Developed by Leslie Morey, PhD, in 1991

Transcription

1 Matthew Clem, MEd

2 Objectives In-Depth Overview of the Personality Assessment Inventory (PAI) Brief Overview of Minnesota Multiphasic Personality Inventory 2 (MMPI-2) Compare/Contrast PAI & MMPI-2 as personality assessment instruments Discuss Approach to Assessment in a Psychiatric Population Instruments, Clinical Presentation, Context Case Examples Patients with both MMPI-2 and PAI Results

3 Goals Basic understanding of PAI development, administration and interpretation Learn advantages/disadvantages of the PAI compared to other personality assessments Become more informed in test selection based on appropriate applications of the PAI

4 Background Developed by Leslie Morey, PhD, in 1991 Self-report, objective measure of adult personality and broad range of psychopathology for use in a variety of contexts Consists of 22 non-overlapping scales: 4 validity scales 11 clinical scales 5 treatment scales 2 interpersonal scales

5 Test Development Developed based on construct validation framework Constructs selected based on: Stability of construct/disorder over time Importance in contemporary practice Differs from purely empirical approach Scales designed to measure particular constructs

6 Test Development No single item parameter used as sole criterion for item selection Sought balance b/w content coverage and empirical characteristics Item response-scaling to ensure adequate depth of coverage: F, ST, MT, VT ICC s used to ensure different levels of severity in manifested symptomatology Ex] SUI: from vague thoughts to immediate plans Efforts to reduce bias, increase discriminant validity

7 Administration 4 th grade reading level Individual or group settings 344 items 60 minutes or less Computer, audio administration available Available in Spanish, French, Danish, Korean, Hebrew

8 Validity Scales Inconsistency (ICN) Each pair consists of highly correlated items. Infrequency (INF) Items are neutral with respect to psychopathology and have extremely high or low endorsement rates. Negative Impression Management (NIM) Positive Impression Management (PIM)

9 Clinical Scales Somatic Complaints (SOM) Conversion (SOM-C), Somatization (SOM-S), Health Concerns (SOM-H) Anxiety (ANX) Cognitive (ANX-C), Affective (ANX-A), Physiological (ANX-P) Anxiety-Related Disorders (ARD) Cognitive (ARD-O), Phobias (ARD-P), Traumatic Stress (ARD-T) Depression (DEP) Cognitive (DEP-C), Affective (DEP-A), Physiological (DEP-P) Mania (MAN) Activity Level (MAN-A), Grandiosity (MAN-G), Irritability (MAN-I)

10 Clinical Scales Paranoia (PAR) Resentment (PAR-R), Hypervigilance (PAR-H), Persecution (PAR-P) Schizophrenia (SCZ) Psychotic Experiences (SCZ-P), Social Detachment (SCZ-S), Thought Disorder (SCZ-T) Borderline Features (BOR) Affective Instability (BOR-A), Identity Problems (BOR-I), Negative Relationships (BOR-N), Self-Harm (BOR-S) Antisocial Features (ANT) Antisocial Behaviors (ANT-A), Egocentricity (ANT-E), Stimulus- Seeking (ANT-S) Alcohol Problems (ALC) Drug Problems (DRG)

11 Treatment & Interpersonal Scales Aggression (AGG) Aggressive Attitude (AGG-A), Verbal Aggression (AGG-V), Physical Aggression (AGG-P) Suicidal Ideation (SUI) Stress (STR) Nonsupport (NON) Treatment Rejection (RXR) Dominance (DOM); Warmth (WRM) Two sided dimension: warm, outgoing style at the high end; cold, rejecting style at the low end

12 Interpretation Steps 1. Extent to which profile is free from potential response distortions 2. Consideration of appropriate reference comparison for profile Community v. clinical If elevated above T = 70, evaluate problems in comparison to clinical population Distorted v. non-distorted If distortions occur, helpful to compare to response-style standardized profiles Specific referral contexts Norms gathered for certain contexts (personnel selection, treatment settings)

13 Interpretation Steps 3. Individual scales and components are examined Full Scale Score T = 70+ then compare to clinical norms Subscale Scores Look at subscales to isolate core elements/clarify meaning of full scale elevations; aid in configural diagnostic decision-making Individual Items Inspect items to assess specific clinical problems

14 Interpretation Steps 4. Consider impact of particular combinations or configurations of scales Profile Code Types: two highest clinical scale scores Mean Profile Comparison: through Interpretive Explorer Conceptual Indices: Malingering, Defensiveness, Violence Potential, Suicide Potential, Treatment Process Based on theoretical formulations of specific issues Actuarial Decision Rules: Discriminating bona-fide v. simulated Schizophrenia Limited number of functions in need of cross-validation samples

15 PAI Interpretive Explorer Report

16 PAI Interpretive Explorer Report

17 MMPI-2 Overview MMPI-2 was a product of dustbowl empiricism Narrowed from items to originally 504 by identifying items that: Normals scored in one direction and Clearly identified diagnostic groups scored in opposite direction Flaws in this early approach are clearly documented in many sources, and include: Imbalance in numbers of items by scale No real item construct validation atheoretical approach to item selection Normals were relatives of hospitalized pt at U of Minn; even restandaridization sample under-represents minorities Does NOT assume that endorsement of an individual item actually has any particular correlation to the patient s behavior, so itemlevel analysis and interpretation is not supported by the test construction process. Restandardization led to MMPI-2 in Restandardization committee attempted to retain enough of the original that a substantial portion of the original research could still be regarded as useful while updating item content and using a more representative standardization sample.

18 MMPI-2 Overview VRIN TRIN F F B F P FBS L K S Hs D Hy Pd Mf Pa Pt Sc Ma Si Raw Score K Correction T Score Non-Gen T Response %

19 MMPI-2 Overview 1. What was the test-taking attitude of the examinee and how should this attitude be taken into account in interpreting the protocol? 2. What is the general level of adjustment of the examinee? 3. What kinds of behaviors (symptoms, attitudes, defenses, etc.) can be inferred about or expected from the examinee? 4. What etiology or psychological dynamics underly these behaviors? 5. What are the most appropriate diagnostic labels for the examinee? 6. What are the implications for treatment of the examinee?

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21 Test Development PAI Construct-validation approach -Theoretical MMPI-2 Purely empirical approach - Dust-bowl empiricism Item Selection Process Written to assess constructs Validation Samples 1000 community-dwelling adults 1265 patients from 69 clinical sites 1051 college students Selected from personality inventories, textbooks and clinical experience 2600 adults in community -Minorities underrepresented Clinical Scales Administration Non-overlapping -Subscales can contribute regardless of clinical elevation 4 th grade reading level min 344 items Numerous subscales, indices 6 th -8 th grade reading level min 567 items Research Backing ~2,500 citations ~10,000 citations

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23 Assessment in Clinical Populations Assessment is done to generate answers to (i.e., advanced hypotheses about) a particular set of clinical questions in a focused and efficient manner. Assessment is generally broad-based and multi-modality, with results integrated from diverse sources and methods. Assessment is contextual taking into account the specific circumstances of patient presentation, setting, and other clinical considerations Consistent with virtually all other biomedical clinical assessment protocols, psychological assessment uses scientifically validated data in standardized ways, but it is not the same thing as a research-generated scientific conclusion. Rather, psychological assessment in purely clinical settings synthesizes data from a variety of sources into a meaningful formulation, taking into account the probable validity of each data source. Relatively more valid / more wellvalidated data is prioritized, but all data are integrated into a meaningful whole. It is essentially an advanced hypotheses that addresses the clinical / referral questions. Therefore, assessment is always to some degree inferential. The degree to which you can infer answers / generate hypotheses from test data is related to overall data validity.

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25 Case Background - CF 26 y/o W Female; outpatient Presentation: Severe mood and anxiety symptoms History: Adopted at 5m through foster care Dropped out of school, prior Special Education Long history of polysubstance use Arrested 5x, probation 3x, prison 1x Recent MVA Long history of abuse chronic pain, possible amputation

26 MMPI-2

27 PAI

28 PAI Mean Profile Comparison

29 Brief Conclusion Magnification of psychopathology due to negative self-view Constantly vigilant of surroundings to avoid more psychological trauma Diagnosis Major Depressive Disorder Post-traumatic Stress Disorder Unspecified Personality Disorder Cluster B and C features

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31 Case Background - JL 39 y/o divorced W Male; outpatient Presentation: Social withdrawal, no social interaction; trying to manage symptoms the natural way History: On full disability through MHMR Doesn t remember most of childhood Step-father sexually abused, mother neglected, father physically abused Behaviorally disturbed at 14 y/o; encopresis Prev Dx: Bipolar, Schizoaffective, BPD, Dysthymia, Schizoid/Avoidant PD, ODD, ADHD, PTSD, Anxiety, LD, Polysubstance Abuse

32 The MMPI-2

33 PAI

34 PAI Mean Profile Comparison

35 Brief Conclusion No psychosis, intact reality-testing; chronic depressive affect (alexythymia) Adult life stabilized w/decreased treatment Diagnoses: Persistent Depressive Disorder Unspecified Personality Disorder (Cluster B,C) Rec s: Ongoing, established relationship with psychiatrist Individ./group therapy-characterological/interpers.

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37 Case Background LKP 52 yo married W Female; inpatient Presentation: 3 involuntary admits to PEC over 1 month period Symptoms resembling psychosis; rapid recompensation History Raped by family friend 10/ /30/14 AMS, bizarre beh. 12/25/14 AMS, SUI ideation, bizarre beh. 01/18/15 AMS, SUI threats, bizarre beh., delusions 8 psych hospitalizations in 5 yrs

38 PAI 12/31/14

39 The MMPI-2 01/23/15

40 Brief Conclusion Validity in question across all measures High functioning w/intermittent episodes of profound disorganization, confusion Diagnosis R/O Unspecified Psychotic Disorder R/O Cognitive Disorder R/O Personality Disorder

41 References Greene, Roger L. The MMPI-2: An interpretive manual. Allyn & Bacon, Morey, L. C. (2003). Essentials of PAI assessment. Hoboken, N.J.: John Wiley & Sons, Inc. Morey, L. C. (2011). Personality assessment inventory [PowerPoint slides]. Retrieved from www4.parinc.com/webuploads/ppt/pai.ppt Morey, Leslie C., and C. Boggs. Personality assessment inventory (PAI). PAR, Butcher, James Neal, and Carolyn L. Williams. Essentials of MMPI- 2 and MMPI-A interpretation. Minneapolis: University of Minnesota Press, Caldwell, A. B. "MMPI-2 data research file for clinical patients." Unpublished raw data (1997). Lovitt, R. (2003) A response to Woods and Nezwarski (unpublished paper)

42 Questions?