Construct Validity of MMPI-2-RF Scales in Forensic Inpatient Hospital Setting
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Nasreen Toorabally & Isabella Romero
Supervised by Dr. Danielle Burchett
California State University, Monterey Bay
In collaboration with Dr. David Glassmire
Patton State Hospital
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•
The Minnesota Multiphasic Personality Inventory-2
(MMPI-2) one of the
most widely used assessment
tools by mental health clinicians in the U.S.
(Camara,
et. al, 2000; Graham, 2011)
•
The MMPI-2-RF [Restructured Form] is a 338-item
self-report measure. Using
51
scales, it measures
o
psychopathology (mental illness), personality
constructs
o
accuracy of self-report
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Can the MMPI-2-RF distinguish between
individuals diagnosed with
different
disorders
(construct validity)
in a
forensic inpatient setting
?
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EID and THD scales are especially useful
in differentiating between patients
diagnosed with schizophrenia or mood
disorders (e.g., major depressive
disorder)
(Sellbom et al., 2012)
.
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Paraphilic disorders are assessed by
MMPI-2-RF,
such as pedophilic
disorder
•
Sex offenders against children tend to
report higher levels of depression,
anxiety, and somatic concerns, as well
as lower self-esteem
(Kalichman, 1991)
.
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*Can the MMPI-2-RF distinguish between
patients diagnosed with different disorders
(Construct validity) in a forensic inpatient
setting?
Two studies:
Two studies:
•
Study 1:
Study 1:
Mood vs. Psychotic
•
Study 2:
Study 2:
Pedophilic Disorder vs. Other
Paraphilic Disorders
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66.7% Male
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57.1% Caucasian
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20% African American
•
Mean Age = 41 Years (SD = 11.4)
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Pedophilic Disorder vs. Other
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•
Extended empirical literature
demonstrating the utility of the MMPI-2-
RF in differential diagnosis.
•
Important to treat
mood, anxiety,
somatic, and psychotic symptoms
throughout many patient groups.
•
Future studies:
Examine replicability
and generalizability of findings in larger
samples and other diagnostic groups.
28
A
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We would like to thank the following for making both this study possible, and
our attendance today:
•
Grant from the University of Minnesota Press, which supported data
collection
•
Our mentor, Dr. Danielle Burchett, CSU Monterey Bay
•
Our collaborator, Dr. David Glassmire, Patton State Hospital
•
The CSUMB Undergraduate Research Opportunities Center
•
U.S. Department of Education, McNair Scholars
R
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s
s
Camara, W.J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage:
Implications in professional psychology.
ProfessionalPsychology:
Research and Practice, 31,
141–154.
Graham, J. R. (2011). MMPI-2: Assessing personality and psychopathology (3rd ed.).
New York, NY: Oxford.
Kalichman, S. C. (1991). Psychopathology and personality characteristics of
criminal sexual offenders as a function of victim age.
Archives of
Sexual Behavior, 20,
187-197.
Sellbom, M., Bagby, R. M., Kushner, S., Quilty, L. C., & Ayearst, L. E. (2012).
Diagnostic construct validity of MMPI-2 Restructured Form (MMPI-
2-RF) scale scores.
Assessment, 19
, 176-186.
29
MMPI-2-RF Scales
30
31
32
33
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*Independent Samples t-test:
•
Statistical significance
(
p
< .05)
•
Comparing means of independent
samples
Hedges'
g
values
•
Practical significance
•
S
m
a
l
l
:
.
2
0
-
.
4
9
•
M
e
d
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m
:
.
5
0
-
.
7
9
•
L
a
r
g
e
:
.
8
0
+
34
Normative:
Mean= 50
Clinically Significant:
Mean ≥ 65
35
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•
To be diagnosed with a paraphilic disorder people with
atypical sexual interests must:
o
feel
personal distress
about their interest,
OR
o
have a sexual desire or behavior that
involves
another person’s psychological distress
, injury, or
death, or a desire for sexual behaviors involving
unwilling persons or persons unable to give legal
consent.
•
Examples include: exhibitionistic disorder and
voyeuristic disorder.
36
Hello everyone, my name is Isabella Romero and I am co-author with Nasreen Toorabally. We are both here today representing the CSU Monterey Bay, Psychology Department with our study, looking into the "Construct Validity of MMPI-2-RF Scales in a Forensic Inpatient Hospital Setting“.
MMPI-2-RF scales are examined for distinguishing between different disorders in a forensic inpatient setting. Studies on psychopathology in mood versus psychotic disorders and psychopathology in sex offenders are highlighted, with a focus on assessing paraphilic disorders. The current study aims to establish the construct validity of MMPI-2-RF in distinguishing between patients with various diagnoses.
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Construct Validity of MMPI-2-RF Scales in a Forensic Inpatient Hospital Setting Nasreen Toorabally & Isabella Romero Supervised by Dr. Danielle Burchett California State University, Monterey Bay In collaboration with Dr. David Glassmire Patton State Hospital 1
MMPI-2-RF The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) one of the most widely used assessment tools by mental health clinicians in the U.S. (Camara, et. al, 2000; Graham, 2011) The MMPI-2-RF [Restructured Form] is a 338-item self-report measure. Using 51 scales, it measures o psychopathology (mental illness), personality constructs o accuracy of self-report 2
Research Question Can the MMPI-2-RF distinguish between individuals diagnosed with different disorders (construct validity) in a forensic inpatient setting? 3
Psychopathology in Mood vs. Psychotic Disorders EID and THD scales are especially useful in differentiating between patients diagnosed with schizophrenia or mood disorders (e.g., major depressive disorder) (Sellbom et al., 2012). 5
Psychopathology in Sex Offenders Paraphilic disorders are assessed by MMPI-2-RF, such as pedophilic disorder Sex offenders against children tend to report higher levels of depression, anxiety, and somatic concerns, as well as lower self-esteem (Kalichman, 1991). 6
Current Study *Can the MMPI-2-RF distinguish between patients diagnosed with different disorders (Construct validity) in a forensic inpatient setting? Two studies: Study 1: Mood vs. Psychotic Study 2: Pedophilic Disorder vs. Other Paraphilic Disorders 7
Study 1 Mood vs. Psychotic Disorders 8
Study 1 Sample Demographics 66.7% Male 57.1% Caucasian 20% African American Mean Age = 41 Years (SD = 11.4) 9
Study 1 Method Final Sample 120 80 Mood Disorder Mood Disorder 213 368 Mood & Psychotic Disorder Random responders and underreporters removed (n=119) Mood & Psychotic Disorder 1,111 280 508 Total Sample Psychotic Disorder Psychotic Disorder Approved by California Committee for the Protection of Human Subjects 80 43 All other Diagnoses All other Diagnoses 10
Study 1 Hypothesis 1 Mood/Internalizing-Related Scales Emotional / Internalizing Dysfunction EID Demoralization Low Positive Emotions Suicidal Ideation Helplessness Self-Doubt Inefficacy Negative Emotionality RCd RC2 SUI HLP SFD NFC NEGE-r 11
Study 1 Hypothesis 2 Psychoticism-Related Scales Thought Dysfunction Ideas of Persecution Aberrant Experiences Psychoticism THD RC6 RC8 PSYC-r 12
Study 1 Results & Discussion Internalizing Scales Mood/ Psychotic [2] (n = 213) Mood [1] (n = 80) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges g Effect Sizes g12 g13 g14 g23 g24 g34 M M M M EID: Emotional/ Internalizing 54.94 53.30 49.03 53.33 0.13 0.55* 0.13 0.38* 0.00 -0.40 RCd: Demoralization 56.06 55.53 51.42 54.23 0.04 0.43* 0.15 0.37* 0.11 -0.26 RC2: Low Positive Emotions 55.18 53.03 50.27 55.56 0.15 0.42* -0.03 0.22* -0.18 -0.45 SUI: Suicidal/ Death Ideation 54.91 53.93 49.70 53.02 0.06 0.42* 0.11 0.34* 0.06 -0.31 SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27 NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09 NEGE-r: Negative Emotionality 52.96 52.30 48.05 51.12 0.06 0.49* 0.16 0.41* 0.10 -0.29 13
Study 1 Results & Discussion Internalizing Scales Mood/ Psychotic [2] (n = 213) Mood [1] (n = 80) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges g Effect Sizes g12 g13 g14 g23 g24 g34 M M M M EID: Emotional/ Internalizing 54.94 53.30 49.03 53.33 0.13 0.55* 0.13 0.38* 0.00 -0.40 RCd: Demoralization 56.06 55.53 51.42 54.23 0.04 0.43* 0.15 0.37* 0.11 -0.26 RC2: Low Positive Emotions 55.18 53.03 50.27 55.56 0.15 0.42* -0.03 0.22* -0.18 -0.45 SUI: Suicidal/ Death Ideation 54.91 53.93 49.70 53.02 0.06 0.42* 0.11 0.34* 0.06 -0.31 SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27 NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09 NEGE-r: Negative Emotionality 52.96 52.30 48.05 51.12 0.06 0.49* 0.16 0.41* 0.10 -0.29 14
Study 1 Results & Discussion Internalizing Scales Mood/ Psychotic [2] (n = 213) Mood [1] (n = 80) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges g Effect Sizes g12 g13 g14 g23 g24 g34 M M M M EID: Emotional/ Internalizing 54.94 53.30 49.03 53.33 0.13 0.55* 0.13 0.38* 0.00 -0.40 RCd: Demoralization 56.06 55.53 51.42 54.23 0.04 0.43* 0.15 0.37* 0.11 -0.26 RC2: Low Positive Emotions 55.18 53.03 50.27 55.56 0.15 0.42* -0.03 0.22* -0.18 -0.45 SUI: Suicidal/ Death Ideation 54.91 53.93 49.70 53.02 0.06 0.42* 0.11 0.34* 0.06 -0.31 SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27 NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09 NEGE-r: Negative Emotionality 52.96 52.30 48.05 51.12 0.06 0.49* 0.16 0.41* 0.10 -0.29 15
Study 1 Results & Discussion Internalizing Scales Mood/ Psychotic [2] (n = 213) Mood [1] (n = 80) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges g Effect Sizes g12 g13 g14 g23 g24 g34 M M M M EID: Emotional/ Internalizing 54.94 53.30 49.03 53.33 0.13 0.55* 0.13 0.38* 0.00 -0.40 RCd: Demoralization 56.06 55.53 51.42 54.23 0.04 0.43* 0.15 0.37* 0.11 -0.26 RC2: Low Positive Emotions 55.18 53.03 50.27 55.56 0.15 0.42* -0.03 0.22* -0.18 -0.45 SUI: Suicidal/ Death Ideation 54.91 53.93 49.70 53.02 0.06 0.42* 0.11 0.34* 0.06 -0.31 SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27 NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09 NEGE-r: Negative Emotionality 52.96 52.30 48.05 51.12 0.06 0.49* 0.16 0.41* 0.10 -0.29 16
Study 1 Results & Discussion Psychoticism-Related Scales Mood/ Psychotic [2] (n = 213) Mood [1] (n = 80) Psychotic [3] (n = 280) Other [4] (n = 43) Hedges g Effect Sizes M M M M g12 g13 g14 g23 g24 g34 THD: Thought Dysfunction 54.16 59.00 57.81 53.70 -0.33 -0.25 0.04 0.08 0.34 0.27 RC6: Ideas of Persecution 58.81 62.51 61.46 60.65 -0.23 -0.17 -0.13 0.07 0.11 0.05 RC8: Aberrant Experiences 53.74 55.80 54.68 52.16 -0.16 -0.08 0.14 0.09 0.27 0.20 PSYC-r: Psychoticism 52.11 57.11 56.07 53.56 -0.34* -0.28 -0.12 0.07 0.23 0.17 17
Study 2 Pedophilic Disorder vs. Other Paraphilic Disorders 18
Study 2 Hypotheses Depression Somatic Concerns RC1 MLS GIC HPC NUC COG Anxiety Interpersonal Deficits/Introversion IPP SAV SHY DSF RCd RC2 EID SUI HLP SFD NFC RC7 STW AXY ANP NEGE-r 19
Study 2 Method 1,037 No paraphilic disorders/missing diagnoses Did not meet inclusion criteria 5 Pedophilic and other paraphilic disorders 1,111 Final Sample Total Sample 49 36 Random responders and overreporters removed Pedophilic Disorder Pedophilic Disorder 20 13 Other Paraphilic Disorders Other Paraphilic Disorders 20
Study 2 Results & Discussion Depression Other Paraphilic Disorder (n = 13) M Pedophilic Disorder (n = 36) Hedges g Effect Sizes M SD SD g Higher-Order Scales EID: Emotional/Internalizing Dysfunction Restructured Clinical Scales RCd: Demoralization 54.31 13.29 46.69 7.31 0.63* 54.33 12.91 50.54 10.34 0.31 RC1: Somatic Complaints 56.25 12.62 52.69 8.54 0.30 RC2: Low Positive Emotions 55.69 16.73 44.92 9.39 0.71* RC7: Dysfunctional Negative Emotions 50.33 11.67 45.23 8.96 0.46 21
Study 2 Results & Discussion Depression Other Paraphilic Disorder (n = 13) M Pedophilic Disorder (n = 36) Hedges g Effect Sizes M SD SD g Higher-Order Scales EID: Emotional/Internalizing Dysfunction Restructured Clinical Scales RCd: Demoralization 54.31 13.29 46.69 7.31 0.63* 54.33 12.91 50.54 10.34 0.31 RC1: Somatic Complaints 56.25 12.62 52.69 8.54 0.30 RC2: Low Positive Emotions 55.69 16.73 44.92 9.39 0.71* RC7: Dysfunctional Negative Emotions 50.33 11.67 45.23 8.96 0.46 22
Study 2 Results & Discussion Somatic Concerns Other Paraphilic Disorder (n = 13) Pedophilic Disorder (n = 36) Hedges g Effect Sizes M SD M SD g Somatic/Cognitive Specific Problems Scales MLS: Malaise 52.19 10.29 44.54 6.98 0.80* GIC: Gastrointestinal Complaints 51.61 10.42 51.38 10.40 0.02 HPC: Head Pain Complaints 54.97 13.93 45.92 7.85 0.72* NUC: Neurological Complaints 59.39 11.96 53.08 14.56 0.49 COG: Cognitive Complaints 52.92 11.85 49.08 8.39 0.35 23
Study 2 Results & Discussion Anxiety Pedophilic Disorder (n = 36) M Other Paraphilic Disorder (n = 13) M Hedges g Effect Sizes g SD SD Internalizing Specific Problems Scales SUI: Suicidal/Death Ideation 49.08 8.43 52.46 12.09 -0.35 HLP:Helplessness/Hopelessness 52.19 14.52 47.15 10.26 0.37 SFD: Self-Doubt 51.61 12.06 47.23 6.03 0.40 NFC: Inefficacy 52.75 10.73 48.85 8.64 0.38 STW: Stress / Worry 49.75 10.31 44.69 6.24 0.54 AXY: Anxiety 53.33 12.53 49.46 8.96 0.33 ANP: Anger-Proneness 53.89 13.94 47.38 10.34 0.49 Personality Psychopathology Five Scales (Revised) NEGE-r: Negative Emotionality 52.25 12.61 46.15 7.72 0.53 24
Study 2 Results & Discussion Anxiety Pedophilic Disorder (n = 36) M Other Paraphilic Disorder (n = 13) M Hedges g Effect Sizes g SD SD Internalizing Specific Problems Scales SUI: Suicidal/Death Ideation 49.08 8.43 52.46 12.09 -0.35 HLP:Helplessness/Hopelessness 52.19 14.52 47.15 10.26 0.37 SFD: Self-Doubt 51.61 12.06 47.23 6.03 0.40 NFC: Inefficacy 52.75 10.73 48.85 8.64 0.38 STW: Stress / Worry 49.75 10.31 44.69 6.24 0.54 AXY: Anxiety 53.33 12.53 49.46 8.96 0.33 ANP: Anger-Proneness 53.89 13.94 47.38 10.34 0.49 Personality Psychopathology Five Scales (Revised) NEGE-r: Negative Emotionality 52.25 12.61 46.15 7.72 0.53 25
Study 2 Results & Discussion Interpersonal Deficits/Introversion Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges g Effect Sizes M SD M SD g Interpersonal Specific Problems Scales IPP: Interpersonal Passivity 52.69 12.24 47.54 7.98 0.45 SAV: Social Avoidance 51.83 12.04 48.38 10.05 0.30 SHY: Shyness 49.53 8.71 44.54 5.58 0.62 DSF: Disaffiliativeness 54.28 13.75 53.85 11.00 0.03 26
Study 2 Results & Discussion Unanticipated Differences Pedophilic Disorder (n = 36) Other Paraphilic Disorder (n = 13) Hedges g Effect Sizes M SD M SD g Interest Scales AES: Aesthetic-Literary Interests 47.19 10.75 55.62 9.22 -0.81* MEC: Mechanical-Physical Interests 51.81 8.91 58.85 7.24 -0.82* 27
Integrated Discussion Extended empirical literature demonstrating the utility of the MMPI-2- RF in differential diagnosis. Important to treat mood, anxiety, somatic, and psychotic symptoms throughout many patient groups. Future studies: Examine replicability and generalizability of findings in larger samples and other diagnostic groups. 28
Acknowledgements We would like to thank the following for making both this study possible, and our attendance today: Grant from the University of Minnesota Press, which supported data collection Our mentor, Dr. Danielle Burchett, CSU Monterey Bay Our collaborator, Dr. David Glassmire, Patton State Hospital The CSUMB Undergraduate Research Opportunities Center U.S. Department of Education, McNair Scholars References Camara, W.J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: Implications in professional psychology. ProfessionalPsychology: Research and Practice, 31, 141 154. Graham, J. R. (2011). MMPI-2: Assessing personality and psychopathology (3rd ed.). New York, NY: Oxford. Kalichman, S. C. (1991). Psychopathology and personality characteristics of criminal sexual offenders as a function of victim age. Archives of Sexual Behavior, 20, 187-197. Sellbom, M., Bagby, R. M., Kushner, S., Quilty, L. C., & Ayearst, L. E. (2012). Diagnostic construct validity of MMPI-2 Restructured Form (MMPI- 2-RF) scale scores. Assessment, 19, 176-186. 29
MMPI-2-RF Scales Validity Indicators CNS - Cannot Say VRIN-r -Variable Response Inconsistency TRIN-r -True Response Inconsistency F-r - Infrequent Responses Fp-r - Infrequent Psychopathology Responses Fs - Infrequent Somatic Responses FBS-r - Symptom Validity RBS - Response Bias L-r - Uncommon Virtues K-r - Adjustment Validity Higher-Order (H-O) Scales EID - Emotional / Internalizing Dysfunction THD - Thought Dysfunction BXD - Behavioral / Externalizing Dysfunction 30
Restructured Clinical Scales RCd-(dem) -Demoralization RC1-(som) -Somatic Complaints RC2-(lpe) - Low Positive Emotions RC3-(cyn) - Cynicism RC4-(asb) - Antisocial Behavior RC6-(per) - Ideas of Persecution RC7-(dne) - Dysfunctional Negative Emotions RC8-(abx) - Aberrant Experiences RC9-(hpm) -Hypomanic Activation Somatic / Cognitive Scales MLS - Malaise GIC - Gastro-Intestinal Complaints HPC -Head Pain Complaints NUC -Neurological Complaints COG -Cognitive Complaints 31
Internalizing Scales SUI - Suicidal/Death Ideation HLP - Helplessness/Hopelessness SFD - Self-Doubt NFC -Inefficacy STW -Stress / Worry AXY - Anxiety ANP -Anger Proneness BRF - Behavior-Restricting Fears MSF -Multiple Specific Fears Externalizing Scales JCP - Juvenile Conduct Problems SUB - Substance Abuse AGG - Aggression ACT - Activation 32
Interpersonal Scales FML - Family Problems IPP - Interpersonal Passivity SAV - Social Avoidance SHY - Shyness DSF - Disaffiliativeness Interest Scales AES - Aesthetic-Literary Interests MEC - Mechanical-Physical Interests PSY-5 (Personality Psychopathology Five) Scales, Revised AGGR-r - Aggressiveness-Revised PSYC-r - Psychoticism-Revised DISC-r - Disconstraint-Revised NEGE-r -Negative Emotionality / Neuroticism - Revised INTR-r - Introversion / Low Positive Emotionality- Revised 33
Statistics *Independent Samples t-test: Statistical significance (p < .05) Comparing means of independent samples Hedges' g values Practical significance Small: .20-.49 Medium: .50-.79 Large: .80+ M1 M2 34
EID THD RCd RC2 RC7 RC6 RC8 SUI STW HLP AXY SFD ANP Clinically Significant: Mean 65 Normative: Mean= 50 NFC BRF IPP, SAV, SHY, DSF MSF NEGE-r PSYC-r 35
Paraphilic Disorders To be diagnosed with a paraphilic disorder people with atypical sexual interests must: o feel personal distress about their interest, OR o have a sexual desire or behavior that involves another person s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent. Examples include: exhibitionistic disorder and voyeuristic disorder. 36
