical Introduction

Copyright © 1998 Elsevier Science Ltd. All rights reserved.
4.14
Objective Personality Assessment
with Adults
JAMES N. BUTCHER and JEANETTE TAYLOR
University of Minnesota, Minneapolis, MN, USA
and
G. CYNTHIA FEKKEN
Queen's University, Kingston, ON, Canada
4.14.1 INTRODUCTION 404

4.14.1.1 Intelligence and Insight 404
4.14.1.2 Veridicality of Self-report 405
4.14.1.3 Personality Stability 405
4.14.1.3.1 Definitions 405
4.14.1.3.2 Influences on personality stability 406
4.14.2 ASSESSING ADULTS IN CLINICAL SETTINGS 407
4.14.2.1 The Minnesota Multiphasic Personality Inventory-Revised 407
4.14.2.1.1 Origin of the MMPI/MMPI-2 408
4.14.2.1.2 Measurement dimensions 408
4.14.2.1.3 Recent validity research for the MMPI-2 409
4.14.2.2 Basic Personality Inventory 413
4.14.2.3 Personality Assessment Inventory 415
4.14.3 SPECIALIZED OR FOCUSED CLINICAL ASSESSMENT MEASURES 416
4.14.3.1 Millon Clinical Multiaxial Inventory 416
4.14.3.2 The Beck Depression Inventory 418
4.14.3.3 The State-Trait Anxiety Inventory 418
4.14.3.4 Whitaker Index of Schizophrenic Thinking 419
4.14.4 NORMAL RANGE PERSONALITY ASSESSMENT 420
4.14.4.1 Objective Personality Measures in Research 420
4.14.4.1.1 The Five Factor Model (the Big Five) 420
4.14.4.1.2 NEO Personality Inventory 420
4.14.4.1.3 Multidimensional Personality Questionnaire 420
4.14.4.1.4 Personality Research Form 421
4.14.4.1.5 Sixteen Personality Factor Test 421
4.14.4.1.6 California Psychological Inventory 421
4.14.4.2 Objective Personality Measures in Educational/Vocational Assessment 422
4.14.4.2.1 FFM 422
4.14.4.2.2 NEO-PI 422
4.14.4.2.3 CPI 422
4.14.4.2.4 MMPI/MMPI-2 422
4.14.4.3 Personnel Screening 423
4.14.4.4 Other Personality Measures in Personnel Selection 423
4.14.4.5 The 16PF 423
4.14.4.6 FFM 423
403
404 Objective Personality Assessment with Adults
4.14.4.7 NEO-PI 424

4.14.4.7.1 CPI 424
4.14.5 SUMMARY 424
4.14.6 REFERENCES 425
4.14.1 INTRODUCTION relationship between a client's level of intelli-

gence and his or her ability to competently
Objective personality tests form a standard reveal information about personality through a
part of most applied psychologists' toolboxes self-report instrument.
when it comes to measuring personality. In Objective personality measures leave the issue
contrast to projective techniques and to sub- of the client's intellectual functioning in the
jective approaches to personality assessment, hands of the clinician. None of the widely used
objective personality questionnaires are made personality assessment instruments require a
up of relatively unambiguous stimuli or items; pre-screening for normal or above normal
offer the respondent relatively restricted re- intelligence. However, most self-report person-
sponse options; and present a scoring scheme ality instruments require that the examinee have
that involves few, if any, scoring judgments, a minimum reading level competency (often
resulting in high scoring reliability (Wiggins, expressed as a minimum grade level). Thus, a
1973). Most objective personality assessment minimum level of school achievement is implicit
instruments used by clinicians and researchers in the validity of a client's score, and it follows
employ a self-report format. In contemporary that the clinician should use care when admin-
psychology, the Minnesota Multiphasic Person- istering a self-report instrument to a client with
ality Inventory (MMPI) and the MMPI-2 are known or suspected intellectual impairment. It
the most widely used personality assessment is also essential for the clinician to be aware of
instruments in both clinical and research the educational range of the standardization
settings (Butcher and Rouse, 1996). The next sample for any self-report measure, and to use
most popular instruments used to assess caution when interpreting protocols from
personality, the Rorschach and the Thematic clients who fall outside of that range.
Apperception Test, are projective (not objec- The clinician needs to be aware of a client's
tive), but each still requires the clinician to intellectual functioning as it may influence the
obtain self-reported behavior. In essence, the client's ability to provide information about his
clinician is dependent on the client's ability and or her personality on a self-report measure. If a
willingness to make accurate self-reports when client appears to be low in intellectual function-
assessing personality with standardized instru- ing, then the results of self-report measures
ments. It is, therefore, important to determine should be interpreted with caution and perhaps
whether adults being assessed can competently supplemented with reports from other sources.
reveal information about their personalities While the capacity for insight cannot readily
through self-report instruments. In order to be extrapolated from an intelligence quotient in
address this question, the client's intelligence a linear fashion, insight into one's problems
and insight in sharing self-information and the might be discernible from the personality profile
success of personality tests for eliciting self- itself. As Butcher and Rouse (1996) note in their
information that can be externally verified need recent review of personality research, several
to be considered. We will examine each of these of the widely used objective personality mea-
considerations below. sures have attitudinal measures that aid the
clinician in evaluating the client's disclosure
4.14.1.1 Intelligence and Insight capability. Crookes and Buckley (1976) found a
relationship between the Eysenck Personality
The existing literature on intelligence and Inventory Lie (L) scale score and diagnosis
personality is largely focused on the predictive among both psychiatric inpatients and out-
relationship between the two constructs. How- patients. They found that high L scale scores
ever, clinicians are generally not concerned were positively related to diagnosis of disorders
about the ability of a personality profile to associated with low insight. They concluded
predict an intelligence quotient or vice versa. that the L score (a validity indicator found on
Instead, most are concerned with the more basic several objective personality instruments) is
question of how intellectual functioning impacts highly related to a person's awareness of his or
the ability of a client to self-disclose on an her behavior. Moreover, this finding is in
objective personality test. No literature exists agreement with the interpretive guidelines for
which directly addresses the issue of the the MMPI-2 L scale, which suggests the general
Introduction 405
utility of this measure at appraising a client's Jaffe and Archer, 1987), and the Basic Person-
self-awareness. ality Inventory (BPI; Holden, Fekken, Reddon,
The quality of insight that a client brings to Helmes, & Jackson, 1988), to name three.
the assessment situation may greatly influence Although the research literature shows that
the validity of the assessment. Some instruments people can competently disclose information
are designed to assess clients through behavioral about their personalities through standardized,
items that require low insight or self-observa- objective, self-report measures, some indivi-
tion. These items are specifically selected duals, however, may not be motivated to
because of their ability to predict relevant cooperate in their psychological assessment.
criteria and may appear at face value totally That is, some respondents, because of a need or
unrelated to the particular aspects of person- motivation to present themselves in a particular
ality functioning intended to be predicted. This way, do not respond in a truthful, open manner.
highlights one advantage of using objective The most common examples of individuals
personality measures in clinical settings: clients being motivated to appear different from the
who may yield poor information during a way they actually are in today's assessment
clinical interview that requires self-evaluation settings are applicants for employment, parents
and/or introspection may be fully capable of involved in custody disputes, and other in-
providing valuable clinical information when a dividuals being evaluated as part of a court case.
personality instrument comprising empirically A self-report assessment instrument must con-
selected items is employed. tain an effective means of identifying respon-
dents who are dissimulating. Perhaps the most
common way of detecting whether people are
4.14.1.2 Veridicality of Self-report not motivated to report accurately about
themselves is via validity scales or control
Aside from the issues of intellectual function- scales. In some assessment situations the
ing and insight the utility of self-report measures validity scales provide the most important
can be assessed by examining their success at and useful information about the client. A
corroborating independent facts about a client. self-report personality measure without effec-
For example, in an early study of the MMPI, tive validity scales is too limited to operate
Payne and Wiggins (1972) examined the across a broad range of assessment situations.
relationship between content-based profiles Furthermore, tests that possess validity indica-
and external descriptors of a large group of tors, such as the L scale on the MMPI/MMPI-2,
psychiatric inpatients. Interpretation of offer the clinician information regarding both
content-based profiles is based on combinations the client's willingness to cooperate with the
of ªobviousº test items which correspond to assessment and his or her level of insight. These
traditional self-report instruments (e.g., ªI am a points argue in favor of the continued use of
high-strung personº). That is, the client en- standardized, objective self-report measures in
dorses the item as a means of directly relaying the assessment of personality in clinical settings.
information about him- or herself. The authors
found that the patients' self-reported MMPI
profiles matched quite well with interview 4.14.1.3 Personality Stability
report and external observation.
In a similar vein, Koss and Butcher (1973) One of the assumptions of objective person-
found that psychiatric inpatients identified ality assessment is that the personality char-
(through their observed behavior and present- acteristic being measured is stable. Various
ing symptoms) as belonging to one of six major studies have come to the conclusion that
operationally defined crisis situations could be personality changes little in adulthood, parti-
discriminated from one another on the basis of cularly after age 30 (Conley, 1985; Finn, 1986;
their endorsed MMPI content. The authors McCrae & Costa, 1990; Schuerger, Zarrella, &
interpreted their results as providing evidence Hotz, 1989). Typical levels of stability on
for the competence and willingness of adults in personality tests are in the 0.5±0.7 range. This
clinical settings to reflect information accurately generalization bears some comment.
about their personality and psychological
functioning through self-report test items.
4.14.1.3.1 Definitions
Similar evidence of a positive relationship
between self-reported personality measures What exactly is meant by stable responding?
and external criteria has been found for certain On an objective personality questionnaire, a set
scales from the California Psychological In- of responses that are consistent over time may
ventory (CPI; e.g., Hindelang, 1972), the Millon be defined in at least three ways: (i) as an
Clinical Multiaxial Inventory (MCMI; e.g., identical scale score, (ii) as a set of identical item
responses, or (iii) as a scale score that signifies however, proposed a substantive rather than a
the same relative standing on the personality methodological explanation. He argued that
characteristic. particular personality characteristics ªswellº
Conclusions about the stability of personality into prominence over the short term and then
are most commonly based on scale scores. That fade again. For a student entering college, for
is, the stability of personality estimates result example, ªindependenceº may become a salient
from comparing scale scores obtained at two dimension and hence, self-reports on this
points in time. Presumably the same scale score dimension are likely to have exaggerated
could result even if the test respondent endorsed consistency over the (short) time period when
somewhat different subsets of items. The ªindependenceº is prominent.
consistency of responses to individual test items A third influence on personality stability has
has been studied as a meaningful individual to do with the operationalization of personality.
differences variable and as an index for Most objective personality questionnaires are
establishing the interpretability of individual intended to measure traits that are by definition
response protocols. Item response consistency stable and enduring. The construction of such
has not been examined as a definition of questionnaires favors selection of items that will
longitudinal personality stability per se. yield stable scores. In addition, the overall
Many researchers have focused on changes in instructions as well as the wording of specific
average scale scores. Their goal is to understand items prompt people to make broad general-
normative changes in personality. On the other izations about themselves and to downplay
hand, some researchers examine personality variations. Thus, personality may appear to be
stability by correlating scale scores. Thus, when stable because the constructs of personality are
coefficients of personality stability are reported explicitly conceptualized and measured as
to be in the 0.5±0.7 range, this should be stable. There are certainly empirical studies
understood to be a statement about relative, and that challenge the idea of personality stability by
not absolute, scale score stability. providing evidence of developmental change
over long time periods based on personality
constructs and measures that expressly incor-
4.14.1.3.2 Influences on personality stability
porate the notion of change (e.g., Whitbourne,
Although the typical stability of personality Zuschlag, Elliot, & Waterman, 1992).
scale scores is quite high, there are nonetheless Fourth, some personality constructs are
particular variables that affect score stability in associated with more stability than others.
predictable ways. The first consideration is the Schuerger et al.'s (1989) data show that
influence of instrument characteristics. Specifi- measures of psychopathology have less scale
cally, the average number of items per scale and score stability than measures of ªnormalº
the homogeneity of the scales are the important personality characteristics. Perhaps ªnormalº
predictors of scale score stability (Finn, 1986; personality constructs are more crystallized
Schuerger et al., 1989). Variance associated with than psychopathological constructs and thus
specific instruments (e.g., the MMPI vs. the less error is built into the construct itself.
Sixteen Personality Factor Test [16PF]) appar- Similarly, psychopathological constructs may
ently does not contribute to greater personality be more confounded with the effects of response
stability beyond the effects of scale length and style variance such as social desirability and
homogeneity (Schuerger et al., 1989). Such acquiescence than normal personality con-
findings underscore the need for test users to structs, again compounding the noisiness of
select reliable measures, particularly if test data the construct.
are intended to evaluate long-term personality Many researchers have tried to highlight
change. differences in stability among the specific
Second, estimates of personality stability are constructs that they chose to study. For
affected by the length of the retest interval. Not example, Finn (1986) demonstrated that mood-
surprisingly, personality appears to more stable related constructs (e.g., depression) had com-
over short intervals than long ones. In parti- paratively low levels of consistency, whereas
cular, score stability drops over the first year Helson and Moane (1987) found that constructs
before it levels off (Schuerger et al., 1989; related to socialization had high stability. There
Windle, 1954) and then stays stable at the same are shortcomings to such an approach. The
level for very long periods of time (McCrae & identification of those dimensions on which
Costa, 1990). people are changeable (i.e., states) as distinct
One simple reason for relatively high short- from the more permanent individual differences
term personality stability may be that people dimensions needs to be tackled systematically if
remember and repeat their responses to the a comprehensive list is to be obtained (Cattell,
items on a questionnaire. Lumsden (1977), 1963).
Assessing Adults in Clinical Settings 407
The interpretation of differences in stability expected to change on different constructs as a

between constructs is further complicated by function of distinct life paths or societal
age and cohort effects. Studies such as that of pressures. Few studies have been explicitly
Helson and Moane (1987) estimate personality designed to compare sex differences in person-
stability using information obtained from a ality stability.
single group of subjects who have been assessed Overall, personality shows considerable sta-
at different points in time. There are limits to the bility in adulthood. The objective measures
generalizability of this information to other traditionally used in personality assessment may
groups of people. Other studies such as that of predispose us to find evidence of stability as a
Finn (1986) use basically a cross-sectional function of the kinds of constructs, instructions,
approach. They assess two or more groups of and test construction techniques associated with
subjects having different ages at a single time. these measures. Aspects of the test instrument
Here it is difficult to attribute differences in the itself, such as length or homogeneity, may
stability of particular personality constructs to moderate stability estimates, as could the length
age as opposed to generational factors. More of the interval between personality assessments.
complicated designs may be needed in order to Samples of ªnormalsº and of older adults may
understand such age and cohort effects (Conley, exhibit more personality stability; sex differ-
1985). At the very least, any generalizations ences in general personality stability appear to
about which personality constructs are more or be minimal. The assumption of personality
less stable need to be carefully qualified. stability, at least over the short run, is central to
A fifth influence on personality stability has objective personality assessment if test scores
to do with features of the persons being are going to predict relevant behaviors and have
evaluated. Test respondents exhibit remarkable an impact on planning how to manage that
individual differences in personality stability behavior.
(Assendorp, 1992; McCrae & Costa, 1990). Do
some subgroups of people show more person-
ality stability? Across studies, patient and 4.14.2 ASSESSING ADULTS IN CLINICAL
prisoner samples show less personality test SETTINGS
score stability than ªnormalsº (Schuerger et al.,
In this section we will provide an overview of
1989). Perhaps ªnon-normalsº have system-
a number of objective personality inventories
atically higher scale scores than ªnormalsº and,
that have been designed to assess adults in
hence, their retest scores show regression
clinical settings. More detail on the use of the
toward the mean (Windle, 1954). Alternatively,
MMPI-2 will be given because it is the most
ªnon-normalº groups also may be more likely
widely researched and used measure. Two other
than normal groups to seek actively to change
measures that have recently been published to
personality.
measure essentially the same clinical problem
The other two person variables that have
areas as the MMPI-2, BPI (Jackson, 1989) and
received attention in the literature on person-
the Personality Assessment Inventory (PAI)
ality stability are age and sex differences. Some
(Morey, 1991) will be briefly described. In the
researchers report that older adults are more
next section, several specialized measures will
stable than younger adults on many traits (Finn,
then be surveyed that have been developed to
1986; Schuerge et al., 1989) although others
measure more specific clinical problems or
argue that stability differences after about age
behaviors: the MCMI to assess personality
30 are minimal (McCrae & Costa, 1990). Finn
disorders; the Beck Depression Inventory (BDI;
(1986) has asked whether older adults might just
Beck, Steer, & Garbin, 1988) to assess anxiety;
be more rigid in their self-perceptions. However,
the State±Trait Anxiety Inventory (STAI;
the picture of personality stability that results
Spielberger, Gorsuch, & Lushene, 1970); and
from self-reports does tend to be substantiated
the Whitaker Index of Schizophrenic Thinking
by ratings on personality information collected
(WIST; Whitaker, 1973).
from others, such as spouses (McCrae & Costa,
1990). Thus, personality may indeed be more
stable in older adults. 4.14.2.1 The Minnesota Multiphasic
Many studies in the area of personality Personality Inventory-Revised
stability sample exclusively men or women.
Yet there seems to be little evidence of an overall The MMPI-2 is the most widely used
difference in the level of personality stability for personality test with adults (Lubin, Larsen, &
men and women (Schuerger et al., 1989). Matarazzo, 1984; Watkins, 1996). Keilen and
Nonetheless, researchers interested in norma- Bloom (1986) found that the MMPI/MMPI-2
tive change often argue that men (Finn, 1986) was the most frequently used test in custody
and women (Helson & Moane, 1987) may be evaluations. Developed originally in the late
1930s by Starke Hathaway and J. C. McKinley they had a mean score of 50 and a standard
and redeveloped by Butcher, Dahlstrom, Gra- deviation of 10. These standard score distribu-
ham, Tellegen, and Kaemmer (1989), this tions then allowed the scores to be plotted on a
instrument provides a comprehensive survey profile so that the interpreter would have a
of personality characteristics and clinical pro- visual picture of how extreme a particular score
blems. In the original MMPI, a strictly empirical was when compared with the normal. Their
scale construction approach was followed to empirical approach produced highly valid and
develop scales that would assess a patient's effective scales that predicted or described the
probable ªmembershipº in a clinical group. An likelihood that a person's score on a scale was in
extensive amount of research has been pub- the clinical range or similar to the patient
lished on the effectiveness of these measures at groups.
predicting and describing problems in adults. The original MMPI clinical scales have
Research on the original version of the MMPI undergone very substantial study and cross-
covered a very broad range of peopleÐ validation since their publication. They have
psychiatric and medical patients, substance become a standard means of objective symptom
abusers, incarcerated felons, and many other classification since their development. The
clinical groups. clinical scales and configurations of scales,
In addition, a very broad range of ªnormalsº referred to as code types, have undergone
have been studied including applicants for substantial documentation as an objective
various jobs such as airline pilots, US Navy classification schemaÐoften referred to as
submariner crew members, and police and ªcookbooks.º Researchers, for example, have
security personnel. Moreover, the instrument cataloged the behavioral characteristics asso-
came to be widely employed as a personality ciated with their test indices allowing for
research instrument. Butcher and Rouse (1996), automatic interpretation. That is, when a
in a survey of 20 years of research in clinical particular scale score or cluster of scales are
assessment, found that the MMPI/MMPI-2 is obtained, then a well-validated set of behavioral
the most widely researched instrument with descriptionsÐknown as descriptorsÐare ap-
nearly twice the number of articles as the seven plied. Their objective classification approach to
next leading tests. What has made the MMPI/ interpretation fostered the development of
MMPI-2 the most widely used assessment computer-based interpretation methods so pop-
technique in the personality area? We will ular today (Butcher, 1995; Butcher et al., 1998).
examine the make-up, utility, and limitations of
the instrument in assessing adults. 4.14.2.1.2 Measurement dimensions
(i) Validity scales
4.14.2.1.1 Origin of the MMPI/MMPI-2
As noted earlier, it is essential to any self-
A growing dissatisfaction with subjective reported personality assessment to appraise
methods of evaluating patients in clinical carefully possible invalidating conditions or
situations (such as interviews and projective circumstances. Structural elements of the test
tests) led the original MMPI developers, Hath- administration require evaluation to determine
away (a psychologist) and McKinley (a psy- if extratest factors influenced the item re-
chiatrist), to experiment with an objective sponses. For example, were the instructions
method of clinical problem assessment. They clearly presented, was the individual able to read
accumulated a large number of items (symp- and comprehend the items?
toms, beliefs, attitudes, etc.) from tests and case The MMPI-2 contains a number of scales and
material and administered them to a large group indexes that provide the test interpreter with
of ªnormalº people to serve as a comparison information on the individual's cooperativeness
group. They then administered the items to well- and honesty in responding to the items (see
defined and homogeneous groups of clinical Table 1 for a summary of the validity or control
patients. They empirically contrasted the re- scales for the MMPI-2). A clear picture is
sponses of the patient groups with the normals obtained as to whether the person has attempted
to obtain items that significantly separated the to present a false picture on the test. These scales
groups. These items were then combined into are of several types. First, noncontent-oriented
scales for the various clinical problem areas such measures can provide information on whether
as depression, schizophrenia, and so forth. Once the person was inconsistent in responding (the
derived, the clinical scales were normed on the True Response Inconsistency or TRIN and
non-patient sample and T scores were developed Variable Response Inconsistency or VRIN
to enable the test interpreter to determine how scales). Additionally, the Cannot Say or ª?'
extreme a particular person's score was on a scale provides information about the person's
given scale. All of the scales were normed so that cooperation in completing the items. Two other
indexes that can provide clues to uncooperative instrument to assess personality characteristics
test-taking behavior are the percentage of true of masculine±feminine interests and social
and percentage of false endorsement. Records introversion.
with a nearly all true or all false response pattern
suggest uncooperativeness in completing the
(iii) Content scales
task.
Three scales have been developed to provide The expanded item pool of the MMPI-2
information about the tendency on the part of allowed for the development of a new set of
some people to claim excessive virtue or to deny content-based scales to assess an expanded array
problems. The L scale assesses an unsophisti- of problems compared with the traditional
cated tendency to claim excessive virtue; the K clinical measures. The 15 content scales (see
scale measures test defensiveness; and the S Table 3) were developed according to a multi-
scale (Superlative Self-presentation) assesses the method/multistage strategy. The 567 items were
tendency of some people to present themselves subjected to a content analysis in order to derive
in a highly favorable manner (Butcher & Han, homogeneous content groups rationally. This
1995). approach is not as theoretically blind as it seems,
Three scales have been developed to assess the since the original MMPI content had been well
tendency that some respondents have to claim delineated by Wiggins (1969) and many of these
excessive mental health symptoms. The original constructs were still available in a modified or
F scale developed by Hathaway and McKinley reduced form in the revised instruments. More-
(1940) assesses excessive symptom checking by over, the MMPI-2 committee also wrote new
attending to extreme or rare responses. Those items to cover contents that were limited or not
who endorse a large number of rare items are available in MMPI-2, for example, suicide
thought to be presenting an unselective or ideation, substance abuse, and type A behavior.
exaggerated complaint pattern. High scores on It therefore became possible to develop scales for
F have been associated with malingering (Berry, a number of problem areas that have clinical
Baer, & Harris, 1991; Schretlen, 1988). relevance and are sufficiently large to assess
The F(b) scale, an infrequency scale that reliably. Following provisional derivation, other
covers extreme items in the back of the MMPI-2 scale construction strategies such as internal
items operates much like the original F scale consistency, item scale correlation, and external
(Butcher et al., 1989). The newest validity validation were followed to define and improve
measure developed by Arbisi and Ben-Porath the item groups.
(1995) is an extremely valuable type of Content scales provide a different type of
infrequency scale that differs from the original information to the clinical interpreter's re-
F scale in an important way: the F(p) scale sources. These scales are viewed as direct
assesses extreme responding in a clinical sample. communications between the client and the
The F(p) scale assesses infrequent responding in clinician. The obvious content on the scales
a clinical setting and thereby, when extreme, enables the client to address problems he or she
suggests malingering of psychiatric symptoms. has that are considered important to address in
the clinical intervention.
In addition to their value as summaries or
(ii) Clinical scales
themes considered pertinent by the patient the
The traditional MMPI clinical scales (Hath- content scales have clearly established external
away & McKinley, 1940) have been updated in validity. A number of studies have provided
the MMPI-2 (Butcher et al., 1989) and have data on the external validity of the content
been extensively revalidated in their revised scales (Ben-Porath, Butcher, & Graham, 1991;
form (Archer, Griffin, & Aiduk, 1995; Butcher Butcher, Graham, Williams, & Ben-Porath,
& Williams, 1992; Graham & Ben-Porath, 1990; 1990).
Graham & Butcher, 1988). The MMPI-2
clinical scales are empirically derived measures
4.14.2.1.3 Recent validity research for the
of several well-established clinical patterns such
MMPI-2
as hypochondriasis, depression, paranoia, and
schizophrenia (see Table 2). An empirically derived and based instrument
These scales have been well studied over more requires substantial research validation in order
than 50 years. They were kept nearly intact in to be useful. The MMPI-2 has been substan-
MMPI-2 because of their descriptive power and tially researched and validated. The fact that the
ability to generalize across groups. MMPI-2 clinical scales are the same items as in
Two scales on the clinical profile, Mf and Si, the original instrument means that all of the
are not empirically derived scales as were the research on the traditional measures applies
original clinical scales but were included on the with the revised form.
Table 1 Personality characteristics associated with validity indicator elevations.
? Cannot say score

The total number of unanswered items. A defensive protocol with possible attenuation of scale scores is
suggested if the ? raw score is more than 35.
L (Lie) scale
A measure of an unsophisticated or self-consciously ªvirtuousº test-taking attitude. Elevated scores (above 70
T) suggest that the individual is presenting himself or herself in an overly positive light, attempting to create an
unrealistically favorable view of his or her adjustment.
F (Infrequency) scale
A high score (T above 90) suggests an exaggerated pattern of symptom checking that is inconsistent with
accurate self-appraisal and suggests confusion, disorganization, or actual faking of mental illness. T scores
above 100 invalidate the profile.
F(B) scale
A second infrequency scale that appears toward the back of the MMPI-2 item pool is used to assess exaggerated
responding at the end of the test. This scale operates much like the original MMPI F scale in detecting
malingering, random responding, or motivation to exaggerate symptoms.
F(p) scale
The Psychopathology Infrequency Scale F(p) was developed by Arbisi and Ben-Porath (1995) to assess
infrequent responding in psychiatric settings. This scale is valuable in appraising the tendency for some people to
exaggerate mental health symptoms in the context of patients with genuine psychological disorder.
K (Defensiveness) scale
Measures an individual's willingness to disclose personal information and discuss his or her problems. High K
scores (T above 65) reflect an uncooperative attitude and an unwillingness or reluctance to disclose personal
information. Low scores (T below 45) suggest openness and frankness. This scale is positively correlated with
intelligence and educational level, which should be taken into account when interpreting the scores.
Variable response inconsistency

The VRIN scale consists of 49 pairs of specially selected items. The members of each VRIN item pair have either
similar or opposite content; each pair is scored for the occurrence of an inconsistency in responses to the two
items. The scale score is the total number of item pairs answered inconsistently. High VRIN scores are a warning
that a test subject may have been answering the items in the inventory in an indiscriminate manner, and raise the
possibility that the protocol may be invalid and that the profile is essentially uninterpretable.
True response inconsistency

The TRIN is made up of 20 pairs of items that are opposite in content. If a subject responds inconsistently by
answering True to both items of certain pairs, one point is added to the TRIN score; if the subject responds
inconsistently by answering False to certain item pairs, one point is subtracted. A very high TRIN score
indicates a tendency to give True answers to the items indiscrimately (ªacquiescenceº), and a very low TRIN
score indicates a tendency to answer False indiscriminately (ªnonacquiescenceº). (Negative TRIN scores are
avoided by adding a constant to the raw score.) Very low or very high TRIN scores are a warning that the test
subject may have been answering the inventory indiscriminately so that the profile may be invalid and
uninterpretable.
S scale
A new MMPI-2 scale was developed in an effort to improve the assessment of highly virtuous responding. The
subjects used in the development of the scale were 274 male airline applicants and the MMPI-2 normative
sample (N = 1138 men and 1462 women). The S scale was initially developed by examining item response
differences between airline pilot applicants, who tend to engage in superlative self-description in order to
impress examiners, and normative men from the MMPI-2 restandardization sample. The scale was refined by
using internal consistency methods to ensure high-scale homogeneity. A factor analysis of the resulting 50 item
scale (S) yielded five factors named: Beliefs in ªHuman Goodnessº; Serenity; Contentment with Life; Patience
and Denial of Irritability and Anger; and Denial of Moral Flaws. Linear T score conversion tables were
computed for both men and women separately and combined (unisex) using the MMPI-2 restandardization
data sets. The S scale was shown to have a number of behavioral correlates reflecting the presentation of oneself
as a well-controlled, problem-free person.
Table 2 Empirical correlates for MMPI-2 clinical scales.
Scale 1 (Hypochondriasis)
High-scoring people show: excessive bodily concern; somatic symptoms that tend to be vague and undefined;
fatigue, pain, weakness; manifest anxiety; selfish, self-centered, and narcissistic behavior; pessimistic, defeatist,
cynical outlook on life; dissatisfied and unhappy; make others miserable with whining, complaining behavior;
demanding and critical of others; expresses hostility indirectly; rarely act out; dull, unenthusiastic, unambitious;
ineffective in oral expression, longstanding health concerns; function at a reduced level of efficiency without
major incapacity; not very responsive to therapy, tend to terminate therapy when therapist is seen as not giving
enough attention and support; tend to seek medical solutions to life problems.
Scale 2 (Depression)
High-scoring people show: depressed, unhappy, and dysphoric behavior; they are pessimistic and self-
deprecating; tend to feel guilty; report being sluggish; have somatic complaints such as weakness, fatigue, and
loss of energy; are agitated, tense, highly-strung, and irritable; prone to worry; lack self-confidence; feel useless
and unable to function; feels like a failure at school or on the job; introverted, shy, retiring, timid, and seclusive;
aloof, maintain psychological distance; avoids interpersonal involvement; cautious, and conventional; has
difficulty making decisions; nonaggressive; overcontrolled, deny impulses; make concessions to avoid conflict;
motivated for therapy.
Scale 3 (Hysteria)
High-scoring people show: poor response to stress; they avoid responsibility through development of physical
symptoms; have headaches, chest pains, weakness, and tachycardia, anxiety attacks; symptoms appear and
disappear suddenly; lack insight about causes of symptoms; lack insight about own motives and feelings; lack
anxiety, tension, and depression; rarely report delusions, hallucinations, or suspiciousness; psychologically
immature, childish, and infantile; self-centered, narcissistic, and egocentric; expect attention and affection from
others; use indirect and devious means to get attention and affection; do not express hostility and resentment
openly; socially involved; friendly, talkative, and enthusiastic; superficial and immature in interpersonal
relationships; show interest in others for selfish reasons; occasionally act out in sexual or aggressive manner with
little apparent insight; initially enthusiastic about treatment; respond well to direct advice or suggestion; slow to
gain insight into causes of own behavior; resistant to psychological interpretations.
Scale 4 (Psychopathic deviate)

High-scoring people show: antisocial behavior; rebellious toward authority figures; stormy family relationships;
blame parents for problems; history of under-achievement in school; poor work history; marital problems;
impulsive; strive for immediate gratification of impulses; do not plan well; act without considering consequences
of actions; impatient; limited frustration tolerance; poor judgment; take risks; do not profit from experience;
immature, childish, narcissistic, self-centered, and selfish; ostentatious, exhibitionistic; insensitive; interested in
others in terms of how they can be used; likeable and usually create a good first impression; shallow, superficial
relationships, unable to form warm attachments; extroverted, outgoing; talkative, active, energetic, and
spontaneous; intelligent; assert self-confidence; have wide range of interests; lack definite goals; hostile,
aggressive; sarcastic, cynical; resentful, rebellious; act out; antagonistic; aggressive outbursts, assaultive
behavior; little guilt over negative behavior; may feign guilt and remorse when in trouble; free from disabling
anxiety, depression, and psychotic symptoms; likely to have personality disorder diagnosis (antisocial or
passive±aggressive); prone to worry; dissatisfied; show absence of deep emotional response; feel bored and
empty; poor prognosis for change in therapy; blame others for problems; intellectualize; may agree to treatment
to avoid jail or some other unpleasant experience but are likely to terminate before change is effected.
Scale 5 (Masculinity±femininity)
MALES
Scores of T over 80: Show conflicts about sexual identity; insecure in masculine role; effeminate; aesthetic and
artistic interests; intelligent and capable; value cognitive pursuits; ambitious, competitive, and persevering;
clever, clear-thinking, organized, logical; show good judgment and common sense; curious; creative,
imaginative, and individualistic in approach to problems; sociable; sensitive to others; tolerant; capable of
expressing warm feelings toward others; passive, dependent, and submissive; peace-loving; make concessions to
avoid confrontations; good self-control; rarely act out. (The interpretation of high 5 scores should be tempered
for males with advanced academic degrees.)
High T score between 70 and 79: May be viewed as sensitive; insightful; tolerant; effeminate; showing broad
cultural interests; submissive, passive. (In clinical settings, the patient might show sex role confusion; or
heterosexual adjustment problems.)
Table 2 (continued)
Low T < 35: ªMachoº self-image, present self as extremely masculine; overemphasize strength and physical
prowess; aggressive, thrill-seeking, adventurous, and reckless; coarse, crude, and vulgar; harbor doubts about
own masculinity; have limited intellectual ability; narrow range of interests; inflexible and unoriginal approach
to problems; prefer action to thought; are practical and nontheoretical; easy-going, leisurely and relaxed;
cheerful, jolly, humorous; contented; willing to settle down; unaware of social stimulus value; lack insight into
own motives; unsophisticated.
FEMALES
Scores of T over 70: Reject traditional female roles and activities; masculine interests in work, sports, hobbies;
active, vigorous, and assertive; competitive, aggressive, and dominating; coarse, rough, and tough; outgoing,
uninhibited, and self-confident; easy-going, relaxed, balanced; logical, calculated; unemotional, and unfriendly.
Low T < 35: Describe self in terms of stereotyped female role; doubts about own femininity; passive, submissive,
and yielding; defer to males in decision-making; self-pity; complaining, fault finding; constricted; sensitive;
modest; idealistic. (This interpretation for low 5 females does not apply for females with postgraduate degrees.)
Scale 6 (Paranoia)
Extremely high-scoring people (T > 80) show: frankly psychotic behavior; disturbed thinking; delusions of
persecution and/or grandeur; ideas of reference; feel mistreated and picked on; angry and resentful; harbor
grudges; use projection as defense; most frequently diagnosed as schizophrenia or paranoid state.
Moderate elevations (= 65±79 for males; 71±79 for females): Paranoid predisposition; sensitive; overly
responsive to reactions of others; feel they are getting a raw deal from life; rationalize and blame others;
suspicious and guarded; hostile, resentful, and argumentative; moralistic and rigid; overemphasizes rationality;
poor prognosis for therapy; do not like to talk about emotional problems; difficulty in establishing rapport with
therapist.
Extremely low (T < 35): should be interpreted with caution. In a clinical setting, low 6 scores, in the context of a
defensive response set, may suggest frankly psychotic disorder; delusions, suspiciousness, ideas of reference;
symptoms less obvious than for high scorers; evasive, defensive, guarded; shy, secretive, withdrawn.
Scale 7 (Psychasthenia)
High-scoring people show: anxious, tense, and agitated; high discomfort; worried and apprehensive; high strung
and jumpy; difficulties in concentrating; introspective, ruminative; obsessive, and compulsive; feel insecure and
inferior; lack self-confidence; self-doubting, self-critical, self-conscious, and self-derogatory; rigid and
moralistic; maintain high standards for self and others; overly perfectionistic and conscientious; guilty and
depressed; neat, orderly, organized, and meticulous; persistent; reliable; lack ingenuity and originality in
problem solving; dull and formal; vacillates; are indecisive; distort importance of problems, overreact; shy; do
not interact well socially; hard to get to know; worry about popularity and acceptance; sensitive, physical
complaints; shows some insight into problems; intellectualize and rationalize resistant to interpretations in
therapy; express hostility toward therapist; remain in therapy longer than most patients; makes slow but steady
progress in therapy.
Scale 8 (Schizophrenia)
Very high scorers (= over 80±90) show: blatantly psychotic behavior; confused, disorganized, and disoriented;
unusual thoughts or attitudes; delusions; hallucinations; poor judgment.
High (65±79): schizoid lifestyle; do not feel a part of social environment; feel isolated, alienated, and
misunderstood; feel unaccepted by peers; withdrawn, seclusive, secretive, and inaccessible; avoid dealing with
people and new situations; shy, aloof, and uninvolved; experience generalized anxiety; resentful, hostile, and
aggressive; unable to express feelings; react to stress by withdrawing into fantasy and daydreaming; difficulty
separating reality and fantasy; self-doubts; feel inferior, incompetent, and dissatisfied; sexual preoccupation,
and sex role confusion; nonconforming, unusual, unconventional, and eccentric; vague, long-standing physical
complaints; stubborn, moody, and opinionated; immature, and impulsive; highly-strung; imaginative; abstract,
vague goals; lack basic information for problem-solving; poor prognosis for therapy; reluctant to relate in
meaningful way to therapist; stay in therapy longer than most patients; may eventually come to trust therapist.
Scale 9 (Hypomania)
High-scoring people (T > 80) show: overactivity; accelerated speech; may have hallucinations or delusions of
grandeur; energetic and talkative; prefer action to thought; wide range of interest; do not utilize energy wisely;
do not see projects through to completion; creative, enterprising, and ingenious; little interest in routine or
detail; easily bored and restless; low frustration tolerance; difficulty in inhibiting expression of impulses;
episodes of irritability, hostility, and aggressive outbursts; unrealistic, unqualified optimism; grandiose
aspirations; exaggerates self-worth and self-importance; unable to see own limitations; outgoing, sociable, and
Table 2 (continued)
gregarious; like to be around other people; create good first impression; friendly, pleasant, and enthusiastic;
poised, self-confident; superficial relationships; manipulative, deceptive, unreliable; feelings of dissatisfaction;
agitated; may have periodic episodes of depression; difficulties at school or work, resistant to interpretations in
therapy; attend therapy irregularly; may terminate therapy prematurely; repeat problems in stereotyped
manner; not likely to become dependent on therapists; becomes hostile and aggressive toward therapist.
Moderately elevated scores (T > 65, LE 79): Over-activity; exaggerated sense of self-worth; energetic and
talkative; prefer action to thought; wide range of interest; do not utilize energy wisely; do not see projects
through to completion; enterprising, and ingenious; lack interest in routine matters; become bored and restless
easily; low frustration tolerance; impulsive; has episodes of irritability, hostility, and aggressive outbursts;
unrealistic, overly optimistic at times; shows some grandiose aspirations; unable to see own limitations;
outgoing, sociable, and gregarious; like to be around other people; create good first impression; friendly,
pleasant, and enthusiastic; poised, self-confident; superficial relationships; manipulative, deceptive, unreliable;
feelings of dissatisfaction; agitated; view therapy as unnecessary; resistant to interpretations in therapy; attend
therapy irregularly; may terminate therapy prematurely; repeat problems in stereotyped manner; not likely to
become dependent on therapists; become hostile and aggressive toward therapist.
Low scorers (T below 35): Low energy level; low activity level; lethargic, listless, apathetic, and phlegmatic;
difficult to motivate; report chronic fatigue, physical exhaustion; depressed, anxious, and tense; reliable,
responsible, and dependable; approach problems in conventional, practical, and reasonable way; lack self-
confidence; sincere, quiet, modest, withdrawn, seclusive; unpopular; overcontrolled; unlikely to express feelings
openly.
Scale 10 (Social introversion)

High-scoring people (> 65) show: socially introversion more comfortable alone or with a few close friends;
reserved, shy, and retiring; uncomfortable around members of opposite sex; hard to get to know; sensitive to
what others think; troubled by lack of involvement with other people; overcontrolled; not likely to display
feelings openly; submissive and compliant; overly accepting of authority; serious, slow personal tempo; reliable,
dependable; cautious, conventional, unoriginal in approach to problems; rigid, inflexible in attitudes and
opinions; difficulty making even minor decisions; enjoys work; gain pleasure from productive personal
achievement; tend to worry; are irritable and anxious; moody, experience guilt feelings; have episodes of
depression or low mood.
Low (T < 45): sociable and extroverted; outgoing, gregarious, friendly and talkative; strong need to be around
other people; mix well; intelligent, expressive, verbally fluent; active, energetic, vigorous; interested in status,
power and recognition; seeks out competitive situations; have problem with impulse control; act without
considering the consequences of actions; immature, self-indulgent; superficial, insincere relationships;
manipulative, opportunistic; arouses resentment and hostility in others.
Adapted from Butcher (1989).
In addition, prior to publication of the Since the MMPI-2 was published in 1989 a
MMPI-2 there were a number of validity studies number of other validation studies have been
conducted on the revised form. For example, published (Archer, Griffin, & Aiduk, 1995; Ben-
the MMPI revision committee collected person- Porath, McCully, & Almagor, 1993; Blake et al.,
ality ratings on more than 800 couples included 1992; Clark, 1996; Husband & Iguchi, 1995;
in the normative sample. These personality Keller & Butcher, 1991; Khan, Welch, &
ratings clearly cross-validated a number of the Zillmer, 1993).
original scales. Moreover, validation research
was conducted on a number of samples 4.14.2.2 Basic Personality Inventory
including schizophrenics and depressives
(Ben-Porath, Butcher, & Graham, 1991); mar- The BPI (Jackson, 1989) was published as an
ital problem families (Hjemboe & Butcher, alternative to the MMPI-2 for the global
1991); potential child-abusing parents (Egeland, assessment of psychopathology. The key aims
Erickson, Butcher, & Ben-Porath, 1991); alco- in developing the BPI were to produce a broad-
holics (Weed, Butcher, Ben-Porath, & McKen- band measure of psychological dysfunctioning
na, 1992); airline pilot applicants (Butcher, as measured by the MMPI that was: (i)
1994); military personnel (Butcher, Jeffrey et al., relatively short, (ii) incorporated modern prin-
1990). ciples of test construction, and (iii) showed
Table 3 Description of the MMPI-2 content scales.
1. Anxiety (ANX)
High scorers report general symptoms of anxiety including tension, somatic problems (i.e., heart pounding and
shortness of breath), sleep difficulties, worries, and poor concentration. They fear losing their minds, find life a
strain, and have difficulties making decisions. They appear to be readily aware of these symptoms and problems,
are willing to admit to them.
2. Fears (FRS)
A high score indicates an individual with many specific fears. These specific fears can include blood; high places;
money; animals such as snakes, mice, or spiders; leaving home; fire; storms and natural disasters; water; the
dark; being indoors; and dirt.
3. Obsessiveness (OBS)
High scorers have tremendous difficulties making decisions and are likely to ruminate excessively about issues
and problems, causing others to become impatient. Having to make changes distresses them, and they may
report some compulsive behaviors such as counting or saving unimportant things. They are excessive worriers
who frequently become overwhelmed by their own thoughts.
4. Depression (DEP)
High scorers on this scale show significant depression. They report feeling blue, uncertain about their future,
and uninterested in their lives. They are likely to brood, be unhappy, cry easily, and feel hopeless and empty.
They may report thoughts of suicide or wishes that they were dead. They may believe that they are condemned
or have committed unpardonable sins. Other people may not be viewed as a source of support.
5. Health concerns (HEA)
Individuals with high scores report many physical symptoms across several body systems. Included are gastro-
intestinal symptoms (e.g., constipation, nausea and vomiting, stomach trouble), neurological problems (e.g.,
convulsions, dizzy and fainting spells, paralysis), sensory problems (e.g., poor hearing or eyesight),
cardiovascular symptoms (e.g., heart or chest pains), skin problems, pain (e.g., headaches, neck pains),
respiratory troubles (e.g., coughs, hay fever, or asthma). These individuals worry about their health and feel
sicker than the average person.
6. Bizarre mentation (BIZ)
Psychotic thought processes characterize individuals high on the BIZ scale. They may report auditory, visual, or
olfactory hallucinations and may recognize that their thoughts are strange and peculiar. Paranoid ideation (e.g.,
the belief that they are being plotted against or that someone is trying to poison them) may be reported as well.
These individuals may feel that they have a special mission or powers.
7. Anger (ANG)
High scorers tend to have anger control problems. These individuals report being irritable, grouchy, impatient,
hotheaded, annoyed, and stubborn. They sometimes feel like swearing or smashing things. They may lose self-
control and report having been physically abusive towards people and objects.
8. Cynicism (CYN)
High scorers tend to show misanthropic beliefs. They expect hidden, negative motives behind the acts of others,
for example, believing that most people are honest simply for fear of being caught. Other people are to be
distrusted, for people use each other and are only friendly for selfish reasons. They likely hold negative attitudes
about those close to them, including fellow workers, family, and friends.
9. Antisocial practices (ASP)
High scorers tend to show misanthropic attitudes like high scorers on the CYN scale. The high scorers on the
ASP scale report problem behaviors during their school years and other antisocial practices like being in trouble
with the law, stealing or shoplifting. They report sometimes enjoying the antics of criminals and believe that it is
all right to get around the law, as long as it is not broken.
10. Type A (TPA)
High scorers report being hard-driving, fast-moving, and work-oriented individuals, who frequently become
impatient, irritable, and annoyed. They do not like to wait or be interrupted. There is never enough time in a day
for them to complete their tasks. They are direct and may be overbearing in their relationships with others.
11. Low self-esteem (LSE)
High scores on LSE characterize individuals with low opinions of themselves. They do not believe that they are
liked by others or that they are important. They hold many negative attitudes about themselves including beliefs
that they are unattractive, awkward, and clumsy, useless, and a burden to others. They certainly lack self-
confidence, and find it hard to accept compliments from others. They may be overwhelmed by all the faults they
see in themselves.
Table 3 (continued)
12. Social discomfort (SOD)

High scorers tend to be very uneasy around others, preferring to be by themselves. When in social situations,
they are likely to sit alone, rather than joining in the group. They see themselves as shy and dislike parties and
other group events.
13. Family problems (FAM)
High scorers tend to show considerable family discord. Their families are described as lacking in love,
quarrelsome, and unpleasant. They even may report hating members of their families. Their childhood may be
portrayed as abusive, and marriages seen as unhappy and lacking in affection.
14. Work interference (WRK)
High scorers tend to show behaviors or attitudes that are likely to contribute to poor work performance. Some
of the problems relate to low self-confidence, concentration difficulties, obsessiveness, tension and pressure, and
decision-making problems. Others suggest lack of family support for the career choice, personal questioning of
career choice, and negative attitudes towards co-workers.
15. Negative treatment indicators (TRT)
High scorers tend to show negative attitudes towards doctors and mental health treatment. High scorers do not
believe that anyone can understand or help them. They have issues or problems that they are not comfortable
discussing with anyone. They may not want to change anything in their lives, nor do they feel that change is
possible. They prefer giving up, rather than facing a crisis or difficulty.
Adapted from: Butcher, Graham, Williams, & Ben-Porath (1990).
empirical evidence of being able to discriminate However, these norms are almost entirely based
between normal and dysfunctional persons as on white populations. Moreover, most of the
well as being able to predict pathological normative sample was collected using nonstan-
behavior. dard data collection procedures. For example,
The BPI is made up of 240 items, grouped into booklets were mailed to subjects instead of
12 6 20 item scales. Neurotic tendencies are being administered under standard conditions.
measured through the scales of Hypochondria- In addition, each of the subjects in the
sis, Depression, Anxiety, Social Introversion, normative sample responded to one-third of
and Self-depreciation. Aspects of sociopathy are the items in the booklet, an artifact that makes it
measured by Denial, Interpersonal Problems, difficult to perform some analyses on the
Alienation, and Impulse Expression scales. normative sample (e.g., alpha coefficients).
Psychotic behavior is assessed by scales labeled Among the difficulties that have been asso-
Persecutory Ideas, Thinking Disorder, and to ciated with the BPI is a lack of validity scales for
some degree, by the Deviation scale. The identifying invalid response protocols. The one
Deviation scale comprises 20 critical items that content scale that would logically appear to have
are intended to serve as the basis for further some bearing on the issue of protocol validity is
clinical follow up. In contrast, the definitions of the Denial scale, which is described in the
the constructs reflected in the other 11 items on manual as a measure of lack of insight and lack of
the BPI are based on the results of a multivariate normal affect. Unfortunately, Denial appears to
analysis of the content underlying the MMPI be a relatively weak scale in terms of its reliability
and the Differential Personality Inventory and validity in various empirical studies (Holden
(Jackson & Messick, 1971). et al., 1988; Jackson, 1989). Two other com-
The strong internal psychometric properties plaints that have been voiced are a lack of an
of the BPI attest to its careful construction established link to diagnostic categories and a
(Jackson, 1989). Item properties and item factor lack of work on profile interpretation.
analyses support the internal structure of the Overall, the BPI has shown psychometric
instrument. Both internal consistencies and potential as a general measure of psychopathol-
test±retest reliability estimate fall in the 0.70 ogy. The basic developmental work on it is
to 0.80 range. Various validity studies (some sound. What the BPI now needs are more
published in the manual, others in the literature) extensive norms along with further work on its
show that the BPI can indeed discriminate clinical applicability.
between normal and non-normal (e.g., delin-
quent) persons and can, within psychiatric
populations, predict a variety of clinical criteria. 4.14.2.3 Personality Assessment Inventory
Norms exist for adolescents and adults, span-
ning a variety of sample types such as commu- The PAI (Morey, 1991) is another inventory
nity, psychiatric, college, and forensic. of general psychopathology. The PAI is a 344
item self-report measured designed to screen for done maintenance patients scored differently
approximately the same pathological domains from the normative populations.
as the MMPI/MMPI-2. It is used to collect Generally, preliminary data suggest that the
information related to diagnosis, and to provide PAI is a well-constructed and brief measure of
input on treatment planning. psychopathology. More research on its clinical
The PAI includes four validity scales, 11 validity needs to be completed before it can be
clinical scales, five treatment scales and two considered to be a useful measure of psycho-
interpersonal scales. The clinical scales are pathology in clinical settings. There are no data
Somatic Complaints, Anxiety-related Disor- to support the PAI's use in lieu of the MMPI-2
ders, Depression, Mania, Paranoia, Schizo- which has a more substantial empirical data-
phrenia, Borderline Features, Antisocial base.
Features, Alcohol Problems, and Drug Pro-
blems. Treatment scales are Aggression, Suici- 4.14.3 SPECIALIZED OR FOCUSED
dal Ideation, Stress, Nonsupport, and CLINICAL ASSESSMENT
Treatment Rejection. Interpersonal scales are MEASURES
Dominance and Warmth. Of these scales, 10 are
further divided into subscales that are intended In this section we will address several other
to measure distinct constructs. A total of 27 measures that have been developed for clinical
items are designated critical items which, assessment and research to assess specific or
according to the author, should be followed more narrowly focused characteristics rather
up. This does seem to be a relatively large than omnibus instruments such as the MMPI-2.
number of scales to interpret meaningfully in Several of these instruments will be examined to
view of the total number of items. illustrate their application and potential utility
Evidence for the reliability of the 22 scales is for evaluating specific problems in clinical
generally good. Across normative, clinical and settings.
college samples, median alpha coefficients are
all in the 0.80±0.90 range. One month test±retest 4.14.3.1 Millon Clinical Multiaxial Inventory
coefficients are reported to be in the 0.80s in the
manual and in the 0.70s in the literature (Boyle The MCMI (Millon, 1977, 1987, 1994) was
& Lennon, 1994). Interestingly, some of the developed by Theodore Millon for making
lowest reliabilities are found for the validity clinical diagnoses on patients. The MCMI was
scales, a phenomenon that has been found for intended to improve upon the long-established
the validity scales on other instruments such as MMPI. In contrast to the MMPI/MMPI-2, the
the MMPI (e.g., Fekken & Holden, 1991) and MCMI was designed with fewer items; is based
may well be a function of range restriction in the on an elaborate theory of personality and
scores on such scales. psychopathology; and explicitly focuses on
Normative PAI data for the USA are diagnostic links to criteria from the Diagnostic
extensive. Standardization samples for a census- and statistical manual of mental disorders
matched group, a clinical sample representing (DSM).
69 sites, and a college sample drawn from seven The MCMI was developed rationally rather
different US universities each number over 1000 than empirically. Millon has stated in his three
respondents. Normative data in the manual are test manuals (1977, 1987, 1994) as well as
also reported separately by age, education, elsewhere (Millon & Davis, 1995) that devel-
gender, and race. Normative information for opment of the MCMI is to be an ongoing
other countries (Canada, Australia, the UK, process. To keep the MCMI maximally useful
etc.) would be desirable. for clinical diagnosis and interpretation, it must
In view of the recency of the publication of the be continually updated in view of theoretical
PAI, there are only a handful of studies that refinements, empirical validation studies, and
bear on its validity. The manual reports evolutions in the official DSM classification
evidence of the concurrent validity of the PAI systems. Most updated test manuals leave the
in the form of correlations with other measures test user with the impression that the developer
of psychopathology. A number of other studies considered test revision a necessary evil. Very
show that the PAI can discriminate between rarely do you see continuous improvement as a
diagnostic groups. Boyle and Lennon (1994) test developer's goal, in part because this ever-
showed that the PAI can distinguish normals, changing process makes the accumulation of a
alcoholics, and schizophrenics. Schinka (1995) solid research base difficult.
was further able to use the PAI to develop a All three MCMI versions comprise 175 true/
typology for alcoholics that had validity with false items. However, across versions, the exact
several external variables. Finally, Alterman test items have evolved through revision or
and colleagues (1995) demonstrated that metha- replacement. The number of scales and validity
Specialized or Focused Clinical Assessment Measures 417
indices that can be calculated from these items the following three generalizations. First, the
has also increased. The original version, the MCMI has only modest accuracy for assigning
MCMI-I, had 20 clinical scales and two validity patients to diagnostic groups across a variety of
scales. The MCMI-II yielded 22 clinical scales clinical criteria (e.g., Chick, Martin, Nevels, &
and three validity scales. The current MCMI-III Cotton, 1994; Chick, Sheaffer, Goggin, & Sison,
has 24 clinical scales, three modifying indices 1993; Flynn, 1995; Hills, 1995; Inch & Crossley,
and a validity index. Many items appear on 1993; Patrick, 1993; Soldz, Budman, Demby, &
several scales making for great item overlap. Merry, 1993). Second, the MCMI may be better
On the MCMI-III, 14 clinical scales assess at predicting the absence than the presence of a
personality patterns that relate to DSM-IV Axis disorder (Chick et al., 1993; Hills, 1995; Soldz
II disorders. Another 10 scales measure clinical et al., 1993). Third, the MCMI may be better at
syndromes related to DSM-IV Axis I disorders. predicting some types of disorders than others
The modifying indices, Disclosure, Desirability, but there is little agreement on which ones (Inch
and Debasement, are correction factors applied & Crossley, 1993; Soldz et al., 1993).
to clinical scale scores to ameliorate respon- One source of the difficulty may be the base
dents' tendencies to distort their responses. The rate scores. Raw scores on scales are weighted
validity index comprises four bizarre or highly and converted to base rate scores. The base rate
improbable items meant to detect careless, scores reflect the prevalence of a particular
random, or confused responding. personality disorder or pathological character-
The relationship between scales and items is istic in the overall population. Their use is
explicated in detail in the manual. Millon intended to maximize the number of correct
started with a theory-based approach to writing classifications relative to the number of in-
items, followed by an evaluation of the internal correct classifications when using the MCMI to
structure of the items, and finally engaged in an make diagnoses (Millon & Davis, 1995). If the
assessment of the diagnostic efficiency of each estimated base rates for the various diagnostic
item for distinguishing among diagnostic categories are poor, then the predictive accuracy
groups before final placement of an item on a of the MCMI can be expected to be poor
scale. Millon departed from usual psychometric (Reynolds, 1992).
practice in a way that results in some unfortu- One negative consequence of the type of
nate complications. Item overlap across scales is norms used in the development of the MCMI
permitted: on average, items appear on three inventories is that they do not discriminate
different scales with differential weights. This between patients and normals. Use of the
makes scoring inordinately complex, which MCMI assumes that the subject is a psychiatric
makes assessment of scale homogeneity com- patient. Consequently, the MCMI overpatho-
plex, and in turn this makes evaluation of the logizes individuals who are not actually
empirical structure underlying the scales com- patients. The MCMI should not be used where
plex. There are technical solutions for these issues of normality need to be addressed. For
problems but the result is that the MCMI is not example, if the test were used in family custody
an easy instrument with which to work. evaluations or personnel screening, the test
Despite its psychometric drawbacks, the interpretation would appear very
theory underlying the MCMI is generally pathologicalÐit cannot do otherwise.
agreed to be elegant and a substantial asset How does the MCMI compare to the MMPI?
(McCabe, 1987; Reynolds, 1992). Each dimen- The MCMI publisher appears to emphasize that
sion measured by the test has a clear conceptual the MCMI and MMPI-2 measure different
link to Millon's theory of psychopathology. characteristics and the MCMI is shorter to
Such a theory allows for the generation of administer to patients. Whereas the MMPI
clinical inferences based on a small number of measures a broad range of psychopathology,
fundamental principles (Millon & Davis, 1995). the MCMI has its premier focus on the
Not only do these inferences guide measure- assessment of personality disorders. Consonant
ment, but also they enhance understanding of with its rational construction, the elaborate
the constructs, bear on practical treatment theoretical underpinnings of the MCMI are
decision, and produce research hypotheses. impressive. In contrast, however, the test
One of the stated goals of the MCMI is to literature that supports the validity of the
place patients into target diagnostic groups. To MMPI/MMPI-2 is not available for the MCMI.
this end, the MCMI scales are directly co- Validation research on it has not proceeded at a
ordinated with the DSM diagnostic categories. very high pace. Whether the MCMI will have
How well does the MCMI live up to its aim? The either the clinical utility or the heuristic value
manuals report good evidence of diagnostic that the MMPI enjoys remains unanswered
efficiency. However, the recent literature (avail- until more clinical research, and perhaps more
able on the MCMI-I and MCMI-II) suggests refinements, are undertaken with the MCMI.
4.14.3.2 The Beck Depression Inventory certain instructions yield a state-like index of
depressive thinking, whereas, other instructions
The BDI was first introduced in 1961, and it yield a more trait-like index of depressive
has been revised several times since (Beck et al., thinking. Again, clinicians are encouraged to
1988). The BDI has been widely used as an use caution when administering the BDI and to
assessment instrument in gauging the intensity tailor the administration instructions to the type
of depression in patients who meet clinical of index (state or trait) that is desired.
diagnostic criteria for depressive syndromes. In their review of the psychometric properties
However, the BDI has also found a place in of the BDI, Beck et al. (1988) reported high
research with normal populations, where the internal consistency reliability of the instrument
focus of use has been on detecting depression or among both psychiatric and nonpsychiatric
depressive ideation. populations. The authors also reported that
The BDI was developed in a manner similar the BDI closely parallels the changes in both
to the MMPI: clinical observations of symp- patient self-report and clinicians' ratings of
toms and attitudes among depressed patients depression (i.e., the BDI score accurately
were contrasted to those among nondepressed reflects changes in depressive thinking). Finally,
patients in order to obtain differentiation of the they also presented evidence for the content,
depressed group from the rest of the psychiatric concurrent, discriminant, construct, and factor-
patients. The 21 symptoms and attitudes ial validity of the BDI.
contained in the BDI reflect the intensity of The acceptable reliability and validity of the
the depression; items receive a rating of zero to BDI have helped make it a widely used objective
three to reflect their intensity and are summed index of depressive thinking among clinicians.
linearly to create a score which ranges from 0 to Perhaps the most obvious use of the BDI is as an
63. The 21 items included reflect a variety of index of change in the level or intensity of
symptoms and attitudes commonly found depression. With an increasing focus on man-
among clinically depressed individuals (e.g., aged healthcare and accountability by psy-
Mood, Self-dislike, Social Withdrawal, Sleep chotherapeutic service providers, the BDI offers
Disturbance). The BDI administration is a reliable and valid index of depressive
straightforward, and it can be given as an symptoms and attitudes which can be used
interview by the clinician or as a self-report effectively to document changes brought about
instrument (requiring a fifth or sixth grade in therapy.
reading level).
The BDI is interpreted through the use of cut- 4.14.3.3 The State-Trait Anxiety Inventory
off scores. Cut-off scores may be derived based
on the use of the instrument (i.e., if a clinician The STAI was developed by Spielberger et al.
wishes to identify very severe depression, then (1970) to measure anxiety from the perspective
the cut-off score would be set high). According of states vs. traits. The state measurement
to Beck et al. (1988), the Center for Cognitive assesses how the individual feels ªright nowº or
Therapy has set the following guidelines for BDI at this moment. Subjects are asked to rate the
cut-off scores to be used with affective disorder intensity of their anxious feelings on a four point
patients: scores from 0 through 9 indicate no or scale as to their experience of feelings in terms
minimal depression; scores from 10 through 18 of: not at all, somewhat, moderately so, or very
indicate mild to moderate depression; scores much so. The trait anxiety measure addresses
from 19 through 29 indicate moderate to severe how the individuals generally feel by rating
depression; and scores from 30 through 63 themselves on a four-point scale: almost never,
indicate severe depression. sometimes, often, or almost always.
Two important issues must be considered by Since it was developed in 1966 the STAI has
clinicians regarding the results of the BDI. been translated into over 48 different languages
Unlike the MMPI/MMPI-2 and other major and has been widely researched in a variety of
self-report instruments, the BDI has no safe- clinical and school settings (Spielberger, Ritter-
guards against faking, lying, or variable re- band, Sydeman, Reheiser, & Unger, 1995). The
sponse sets. Thus, clinicians are warned against evidence for construct validity of the STAI
this drawback of the BDI in assessing depressive comes from a variety of sources, for example,
thoughts and symptoms. In settings where correlations with other anxiety measures (Spiel-
faking or defensiveness are probable threats berger, 1977), clinical settings (Spielberger,
to the validity of the test, clinicians may need to 1983), and medical and surgical patients
reconsider their use of the BDI. The other issue (Spielberger, 1976). Nonetheless, there has been
pertains to the state±trait debate in assessment. general debate in the literature about the
The BDI is extremely sensitive to differences in conceptual and practical benefits of the trait
the instructions given to an examinee such that vs. state distinction.
Specialized or Focused Clinical Assessment Measures 419
The STAI has become a very widely used conceptualization finds mixed results at best
measure in personality and psychopathology (Fekken, 1985). One view is that the predictive
research in the USA and in other countries. efficiency of the WIST is not enhanced by
However, the state-trait inventories have not including the Time component.
been as broadly used as clinical assessment There are two parallel forms of the WIST
instruments. which differ in content. Items on Form A are
intended to be stressful or anxiety provoking.
4.14.3.4 Whitaker Index of Schizophrenic They assess oral-dependency, hostility, and
Thinking manifestly sexual content. The content of Form
B is neutral. There has been little formal
The WIST (Whitaker, 1973, 1980) was evaluation of the comparability of the two
developed to measure the type of thought forms. Although some studies have reported
impairment that differentiates between schizo- similar rates of diagnostic efficiency for the two
phrenic and ªnormalº thought processes. The forms (Evans & Dinning, 1980; Leslie, Land-
WIST is intended to be individually adminis- mark, & Whitaker, 1984), overall validity
tered as a screening tool or as one part of a evidence would suggest that Form A is stronger
battery of tests. Its multiple choice format makes than Form B. Additional work to clarify the
the WIST a test that is easy to give and to score. comparability of Forms A and B would have
On the WIST, schizophrenic thought is implications for selecting which form to use and
defined as a discrepancy between actual and for using these alternate WIST forms to assess
potential performance on cognitive reasoning changes in symptomatology.
tasks. This impaired thinking has three compo- There is relatively little information on
nents: (i) a degree of illogicality, as reflected in reliability available on the WIST. The manual
inappropriate associations and false premises; does report intratest reliabilities of the two
(ii) a degree of impairment relative to previous WIST forms as Hoyt's reliability coefficients of
performance, as reflected in slowness; and (iii) a around 0.80. Test±retest reliability data, either
degree of unwittingness, as reflected in un- on the WIST subscores or subscales, are not
awareness of the incorrectness of responses. provided in the manual nor do they appear to be
Whitaker's definition of schizophrenic thought readily available in the literature. Similarly,
is carefully explicated in the manual, making it alternate forms of reliability, calculated as
possible for the test user to understand exactly correlations between subscales, or subscores,
what the WIST is measuring. Whitaker, how- are not readily available.
ever, has been criticized for basing his definition There is reasonable evidence for the con-
on a narrow reading of the literature on vergent validity of the WIST. Two reviews
schizophrenic thought disorder (Payne, 1978). report that WIST scores tend to have a 60±70%
The WIST itself is made up of 25 multiple agreement with systems for diagnosing schizo-
choice items that are divided into three subtests: phrenia (Fekken, 1985; Grigoriadis, 1993). The
Similarities, Word Pairs, and New Inventions. WIST has been empirically associated with
Each item consists of a stimulus and five other indices of schizophrenia such as the
response options that differ in degree of MMPI/MMPI-2 Sc scale (Evans & Dinning,
illogicality. To illustrate, consider this sample 1980; Fishkin, Lovallo, & Pishkin, 1977;
item for the Similarities subtest: car: automo- Grigoriadis, 1993) although not with other
bile, tires, my transportation, jar, smickle. The schizophrenia indices including conceptually
correct answer receives a score of 0; a loose relevant SCL-90 scales (Dinning & Evans, 1977)
association, reference idea, clang association, and the New Haven Schizophrenic Index
and nonsense association would receive scores (Knight, Epstein, & Zielony, 1980).
of 1, 2, 3, and 4, respectively. The test Discriminant validity of the WIST has been
administrator presents for a second time any harder to establish. The WIST has difficulty
items that the respondent answered incorrectly distinguishing among different psychiatric di-
on the initial test taking. agnostic groups (e.g., Burch, 1995; Pishkin,
Three scores are calculated for the WIST: Lovallo, & Bourne, 1986). This is a serious
total Score for all response alternatives selected shortcoming because the WIST is likely to be
either in the original or in the second enquiry used in clinical settings precisely to help make
phase; total Time for the initial completion such distinctions. A second problem with
of the WIST; and an overall Index that discriminant validity has been the tendency of
combines WIST Score and WIST Time. Pre- the WIST to correlate negatively with measures
sumably the WIST Score and Time components of general cognitive ability. Based on such data
are added together because they both relate to one could share the view of at least one
schizophrenic thought disorder. However, a pessimistic reviewer and claim that the WIST
review of the empirical data supporting this has no demonstrated use (Payne, 1978).
Alternatively, the WIST may have a role in a lay people often use the term narrowly to refer
comprehensive assessment battery. The WIST to general ªoutgoingness.º Openness to Experi-
has never been promoted as a stand-alone test, ence represents, broadly, a person's level of
nor has it ever been promoted as a comprehen- constriction in their experiencing of the world; it
sive measure of the full range of schizophrenic is often associated with creativity (and even
symptomatology. Rather, the data on the WIST hypnotizability). Agreeableness represents the
may be thought of as a general measure of dimension of interpersonal behavior; the coun-
cognitive deficit rather than cognitive deficit terpart of Agreeableness is Antagonism. Final-
specific to schizophrenia. Thus, it may provide ly, Conscientiousness represents a dimension of
one objective source of data for accepting or scrupulous organization of behavior.
rejecting a more general diagnosis of psychosis.
4.14.4.1.2 NEO Personality Inventory

4.14.4 NORMAL RANGE PERSONALITY The NEO-PI is a 181-item inventory de-
ASSESSMENT signed to index the FFM personality dimen-
Identification and description of psychologi- sions (N, E, O, A, and C); the NEO-PI also
cal disorder is but one reason to administer a yields several subscales of the N, E, and O
personality measure to an adult. Objective dimensions (Costa & McCrae, 1992). There is a
personality measures also are widely used self-report form of the NEO-PI as well as an
outside the clinic or hospital setting for normal observer-rating form. Although the authors of
range assessment situations. Several objective the NEO-PI argue for its utility in clinical
personality measures will be discussed regarding settings, the instrument has been studied almost
their use in research, educational, vocational exclusively in nonclinical populations. One
assessment, and personnel selection. example of a recent investigation using the
NEO-PI in research with psychiatric samples is
the examination of differences in stimulus
4.14.4.1 Objective Personality Measures in intensity modulation among older depressed
Research individuals with and without mania features
(Allard & Mishara, 1995). The NEO-PI was
4.14.4.1.1 The Five Factor Model (the Big Five) used to examine the hypothesis that stimulus
intensity augmenters with unipolar depression
One of the most popular current conceptua-
would be introverted, whereas reducers with
lizations being studied today involves taxo-
bipolar depression would be extroverted.
nomies of personality traits based on factor
Determinations of depression with and without
analytic methods and is commonly referred to as
mania features were based on scores on the
the ªBig Five,º or the Five Factor Model
MMPI. Costa and McCrae (1992) point to the
(FFM). As Butcher and Rouse (1996) note in
NEO-PI as a useful assessment tool in aiding
their review, some personality researchers have
the clinician with understanding the client,
rejected the FFM as an end-all to personality
selection of treatment, and even anticipating
trait theory, while others in the area of
the course of therapy. However, the NEO-PI
personality research continue to embrace it.
has not found wide use among clinicians to date
Among the proponents of the FFM are Costa
(Butcher & Rouse, 1996).
and his colleagues, who have proposed the NEO
Unfortunately, the NEO-PI is very suscep-
Personality Inventory (NEO-PI) as a self-report
tible to faking (Bailley & Ross, 1996) and does
measure of the FFM personality dimensions
not contain validity indices to detect deviant
(Costa & McCrae, 1992). The FFM consists of
response sets.
five factor-analytically derived dimensions of
personality. The five dimensions (are Neuroti-
cism (N), Extroversion (E), Openness to
4.14.4.1.3 Multidimensional Personality
Experience (O), Agreeableness (A), and Con-
Questionnaire
scientiousness (C). Neuroticism has long been
a familiar adjective among clinicians for The Multidimensional Personality Question-
describing people who tend to experience naire (MPQ) is a 300-item self-report instrument
psychological distress. At the opposite end of that was developed by Tellegen (unpublished
the Neuroticism dimension is Emotional Stabi- manuscript) in an attempt to clarify the ªself-
lity, which represents the tendency to stay on a view domainº in personality research. Tellegen
psychologically even keel. Extroversion encom- used a classical iterative test construction
passes the concepts of positive emotionality, approach involving several rounds of factor
sociability, and activity. The Extroversion analysis to come up with the 11 primary scales,
dimension is rather broad in its scope, although six validity scales, and three ªhigher-orderº
Normal Range Personality Assessment 421
factors. The 11 primary scales (which include 4.14.4.1.5 Sixteen Personality Factor Test
the dimensions of Social Potency, Control,
The 16PF was originally developed in the
Harm Avoidance, Well-being, Aggression, and
1940s by Raymond Cattell to measure the
others) load onto the three higher-order scales,
primary factors of normal personality. At that
which represent the familiar personality do-
time, Cattell's unique contribution was to apply
mains of Positive Affectivity, Negative Affec-
factor analysis as a method for uncovering the
tivity, and Constraint. The six validity indices
full scope of personality. The fifth and current
include VRIN and TRIN, which are concep-
edition of the 16PF (Cattell, Cattell, & Cattell,
tually similar to those on the MMPI-2.
1993) measures the well-known 16 personality
The MPQ is not as widely used as other
factors, plus it summarizes these factors into
objective personality measures in either the
five global factors which again bear similarity to
clinical or the research domain. However, recent
the well-known ªBig Five.º The global factors
investigations suggest a place for the MPQ in
are: extroversion, anxiety, tough-mindedness,
normal range and clinical personality assess-
independence, and self-control. Relative to
ment. For example, Kuhne, Orr, and Baraga
earlier editions, the fifth editions includes
(1993) demonstrated the utility of certain MPQ
updated language; fewer items; and improved
scales for discriminating among veterans with
reliability and response style scales to measure
and without post-traumatic stress disorder.
impression management, infrequent respond-
Krueger et al. (1994) administered the MPQ
ing, and acquiescence. Because of the recency of
to adolescents in their community-based long-
the publication of the fifth edition, there are few
itudinal study and found that certain MPQ
studies pertaining to its validity. However, a
scales were useful in distinguishing those who
large database supports the validity of earlier
engaged in delinquency from those who ab-
editions of the 16PF. The 16PF has applicability
stained. These two reports suggest the utility of
in clinical, educational, organizational, and
the MPQ both in clinical settings and in normal
research settings. With the expansion of its
range personality assessment.
interpretive reports and profiles, the 16PF
would appear to be particularly useful in
personal or vocational counseling settings.
4.14.4.1.4 Personality Research Form
One well-known measure of normal person-
4.14.4.1.6 California Psychological Inventory
ality is the Personality Research Form (PRF).
Developed by Douglas N. Jackson (1984), the The CPI developed by Gough (1957) is a
PRF is a true/false, multiscale measure of 20 of multiscale, objective, self-report instrument
the psychosocial needs (e.g., achievement, used with normal range and psychiatric popula-
aggression, sociability) originally defined by tions (Megargee, 1972). The CPI is similar in
Henry Murray (1938). Many psychometrics structure and content to the MMPI (and the
texts hold up the PRF as a model of the MMPI-2). In fact, many of the items on the CPI
construct approach to test construction. Indeed, are identical in wording to the items on the
much of the appeal of the PRF lies in its ability MMPI. The CPI focuses on ªeverydayº con-
to measure a large number of normal person- cepts about personality, such as dominance and
ality characteristics while minimizing both scale responsibility among others. Eighteen scales
intercorrelations and the influence of social (divided into four classes) are derived from the
desirability and acquiescence. Moreover, a CPI; the results of the test are interpreted by
variety of validity studies have been published reference to the plotted profile of standard
in the 1980s and 1990s supporting the psycho- scores. The body of literature using the CPI in
metric soundness of the PRF. Critics of the PRF normal range assessment is quite extensive in
complain that despite its technical elegance the both quantity and breadth. Investigations
PRF does not reflect an integrated model of include the use of the CPI to identify personality
personality, which limits its applicability to real- types, based on profiles, among a group of
life testing situations. Recent research, however, college students (Burger and Cross, 1979) and
shows that the content assessed by the PRF may an examination of the underlying personality
be well described by the Five Factor structure structure as measured by the CPI, again using a
(Paunomen, Jackson, Trzebinski, & Fosterling, sample of college students (Deniston and
1992). In research the popularity of the PRF Ramanaiah, 1993). The CPI also has been
remains high as attested to by the number of employed in the assessment of psychiatric
references in bibliographies, such as the one samples. Especially noteworthy is the utility
produced by MacLennan in 1991, which lists of the CPI with criminal samples (see Laufer,
over 375 studies featuring the PRF in the Skoog, and Day, 1982, for a relevant review of
literature. this literature).
Some specific applications of psychological personality dimensions assessed by the NEO-PI

tests in ªnormal rangeº settings are now and the six vocational personality dimensions
described. proposed by Holland (assessed with the Voca-
tional Preferences Inventory). In general, there
4.14.4.2 Objective Personality Measures in was overlap among two to four of the significant
Educational/Vocational Assessment factors extracted from each of the assessment
instruments. However, the NEO-PI Neuroti-
The use of objective personality measures has cism, Likability, and Control factors were not
become increasingly popular among profes- represented in the Holland vocational person-
sionals in the field of educational/vocational ality dimensions, which suggests a distinctive
assessment. Research has identified the FFM, and qualitatively different role for objective
the NEO-PI, and the CPI as particularly useful personality assessment in vocational counsel-
in educational/vocational assessment. ing. Other work with the NEO-PI has shown
that two of the Big Five personality dimensions,
Neuroticism and Agreeableness, are strongly
4.14.4.2.1 FFM
related to occupational burnout among health-
The Big Five personality dimensions of the care workers (Piedmont, 1993). Healthcare
FFM have been studied in several contexts workers with higher ratings on the Neuroticism
related to educational/vocational assessment. dimension were more likely to experience
Moreover, because the FFM is a theoretical occupational burnout. Conversely, workers
concept, various instruments have been used to with higher ratings on the Agreeableness
assess the relationship between the Big Five dimension were less likely to succumb to
personality dimensions and various educa- occupational burnout.
tional/vocational assessment variables. Two
recent investigations illustrate the utility of
4.14.4.2.3 CPI
the Big Five personality dimensions in identify-
ing candidates for admission to educational The CPI is one of the most widely used
institutions and identifying characteristics personality instruments in normal range assess-
among students in various university programs. ment in educational/vocational settings. Walsh
Williams, Munick, Saiz, and Formy-Duval (1974) examined personality traits among
(1995) found that a mock graduate school college students identified as making hypothe-
admissions board (composed of graduate school tical career choices that were either congruent or
faculty) favored for admission those hypothe- incongruent with their vocational personality
tical candidates whose applications reflected type (as proposed by Holland). It was found
high ratings on the Big Five dimensions of that congruent students could be described by
Conscientiousness and Openness to Experience. their CPI profiles as socially accepted, con-
Conversely, the Big Five dimensions of Ex- fident, and planful, whereas incongruent stu-
troversion and Agreeableness were not asso- dents could be described as impulsive,
ciated with a favorable impression of unambitious, and insecure. The well-known
hypothetical candidates. Kline and Lapham Strong Vocational Interest Blank (SVIB) used
(1992) assessed the Big Five personality dimen- commonly among vocational and educational
sions among a group of college students to counselors is related to various personality traits
examine personality differences among the as well. Johnson, Flammer and Nelson (1975)
various fields of study (i.e., between different found a relationship among SVIB factors and
college majors). Students of various majors were CPI personality factors, especially those related
not discriminated by levels of either Neuroti- to the global introversion/extroversion person-
cism or Extroversion. However, students in two ality dimension.
fields of study (science and engineering) were
marked by high ratings on the Big Five
4.14.4.2.4 MMPI/MMPI-2
personality dimensions of Conscientiousness
and Conventionality. Although it was not designed for educational
research or placement purposes the MMPI/
MMPI-2 has been among the most frequently
4.14.4.2.2 NEO-PI
employed instruments in this context. In a
The personality dimensions that underlie the recent survey of test use in personnel and
NEO-PI appear to be related to at least one well- educational screening the MMPI has been
known typology of vocational personalities employed effectively in a number of studies,
(which, in turn, correspond to vocational for example: Anderson (1949), Appleby and
preferences). Gottfredson, Jones, and Holland Haner (1956), Applezweig (1953), Barger and
(1993) found a relationship between the Big Five Hall (1964), Barthol and Kirk (1956), Burgess
Normal Range Personality Assessment 423
(1956), Centi (1962), Clark (1953, 1964), and (Butcher & Rouse, 1996) and currently is the
Frick (1955) to mention only a few. most frequently used personality measure in
It appears evident that personality assessment personnel screening situations, particularly
contributes information independent of direct when the position is one that requires good
educational/vocational interest measures. There mental health, emotional stability, and respon-
is extensive information available on the use of sible behavior.
the MMPI/MMPI-2 in this setting. As demon- The MMPI-2 is usually employed in person-
strated in the research with the NEO-PI and the nel selection to screen out candidates who are
CPI, objective personality assessment instru- likely to have psychological problems from
ments yield information relevant to vocational critical occupations such as police officer,
assessment over and above that given by airline pilot, and nuclear power control rooms,
narrowly defined vocational personality assess- fire department, or air traffic control personnel.
ments (like the one proposed by Holland).
Moreover, elements of the FFM and indepen-
dent personality constructs of the CPI have 4.14.4.4 Other Personality Measures in
proven their utility in educational assessment in Personnel Selection
diverse areas such as admissions to educational Objective measures of personality character-
institutions and choice of major fields of study. istics have a role in personnel selection similar to
Clearly, objective personality assessment has that in educational/vocational assessment.
carved out a valuable niche in normal range Namely, professionals in the field of personnel
educational/vocational assessment. selection are interested in knowing which
personality variables aid in the selection of
4.14.4.3 Personnel Screening quality employees. The literature suggests a
valuable role for objective personality measures
Among the earliest and most extensive uses of in the normal range assessment field of
personality tests with normals has been for the personnel selection.
purpose of employment screening. The first
formal North American, English language
personality inventory, the Woodworth Person- 4.14.4.5 The 16PF
nel Data Sheet, was developed to screen out
unfit draftees during World War I. A number of One of the most widely used personality
other personality questionnaires were devel- scales for employment screening is the 16PF.
oped in the 1930s to aid in personnel selection This inventory, with broad-ranging
decisions. employment-relevant personality items, has
The development and use of the MMPI been widely used in different contexts including:
during World War II provided a means for law enforcement (Burbeck & Furnham, 1985;
assessment psychologists to detect psychologi- Fabricatore, Azen, Schoentgen, & Snibbe, 1978;
cal problems that might make people unsuitable Hartman, 1987; Lawrence, 1984; Lorr & Strack,
for key military assignments. Early research on 1994; Topp & Kardash, 1986); pilots (Cooper &
the use of the MMPI centered around pilot Green, 1976; Lardent, 1991); cabin crew
selection and selection of nuclear submarine personnel (Furnham, 1991); managers (Bar-
crewman. Following World War II, the MMPI tram, 1992; Bush, & Lucas, 1988; Chakrabarti,
came to be widely used in personnel selection & Kundu, 1984; Henney, 1975); occupational
particularly for occupations that required great therapists (Bailey, 1988); church counselors
responsibility or involved high stress such as air (Cerling, 1983) and teachers (Ferris, Bergin, &
flight crews (Butcher, 1994; Cerf, 1947; Fulk- Wayne, 1988). The 16PF provides information
erson, Freud, & Raynor, 1958; Fulkerson & about personality functioning and is typically
Sells, 1958; Garetz & Tierney, 1962; Geist & employed to screen employees for positive
Boyd, 1980; Goorney, 1970; Jennings, 1948); personality features.
police and other law enforcement personnel
(Beutler, Nussbaum, & Meredith, 1988; Beutler, 4.14.4.6 FFM
Storm, Kirkish, Scogin, & Gaines, 1985;
Butcher, 1991; Dyer, Sajwaj, & Ford, 1993; Barrick and Mount (1991) conducted a meta-
Hargrave & Hiatt, 1987; Saxe & Reiser, 1976; analysis of the Big Five personality dimensions
Scogin, & Beutler, 1986; Scogin & Reiser, 1976); and their relationship to three criterion vari-
and nuclear power employees (Lavin, Chardos, ables (job proficiency, training proficiency, and
Ford & McGee, 1987). personnel data) within five occupational
Following the revision of the MMPI and groups (professionals, police, managers,
publication of the MMPI-2, the revised instru- skilled/semiskilled and sales). Conscientious-
ment has been used in personnel screening ness was related to each of the five occupational
groups. Additionally, Conscientiousness was (including Sense of Well-being, Sociability,

related to the three criterion variables. These and Social Presence) differentiated suitable
findings lead the authors to conclude that from unsuitable cadets. In the second study of
Conscientiousness is a personality trait related the report, the authors compared incumbent law
to job performance across occupational types. enforcement officers who either had or had not
In a similar vein, Dunn, Mount, Barrick, and experienced serious on-the-job problems (e.g.,
Ones (1995) found that the Conscientiousness providing drugs to inmates, excessive use of
personality dimension was related to managers' force). The Socialization scale was among the
ratings of applicant hireability. This held true best discriminators between groups. The
for various job types (medical technologist, authors concluded that the CPI is a useful aid
carpenter, secretary, etc.). Taken together, to the selection of law enforcement officers.
these two reports suggest that professionals In addition to the literature on law enforce-
in the field of personnel selection can gain ment screening, the CPI may be useful as an
valuable information from objective personal- index of work performance in other fields.
ity measures of the FFM. Specifically, the Toward this end, Hoffman and Davis (1995)
Conscientiousness dimension, when taken with validated the Work Orientation and Managerial
other relevant application information, may be Potential scales for the CPI on groups of
a valuable discriminator among prospective job employees in an entertainment facility. How-
applicants. ever, several of the original CPI scales per-
formed as well as the two new scales in
4.14.4.7 NEO-PI predicting job performance, which questions
the need for additional CPI scales in the
While research suggests that the Big Five selection of personnel.
personality dimensions add qualitative infor- In summary, the use of objective personality
mation to the personnel selection process, it may measures in the selection of job applicants has
be that the various instruments used to measure proven a worthwhile endeavor overall. The Big
the Big Five have differential validity across Five personality dimensions, especially Con-
populations. Schmit and Ryan (1993) adminis- scientiousness, might be useful to the personnel
tered a shortened version of the NEO-PI to a selection process especially in the assessment of
sample of college students and to a sample of conscientiousness. Professionals involved in the
government job applicants. The FFM structure screening of law enforcement candidates can use
fitted the student population better than it fitted the CPI to differentiate suitable from unsuitable
the job applicant population, which suggests a candidates. The CPI may also be useful in
note of caution in putting too much weight on discriminating among groups of job applicants
the Big Five personality dimensions in person- (although its primary use has been in the law
nel selection. The authors note that job enforcement field).
applicants are under different situational de- The scales on the 16PF have been shown to be
mands, which may affect their approach to a relevant to personality descriptions that are
personality questionnaire (e.g., they may adopt useful in personnel selection. Finally, when it
a defensive response style). The lack of validity comes to evaluating potential psychopathology
scales to assess response styles clearly limits the in potential employees the MMPI-2 is usually
NEO-PI for this application. A recent study by the instrument most employed.
Bailley and Ross (1996) showed that the NEO- Although objective personality measures
PI is quite vulnerable to faking and is limited in appear to have a place in personnel selection,
not having scales to detect deviant response all information on the candidate must be
attitudes. weighed, as several personality researchers have
noted the problem of response sets associated
with the situational demands of the application
4.14.4.7.1 CPI
process. Specifically, job applicants may feel
The NEO-PI and other personality measures under pressure to make a good impression on
have been examined in personnel selection their prospective employer and they may
studies covering a wide range of occupational subsequently present themselves as overly
groups (managers, secretaries, carpenters, etc.). virtuous or defensive.
However, the CPI has a long tradition of use in
the selection of a specific occupation: law
enforcement officers. Hargrave and Hiatt 4.14.5 SUMMARY
(1989) examined the ability of the CPI scales
to differentiate police cadets rated by their Human fascination with the concept of
instructors as suitable or unsuitable for the job personality lead to the nineteenth century
of law enforcement officer. Several scales invention of the first objective personality test.
References 425
As with those very early personality measures, tories that measure the Big Five (or Five Factor
many of today's objective personality inven- Model, FFM) personality traits: Neuroticism
tories are self-reports. The clinician's first (N), Extroversion (E), Openness to Experience
concern when utilizing an objective personality (O), Agreeableness (A), and Conscientiousness
measure is whether or not a client can accurately (C). The NEO Personality Inventory (NEO-PI)
reveal information about his or her personality assesses N, E, and O and has been used as an
through a self-report instrument. Many objec- index of the Big Five in research. The Multi-
tive personality instruments incorporate indices dimensional Personality Questionnaire (MPQ)
of test-taking attitudes (e.g., the Lie scale of the assesses the broad personality domains of
MMPI/MMPI-2) which allow the clinician to Positive Affectivity, Negative Affectivity, and
gauge a client's level of insight and willingness Constraint. The MPQ contains two validity
to self-disclose. Additionally, research shows indexes (VRIN and TRIN) common to the
that clients who do cooperate with testing MMPI-2, which make the MPQ appealing to
produce personality profiles that match external many researchers. Other objective personality
criteria (e.g., clinician's notes and observations instruments that have been used widely in
regarding the patient). Essentially, most clients research include the Personality Research Form
are able to reveal their personalities compe- (PRF), a measure of several psychosocial needs;
tently through self-report measures. the 16PF, which measures global factors similar
Once a client is able to self-disclose informa- to the Big Five; and the California Psychological
tion regarding his or her personality, the scale Inventory (CPI), designed to assess ªeverydayº
scores that are produced appear to be quite concepts about personality.
stable over time. Thus, most of the objective Finally, professionals working in the fields of
personality measures manage to capture trait educational/vocational assessment and person-
(as opposed to state) characteristics. Five nel selection have found use for several objective
factors exhibit influence on the stability of personality measures. The 16PF, the CPI, and,
personality: (i) instrument characteristics, (ii) most commonly, the MMPI/MMPI-2 have
length of retest interval, (iii) operationalization been used in both of these settings. Objective
of personality as a stable construct for test personality instruments give professionals in-
construction, (iv) the extent to which a formation about an individual's personality
particular personality construct is associated which would not be obtained through standard
with stability, and (v) person variables of the applications or interviews. Thus, professionals
test-taker. can use objective personality inventories as an
Several objective personality measures are efficient method of obtaining more information
designed to assess adults in clinical settings. The to aid them in their task of advising clients about
most well-known and widely used objective educational/vocational decisions or advising
personality inventory in clinical settings is the employers in the selection of personnel.
MMPI-2, which provides a comprehensive Whether one needs a tool to assess adult
survey of personality characteristics and clinical personality in clinical, research, or industry
problems. The Basic Personality Inventory settings, there is probably an objective person-
(BPI) and the Personality Assessment Inventory ality inventory to fit the bill. Many of today's
(PAI) are alternatives to the MMPI-2, but objective inventories offer the efficiency of
neither is as widely used as the MMPI-2. Several providing a comprehensive assessment of
other objective measures have been developed personality functioning, and some even provide
for specialized or focused clinical use including computerized interpretation of the personality
the Millon Clinical Multiaxial Inventory profile. Perhaps most importantly, most of the
(MCMI) designed for making personality objective personality inventories available com-
diagnoses; the Beck Depression Inventory mercially are standardized instruments that can
(BDI), which assesses depressive ideation; the assess adult personality validly and reliably,
State-Trait Anxiety Inventory (STAI) designed which means these instruments can be used over
to assess both long-term and short-term anxiety the course of a client's treatment to document
features; and the Whitaker Index of Schizo- goals for changeÐa feature that is becoming
phrenic Thinking (WIST) designed to measure increasingly important to clinicians in this era of
the type of thought impairment that differenti- managed healthcare.
ates between schizophrenic and ªnormalº
thought processes.
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4.14.1 INTRODUCTION 404

4.14.4.7 NEO-PI 424

4.14.1 INTRODUCTION relationship between a client's level of intelli-

The interpretation of differences in stability expected to change on different constructs as a

Table 1 Personality characteristics associated with validity indicator elevations.

? Cannot say score

Variable response inconsistency

True response inconsistency

Table 2 Empirical correlates for MMPI-2 clinical scales.

Scale 4 (Psychopathic deviate)

Scale 10 (Social introversion)

Adapted from Butcher (1989).

Table 3 Description of the MMPI-2 content scales.

12. Social discomfort (SOD)

Adapted from: Butcher, Graham, Williams, & Ben-Porath (1990).

4.14.4.1.2 NEO Personality Inventory

Some specific applications of psychological personality dimensions assessed by the NEO-PI

groups. Additionally, Conscientiousness was (including Sense of Well-being, Sociability,

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