THE CONSTRUCT VALIDITY OF THE MMPI-2/MMPI-2-RF RESTRUCTURED CLINICAL (RC) SCALES AND THE ASSESSMENT OF PERSONALITY DISORDERS.

THE CONSTRUCT VALIDITY OF THE MMPI-2/MMPI-2-RF RESTRUCTURED CLINICAL (RC) SCALES AND THE ASSESSMENT OF PERSONALITY DISORDERS Mathew Barth Submitted for the degree of Doctor of Philosophy Faculty of Education Monash University May 2013

AMENDMENTS INSERTION OF CHANGES Dr Senior Comment: If Study 1 is eliminated in its entirety it is my belief that the document stands as a highly creditable piece of research and easily meets the requirements for a PhD. I want to assert unequivocally that the N for Study 2, the sample, analyses, and interpretation are sufficient in their own right and the loss of Study 1 does not diminish the value and importance of the research in any way. In this circumstance it is my belief that this constitutes only a minor change to the document (think of the quality and integrity of the research not the number of pages eliminated with one press of the delete key). These changes could be managed by the supervisor and student and, in my opinion would not need to be resubmitted for examination. Study 1 and all references throughout the thesis to Study 1 have been eliminated. Dr Senior Comment: Given the prominence of the MMPI 2 RF in the title this chapter is unusually light with detail of the new restructured form. For those who are familiar with both versions of the MMPI 2 the imbalance stands out. Depending upon the decision the author and supervisor make in relation to my concerns, this imbalance could be addressed either by providing more information in relation to the MMPI 2 RF or less regarding the MMPI 2. For example, the focus could be placed more on the scales that are potentially shared between the two forms, being the RC and Psychopathology 5 scales. The decision was made to include more detail on the MMPI-2-RF. An additional section was included in Chapter 2, pp. 19-21. 2.8 The Minnesota Multiphasic Personality Inventory- Revised Form Impending research on the RC scales has become increasingly relevant due to the release of the Minnesota Multiphasic Personality Inventory- Revised Form (MMPI-2-RF; Tellegen & Ben- Porath, 2008), which contains the nine RC scales as core scales. Tellegen and Ben Porath stated that the aim of the MMPI-2-RF was to capture the clinically significant substance of the MMPI- 2 item pool (p.1) by developing higher and lower order scales to complement the RC scales. The higher and lower order scales of the MMPI-2-RF were developed with the same factor analytic techniques as the RC scales and use a subset of 338 items from the MMPI-2. The first set of scales constructed for the MMPI-2-RF were the three higher-order scales which were developed to provide a broad assessment of psychopathology. The higher order scales were developed by factor analysing the nine RC scales which were found to confirm to the three factor structure of Emotional/Internalizing Dysfunction (EID), Thought Dysfunction (THD) and Behavioural/ Externalizing Dysfunction (BXD). Tellegen and Ben-Porath then decided to develop more narrowly focused scales to complement the RC scales. They emphasised two reasons for this; 1) to provide facet scales which give more specific information for elevations on an RC scale and 2) scales which measure constructs that are not accounted for by the RC scales. This resulted in 25 specific problem scales which are divided into five somatic/cognitive scales, nine internalising scales, four externalising scales and five interpersonal scales.

Due to the popularity of the PSY-5 scales on the MMPI-2 (Butcher et al., 2001), Tellegen and Ben-Porath invited Alan Harkness and John McNulty to construct a set of revised Personality Psychopathology - Five scales for the MMPI-2-RF. Harkness and McNulty (2007) reviewed the 96 items which comprised the MMPI-2 PSY-5 scales by conducting internal and external analysis of the items. This concluded with 22 items being eliminated and 30 new items being added to the five revised scales. Harkness and McNulty reported improved construct validity for the revised scales when compared against external correlates. However, to date there is no published research on the potential incremental validity of the revised scales in the assessment of personality pathology, with such research imperative given the MMPI-2 PSY-5 scales were designed specifically to measure normal and abnormal traits which are relevant to the expression of personality disorders. The MMPI-2-RF is still a recent addition to the field of self-report inventories and as such many of the scales have not been validated extensively. However, Locke et al. (2010) found evidence of the construct validity of RC1 and the five somatic/cognitive scales in the neurological assessment of patients from an epilepsy monitoring unit. Another recent study by Sellbom, Bagby, Kushner, Quilty and Ayearst (2012) has provided evidence for the diagnostic utility of the higher order, RC and a number of the specific problem scales in differentiating patients diagnosed with bipolar disorder, major depressive disorder and schizophrenia encouraging the use of the MMPI-2-RF in the psychological assessment of Axis I pathology. Future research analysing the validity of the MMPI-2-RF in the assessment of Axis II disorders would provide further credibility for its use in clinical settings. Dr Senior Comment: The Dyce and O Connor (1998) study is discussed in some detail. A cautionary note here is that the tenor of this section is that the NEO PI R is capable of discriminating personality disorders. This is not achievable by showing that one self report inventory can predict performance on another. The samples in this study were university students, not individuals with diagnosed personality disorders it is not personality disorders that are being predicted it is scores on another test that purports to measure personality disorders. The central concern here is the pattern of correlations is being related to DSM IV TR diagnostic criteria which the study sample have patently not met. In many ways it is an indictment of the method that data from people without diagnosed personality disorders can be considered consistent with DSM IV TR criteria. While this is noted at the end of the section (after the reader has waded through a number of statements that seem to continually make this interpretative error) it would be more appropriate to put it at the beginning of the section with a caution that the descriptions at no time refer to actual diagnosed personality disorders. The following amendment has been made to the thesis on p.49, at the very beginning of the analysis of the Dyce and O Connor study: However, it must be noted that inferences about the results as they relate to DSM-IV-TR criteria are made very cautiously because of the characteristics of the sample (a student population) and the fact that the participants were not individuals who had been diagnosed with a personality disorder. Dr Senior Comment: Examination of correlation matrices is also extremely vulnerable to misinterpretation as no consideration of multicollinearity is incorporated. Nor is any

indication of the criterion which constitutes a meaningful correlation (this could be indicated in Table 3.2). The following amendment has been made to the thesis on p.50, under Table 3.2: Note. Correlations >. 15 are significant according to the Bonferonni adjustment. Also, on p.58 the following amendment was made in the section discussing the limitations of the study: There was also no consideration given to multicollinearity and the potential effect of excessively high correlations between the independent variables (the NEO-PI-R domain and facet scales) on the integrity of the results (Howell, 2010). Dr Senior Comment: This chapter discusses the findings in Chapter 8. There is substantial redundancy in the repeated presentation of findings from the previous chapter. Table 10.1 presents a well organised structure. I would recommend considering separating out the positive and negative loaded scales to facilitate comparison. The table was implementing Dr Senior s comments has been inserted on p.160: TYPOGRAPHICAL ERRORS Dr Senior Comment: Bagby, Marshall, & Georgiades (2005b) on p 61 line 18 is incorrectly referred to as Bagby, Margarita, & Georgiades (2005b) on p.276 (I believe Marshall s first name is Margarita). ERRATA On p.62 Margarita has been replaced with Marshall. Dr Senior Comment: It also appears that the a, b convention is being used incorrectly a and b are used in references when the same authors have published two papers in the same year meaning their citation in text would look identical. There is no Bagby, Marshall, & Georgiades (2005a) in the references. This mistake is also made in referencing Bagby, Costa, Widiger, Ryder, & Marshall (2005a). However the convention is used correctly on p.278. ERRATA All references to Bagby, Marshall, & Georgiades (2005a) and Bagby, Costa, Widiger, Ryder, & Marshall (2005a) have been deleted and have been amended in the reference list on p.199. Dr Senior Comment: On page 56 when stepwise regression analyses are described some measures are referred to as negatively skewed. I do not recognise the use of the term

skewed in this context where it is used, it is making reference to measures which correlate negatively with the predicted variable skewedness refers to the degree to which a variable s distribution deviates from the symmetrical normal distribution with a bulge in the upper end of the distribution when this is negative is the term intended perhaps negatively associated or negatively loaded? ERRATA All references using the term skewed have been replaced with loaded on p.57. Dr Senior Comment: Some noted typographic errors are: Page XXX, line 17 voluntary should be replaced with voluntarily ; page 46, line 16, consisted should be consistent ; page 75, line 7 coherent should be consistent ; page 77, line 3 in should be with. ERRATA Voluntary has been replaced with voluntarily on page XXX. Consisted has been replaced with consistent on page 47. Coherent has been replaced with consistent on page 78. In replaced with with on page 79. AMENDMENTS Dr Bagby Comment: If I were to question Mr Barth, I would ask him about his choice not to assess for multi-colinearity. Mulicollinearity was assessed using the collinearity diagnostics in SPSS. The tables have been added as Appendix A from pp. 227 231. In the Results section on p.125 it is noted that: Multicollinearity was also assessed by analysing the Tolerance and Variance Inflating Factor (VIF) columns 1. Tolerance levels under.40 and a VIF over 2.5 were noted as indicating the possibility of multicollinearity (Howell, 2010). Comments have also been made in the results section when mulitcollinearity may be present and effecting the results. On p.129 when discussing the results for schizotypal personality disorder and the RC scales:

Also notable were the multicollinearity diagnostics which showed that RC8 had a tolerance level of.36 and a VIF of 2.79 suggesting the possibility of multicollinearity. This is likely to be due to the large correlation between RC6 and RC8 (r =.71). On p.131-132 when discussing the results for borderline personality disorder and the RC scales: The final model for BDL also indicated possible multicollinearity with the tolerance levels for RCd (.31) and RC7 (.25) a concern as well as the VIF s (3.18 and 3.97 respectively). This is not surprising due to the strong positive correlation (r =.82) between the scales. Dr Bagby Comment: Perhaps this information is in the Appendices and I missed it but reporting estimates of internal consistency (Cronbach s alpha and AIC) of the measures in different samples would be needed. The alpha values and AIC values have been reported on p.119, although study 1 has been eliminated from the thesis. Dr Bagby Comment: What would have been nice to include here is some speculation about the implications of the results viz, the proposed DSM-5 P& PD system of conceptualizing personality psychopathology. On p.194 when discussing the implications of the findings for paranoid, dependent and histrionic personality disorders, the following has been included: The results for the RC scales and PAR and DEP have implications for the DSM-V (APA, 2011) which has eliminated both as diagnosed personality disorders. The results demonstrate that whilst there is diagnostic overlap between PAR and SZT and AVD and DEP, both PAR and DEP are distinct with regards to the more severely pathological ideas of persecution in PAR and the pathological nature of persons with DEP to please others in order to gain nurturance. Similarly, the results for the NEO-PI-R domain scales showed that eliminating HST from the DSM-V may also not be well founded as HST was differentiated from NAR by more pathological levels of Extraversion and Openness to Experience. In essence, the results from this study suggest that PAR, HST and DEP are well defined personality disorders which should remain within any future classification system. Also on p. 194 the implication of the findings for the five factor model and a dimensional model of personality disorders is discussed: Another feature of the results which has implications for the DSM-V was the validity of normal personality traits in the assessment of personality disorders. Despite being

outperformed by the RC scales for the assessment of 8 out of 10 personality disorders, the traits measured by the NEO-PI-R from the five factor model (FFM) were still capturing a very respectful amount of variance for the majority of the personality disorders. The dimension model proposed for the DSM-V does not include normal personality traits, only pathological traits which would again seem to be unfounded when examining empirical research demonstrating the effectiveness of the normal personality traits of the FFM and the assessment of personality disorders (Widiger, 2011).

COPYRIGHT NOTICE Under the Copyright Act 1968, this thesis must be used only under the normal conditions of scholarly fair dealing. In particular, no results or conclusions must be extracted from it, nor should it be copied or closely paraphrased without the express written consent of the author. Proper written acknowledgement should be made for any assistance obtained from this thesis. I certify that I have made all reasonable efforts to secure copyright permission of third party content included in this thesis and have not knowingly added copyright content to my work without the owner s permission.

ii TABLE OF CONTENTS Page LIST OF TABLES ABSTRACT DECLARATION ACKNOWLEDGEMENTS vii xvii xix xx CHAPTER 1: OVERVIEW 1 CHAPTER 2: INTRODUCTION 4 2.1 The Clinical Scales 4 2.2 Criticism of the Clinical Scales 7 2.3 The Content Scales 9 2.4 The Supplementary Scales 10 2.5 The Restructured Clinical (RC) Scales 13 2.6 The Clinical Scales versus the RC Scales 15 2.7 Limitations of Research on the RC Scales 19 2.8 The Minnesota Multiphasic Personality Inventory- Revised Form 19 2.9 Conclusion 21 CHAPTER 3: LITERATURE REVIEW 23 3.1 Introduction 23 3.2 Early and Contemporary Concepts of Personality Disorders 23

iii 3.3 Definition of Personality Disorder 28 3.4 Classification of Personality Disorders 32 3.5 Assessment of Personality Disorders 35 3.6 Self-Report Inventories and Personality Disorders 36 3.7 Self-Report Inventories and Dimensional Approaches to 41 Personality Disorders 3.8 The NEO-PI-R and Personality Disorders 46 3.9 The Neuroticism (N) Facets and the Assessment 49 of Personality Disorders 3.10 The Extraversion (E) Facets and the Assessment 52 of Personality Disorders 3.11 The Openness to Experience (O) Facets and the Assessment 53 of Personality Disorders 3.12 The Agreeableness (A) Facets and the Assessment 54 of Personality Disorders 3.13 The Conscientiousness (C) Facets and the Assessment 56 of Personality Disorders 3.14 The NEO-PI-R facets and the Assessment of Personality Disorders 58 3.15 The MMPI-2 and Personality Disorders 68 3.16 The Personality Psychopathology Five (PSY-5) Scales 79 3.17 The Restructured Clinical (RC) Scales 90 3.18 The Restructured Clinical (RC) Scales and the Assessment of Personality 94 and Personality Disorders

iv 3.19 Conclusion 104 CHAPTER 4: PURPOSE OF THE STUDY 107 CHAPTER 5: METHOD 110 5.1 Participants 110 5.2 Measures 112 5.3 Procedure 114 5.4 Hypotheses 115 CHAPTER 6: RESULTS 118 6.1 The MMPI-2-RF Restructured Clinical (RC) Scales and the 118 NEO-PI-R Domain and Facet Scales 6.2 The MMPI-2-RF RC Scales and the SCID-II PQ Personality Disorder 123 Raw Scores 6.2.1 Paranoid Personality Disorder 126 6.2.2 Schizoid Personality Disorder 127 6.2.3 Schizotypal Personality Disorder 128 6.2.4 Antisocial Personality Disorder 129 6.2.5 Borderline Personality Disorder 131 6.2.6 Histrionic Personality Disorder 132 6.2.7 Narcissistic Personality Disorder 134 6.2.8 Avoidant Personality Disorder 135 6.2.9 Dependent Personality Disorder 137 6.2.10 Obsessive-Compulsive Personality Disorder 138

v 6.3 The NEO-PI-R and the SCID-II PQ Personality Disorder Raw Scores 139 6.3.1 Paranoid Personality Disorder 144 6.3.2 Schizoid Personality Disorder 146 6.3.3 Schizotypal Personality Disorder 147 6.3.4 Antisocial Personality Disorder 148 6.3.5 Borderline Personality Disorder 149 6.3.6 Histrionic Personality Disorder 151 6.3.7 Narcissistic Personality Disorder 152 6.3.8 Avoidant Personality Disorder 153 6.3.9 Dependent Personality Disorder 154 6.3.10 Obsessive-Compulsive Personality Disorder 156 6.4 Conclusion 157 CHAPTER 7: DISCUSSION 159 7.1 Paranoid Personality Disorder 159 7.2 Schizoid Personality Disorder 163 7.3 Schizotypal Personality Disorder 164 7.4 Antisocial Personality Disorder 168 7.5 Borderline Personality Disorder 170 7.6 Histrionic Personality Disorder 174 7.7 Narcissistic Personality Disorder 176 7.8 Avoidant Personality Disorder 178 7.9 Dependent Personality Disorder 180

vi 7.10 Obsessive-Compulsive Personality Disorder 183 7.11 Conclusion 185 CHAPTER 8: CONCLUSION 187 8.1 Clinical Implications 187 8.2 Limitations of the Current Study 195 REFERENCES 198 APPENDIX A 227 Multicollinearity diagnostics for the MMPI-2-RF RC scales and the NEO-PI-R domain scales in the prediction of the SCID-II PQ Personality Disorder Raw Scores APPENDIX B 232 The statistical significance of the final regression models of the MMPI-2-RF RC scales and the NEO-PI-R domain scales in the prediction of the SCID-II PQ Personality Disorder Raw Scores

vii LIST OF TABLES Table 3.1 Predictions for the ten DSM -IV personality disorders and 48 the NEO-PI-R Table 3.2 Zero-order correlations of the NEO-PI-R domains and facets 50 and the MCMI-III Personality Disorder scales Table 3.3 Lyman and Widiger (2001) expert ratings for FFM facets and 64 DSM-IV personality disorders Table 3.4 Hierarchical regression results from Wygant et al. (2006) for the 87 MDI Personality Disorder scales, MMPI-2 Clinical scales, Content scales and PSY-5 scales Table 3.5 Hypotheses from Sellbom et al. (2005). Assessing psychopathic 97 personality traits with the MMPI 2. Journal of Personality Assessment, 85, 334 343 scales and MMPI-2 Personality Disorder scales (Non- Overlapping) after the elimination of item overlap (n = 205) Table 6.1 Descriptive statistics for the MMPI-2-RF Restructured Clinical 119 (RC) Scales and NEO-PI-R Domain and Facet scales (n = 83) Table 6.2 Zero-order correlations for the MMPI-2-RF Restructured Clinical 120 (RC) Scales and the NEO-PI-R domain and facet scales (n = 83) Table 6.3 Descriptive statistics for the MMPI-2-RF Restructured Clinical 124 (RC) Scales and SCID-II PQ Personality Disorder Raw Scores (n = 83) Table 6.4 Zero-order correlations for the MMPI-2-RF Restructured Clinical 125 (RC) Scales and SCID-II PQ Personality Disorder Raw Scores (n = 83) Table 6.5 Backward Elimination Regression Analysis for the MMPI-2-RF 126

viii RC Scales and the Paranoid Personality Disorder (PAR) Raw Scores Table 6.6 Significance of the contributions of RC3, RC6, RC7 and RC9 127 in the prediction of PAR Table 6.7 Backward Elimination Regression Analysis for the MMPI-2-RF 127 RC Scales and the Schizoid Personality Disorder (SZD) Raw Scores Table 6.8 Significance of the contribution of RCd in the prediction of SZD 128 Table 6.9 Backward Elimination Regression Analysis for the MMPI-2-RF 128 RC Scales and the Schizotypal Personality Disorder (SZT) Raw Scores Table 6.10 Significance of the contributions of RC2, RC6 and RC8 in the 129 prediction of SZT Table 6.11 Backward Elimination Regression Analysis for the MMPI-2-RF 130 RC Scales and the Antisocial Personality Disorder (ATS) Raw Scores Table 6.12 Significance of the contributions of RC4, RC8 and RC9 in the 130 prediction of ATS Table 6.13 Backward Elimination Regression Analysis for the MMPI-2-RF 131 RC Scales and the Borderline Personality Disorder (BDL) Raw Scores Table 6.14 Significance of the contributions of RCd, RC4, RC7 and RC9 132 in the prediction of BDL Table 6.15 Backward Elimination Regression Analysis for the MMPI-2-RF 133

ix RC Scales and the Histrionic Personality Disorder (HST) Raw Scores Table 6.16 Significance of the contributions of RC7 and RC9 in the 133 prediction of HST Table 6.17 Backward Elimination Regression Analysis for the MMPI-2-RF 134 RC Scales and the Narcissistic Personality Disorder (NAR) Raw Scores Table 6.18 Significance of the contributions of RCd, RC6, RC8 and RC9 in 135 the prediction of NAR Table 6.19 Backward Elimination Regression Analysis for the MMPI-2-RF 136 RC Scales and the Avoidant Personality Disorder (AVD) Raw Scores Table 6.20 Significance of the contributions of RC2 and RC7 in 136 the prediction of AVD Table 6.21 Backward Elimination Regression Analysis for the MMPI-2-RF 137 RC Scales and the Dependent Personality Disorder (DEP) Raw Scores Table 6.22 Significance of the contributions of RCd and RC2 in 138 the prediction of DEP Table 6.23 Backward Elimination Regression Analysis for the MMPI-2-RF 138 RC Scales and the Obsessive-Compulsive Personality Disorder (OBC) Raw Scores Table 6.24 Significance of the contributions of RC3, RC4 and RC7 in 139

x the prediction of OBC Table 6.25 Descriptive statistics for the NEO-PI-R domain and facet scales 140 and the SCID-II-PQ Personality Disorder Raw Scores (n = 83) Table 6.26 Zero-order correlations the NEO-PI-R domain and facet scales 142 and the SCID-II-PQ Personality Disorder Raw Scores (n = 83) Table 6.27 Backward Elimination Regression Analysis for the NEO-PI-R 145 domain scales and the Paranoid Personality Disorder (PAR) Raw Scores Table 6.28 Significance of the contributions of Neuroticism and 145 Agreeableness in the prediction of PAR Table 6.29 Backward Elimination Regression Analysis for the NEO-PI-R 146 domain scales and the Schizoid Personality Disorder (SZD) Raw Scores Table 6.30 Significance of the contributions of Neuroticism and 147 Openness to Experience in the prediction of SZD Table 6.31 Backward Elimination Regression Analysis for the NEO-PI-R 147 domain scales and the Schizotypal Personality Disorder (SZT) Raw Scores Table 6.32 Significance of the contributions of Neuroticism and 148 Conscientiousness in the prediction of SZT Table 6.33 Backward Elimination Regression Analysis for the NEO-PI-R 148 domain scales and the Antisocial Personality Disorder (ATS) Raw Scores

xi Table 6.34 Significance of the contributions of Neuroticism, Extraversion, 149 Openness to Experience and Agreeableness in the prediction of ATS Table 6.35 Backward Elimination Regression Analysis for the NEO-PI-R 150 domain scales and the Borderline Personality Disorder (BDL) Raw Scores Table 6.36 Significance of the contributions of Neuroticism, Extraversion, 150 Agreeableness and Conscientiousness in the prediction of BDL Table 6.37 Backward Elimination Regression Analysis for the NEO-PI-R 151 domain scales and the Histrionic Personality Disorder (HST) Raw Scores Table 6.38 Significance of the contributions of Extraversion, Openness to 152 Experience and Agreeableness in the prediction of HST Table 6.39 Backward Elimination Regression Analysis for the NEO-PI-R 152 domain scales and the Narcissistic Personality Disorder (NAR) Raw Scores Table 6.40 Significance of the contributions of Neuroticism, Extraversion 153 and Agreeableness in the prediction of NAR Table 6.41 Backward Elimination Regression Analysis for the NEO-PI-R 153 domain scales and the Avoidant Personality Disorder (AVD) Raw Scores Table 6.42 Significance of the contributions of Neuroticism, Extraversion 154 Openness to Experience and Conscientiousness in the

xii prediction of AVD Table 6.43 Backward Elimination Regression Analysis for the NEO-PI-R 155 domain scales and the Dependent Personality Disorder (DEP) Raw Scores Table 6.44 Significance of the contributions of Neuroticism and Openness 155 to Experience in the prediction of DEP Table 6.45 Backward Elimination Regression Analysis for the NEO-PI-R 156 domain scales and the Obsessive-Compulsive Personality Disorder (OBC) Raw Scores Table 6.46 Significance of the contributions of Neuroticism, Agreeableness 156 and Conscientiousness in the prediction of OBC Table 6.47 Summary of the MMPI-2-RF RC and NEO-PI-R domain scales 158 as predictors of the SCID-II PQ Personality Disorder Raw Scores (n = 83) Table 7.1 Hypotheses and results for the MMPI-2-RF RC Scales, 160 NEO-PI-R domain scales and SCID-II-PQ Personality Disorder (PD) Raw Scores (n = 83) Appendix A.1 Multicollinearity diagnostics for the MMPI-2-RF RC scales 227 and the prediction of PAR. Appendix A.2 Multicollinearity diagnostics for the MMPI-2-RF RC scales 227 and the prediction of SZD. Appendix A.3 Multicollinearity diagnostics for the MMPI-2-RF RC scales 227 and the prediction of SZT.

xiii Appendix A.4 Multicollinearity diagnostics for the MMPI-2-RF RC scales 227 and the prediction of ATS. Appendix A.5 Multicollinearity diagnostics for the MMPI-2-RF RC scales 228 and the prediction of BDL. Appendix A.6 Multicollinearity diagnostics for the MMPI-2-RF RC scales 228 and the prediction of HST. Appendix A.7 Multicollinearity diagnostics for the MMPI-2-RF RC scales 228 and the prediction of NAR. Appendix A.8 Multicollinearity diagnostics for the MMPI-2-RF RC scales 228 and the prediction of AVD. Appendix A.9 Multicollinearity diagnostics for the MMPI-2-RF RC scales 228 and the prediction of DEP. Appendix A.10 Multicollinearity diagnostics for the MMPI-2-RF RC scales 229 and the prediction of OBC. Appendix A.11 Multicollinearity diagnostics for the NEO-PI-R domain scales 229 and the prediction of PAR. Appendix A.12 Multicollinearity diagnostics for the NEO-PI-R domain scales 229 and the prediction of SZD. Appendix A.13 Multicollinearity diagnostics for the NEO-PI-R domain scales 229 and the prediction of SZT. Appendix A.14 Multicollinearity diagnostics for the NEO-PI-R domain scales 229 and the prediction of ATS.

xiv Appendix A.15 Multicollinearity diagnostics for the NEO-PI-R domain scales 230 and the prediction of BDL. Appendix A.16 Multicollinearity diagnostics for the NEO-PI-R domain scales 230 and the prediction of HST. Appendix A.17 Multicollinearity diagnostics for the NEO-PI-R domain scales 230 and the prediction of NAR. Appendix A.18 Multicollinearity diagnostics for the NEO-PI-R domain scales 230 and the prediction of AVD. Appendix A.19 Multicollinearity diagnostics for the NEO-PI-R domain scales 230 and the prediction of DEP. Appendix A.20 Multicollinearity diagnostics for the NEO-PI-R domain scales 231 and the prediction of OBC. Appendix B.1 Statistical significance of the final regression model of the 232 MMPI-2-RF RC scales in predicting PAR Appendix B.2 Statistical significance of the final regression model of the 232 MMPI-2-RF RC scales in predicting SZD Appendix B.3 Statistical significance of the final regression model of the 232 MMPI-2-RF RC scales in predicting SZT Appendix B.4 Statistical significance of the final regression model of the 233 MMPI-2-RF RC scales in predicting ATS Appendix B.5 Statistical significance of the final regression model of the 233 MMPI-2-RF RC scales in predicting BDL Appendix B.6 Statistical significance of the final regression model of the 233

xv MMPI-2-RF RC scales in predicting HST Appendix B.7 Statistical significance of the final regression model of the 233 MMPI-2-RF RC scales in predicting NAR Appendix B.8 Statistical significance of the final regression model of the 233 MMPI-2-RF RC scales in predicting AVD Appendix B.9 Statistical significance of the final regression model of the 234 MMPI-2-RF RC scales in predicting DEP Appendix B.10 Statistical significance of the final regression model of the 234 MMPI-2-RF RC scales in predicting OBC Appendix B.11 Statistical significance of the final regression model of the 234 NEO-PI-R Domain scales in predicting PAR. Appendix B.12 Statistical significance of the final regression model of the 234 NEO-PI-R domain scales in predicting SZD. Appendix B.13 Statistical significance of the final regression model of the 234 NEO-PI-R domain scales in predicting SZT Appendix B.14 Statistical significance of the final regression model of the 235 NEO-PI-R domain scales in predicting ATS Appendix B.15 Statistical significance of the final regression model of the 235 NEO-PI-R domain scales in predicting BDL Appendix B.16 Statistical significance of the final regression model of the 235 NEO-PI-R domain scales in predicting HST Appendix B.17 Statistical significance of the final regression model of the 235 NEO-PI-R domain scales in predicting NAR

xvi Appendix B.18 Statistical significance of the final regression model of the 235 NEO-PI-R domain scales in predicting AVD Appendix B.19 Statistical significance of the final regression model of the 236 NEO-PI-R domain scales in predicting DEP Appendix B.20 Statistical significance of the final regression model of the 236 NEO-PI-R domain scales in predicting OBC

xvii ABSTRACT The current study examined the construct validity of the Restructured Clinical (RC) scales (Tellegen et al., 2003) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and MMPI-2- Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008) and the assessment of personality disorders. Tellegen et al. (2003) constructed the RC scales to address the perceived psychometric limitations of the Clinical scales and to measure the core psychological constructs of each of the Clinical scales whilst enhancing convergent and particularly discriminant validity. Tellegen et al. s project resulted in the development of nine RC scales that were designed to be independent of the pervasive influence of the first factor, more distinctive and a more accurate measure of the core psychological constructs the original Clinical scales were designed to measure. This study utilised a forensic sample (n = 83) in order to analyse the construct validity of the RC scales when compared to the Structured Clinical Interview for the fourth edition of the DSM (DSM-IV; APA, 1994) Axis II Disorders-Personality Questionnaire (SCID-II PQ; First, Gibbon, Spitzer, Williams & Benjamin, 1997) and the Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992). The findings for this study demonstrated the construct validity of the RC scales when compared to the SCID-II PQ personality disorder raw scores and the NEO-PI-R domain and facet scales. The RC scales also accounted for additional variance over the NEO-PI- R domain scales for 8 out of the 10 SCID-II PQ personality disorder raw scores and provided a clinically accurate profile of personality disorders when expressed in their

xviii more pathological variants in a forensic population. The findings provide strong support for the construct validity of the MMPI-2/MMPI-2-RF RC scales and the assessment of personality disorders in a forensic setting. The results also support the aims of Tellegen et al. to create a set of scales that accurately measure the core psychological constructs of the Clinical scales whilst enhancing convergent and discriminant validity.

xix DECLARATION This is to certify that i) the thesis comprises only my original work and except for the Research Graduate School Committee s approval, contains no material which has been accepted for the award of any other degree or diploma in any university or other institution, ii) iii) due acknowledgement has been made in the text to all other material used, the thesis is less than 100,000 words in length, exclusive of tables, references and appendices. Signed.. Date Mathew Barth Faculty of Education Monash University March 2013

xx ACKNOWLEDGEMENTS There are many people have made the completion of this thesis possible. Firstly, my beautiful wife Valentina whose unconditional love, support, patience, sacrifice and encouragement kept me motivated to push forward during dark times and my daughter Mia who inspired me to be the best person I can be. My mother Robyn, father Dieter and sister Danielle who have always had faith in me to achieve my dreams and have made me the person I am today. The research would not have been possible without my supervisor Dr Philip Greenway and the supportive and insightful manner which he conducted the research with me. What I have learnt from him will stay with me for the rest of my life and he has made me a better psychologist. I would also like to thank Eileen Scott Stokes who has been the most amazing person to me over my years at Monash and has been committed to providing with assistance over and beyond what she needed to. A special thanks to David Ball and Patrick Newton who allowed me to conduct my research at their practice and were dedicated to helping me recruit the participants necessary to complete the thesis. The thesis would not have been finished without your time and effort. Finally, I would like to thank all the participants who voluntarily completed the battery of testing necessary for the thesis. I am very appreciative of your time and effort during a trying period of your life.

1 CHAPTER 1 OVERVIEW The current study aims to examine the construct validity of the Restructured Clinical (RC) scales (Tellegen et al., 2003) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and MMPI-2- Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008a) and the assessment of personality disorders. The presentation of the study proceeds with the introductory chapter (Chapter 2), which provides a history of MMPI-2 scale development beginning with the release of the original Minnesota Multiphasic Personality Inventory (Hathaway & McKinley, 1940; 1943) and the Clinical scales and concluding with the development of the RC scales and the release of the MMPI-2-RF. The introduction begins by reviewing early factor analytic research on the Clinical scales and research supporting the construct validity of the scales in clinical and nonclinical settings. The chapter then explores the common critiques of the Clinical scales including scale heterogeneity, high scale intercorrelations, the effect of the first factor (Tellegen et al., 2003, p.12) and the empirical keying method used to construct the scales. The introductory chapter also provides an overview of additional scales which were developed to aid clinicians with MMPI and MMPI-2 interpretive analysis including the Harris and Lingoes (1955, 1968) subscales, the MMPI Content scales (Wiggins, 1966), the MMPI-2 Content scales (Butcher, Graham, Williams, & Ben-Porath, 1990) and noteworthy Supplementary scales. The chapter concludes by detailing the aims and development of the RC scales and reviews literature relating to the debate within the MMPI-2 research community regarding the psychometric integrity of the scales.

2 The review highlights research detailing whether the more distinctive and homogenous RC scales represent an improvement when compared to the overlapping and heterogeneous Clinical scales in the assessment of personality and psychopathology. Chapter 3 presents the literature review, which begins by reviewing the conceptual history of personality disorders and detailing the introduction of personality disorders as a recognised mental disorder and diagnostic category in the mental health profession. The review also includes the on-going debate of whether a categorical or dimensional approach is the most appropriate system for the definition and classification of personality disorders. The chapter then provides an overview of the assessment of personality disorders with a particular emphasis on the use of self-report inventories and research examining the validity of the Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992) as a dimensional assessment of personality disorders. The remainder of the literature review focuses on previous research involving the MMPI-2 and the assessment of personality disorders with an emphasis on the Clinical scales (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), the MMPI-2 Personality Disorder scales (MMPI-2 PD; Colligan, Morey, & Offord, 1994), the Personality Psychopathology Five (PSY-5; Harkness & McNulty, 1994; Harkness, McNulty & Ben-Porath, 1995) and the RC scales (Tellegen et al., 2003). The chapter concludes with suggestions regarding future research for the RC scales and the assessment of personality disorders. Chapter 4 summarizes the purpose of the current study and the aim to evaluate the construct validity of the RC scales and the assessment of personality disorders. Chapter 4 summarizes the aim of analyzing the validity of the RC scales in a forensic population.

3 The chapter concludes with comments regarding the possible implications of the results for MMPI-2/MMPI-2-RF analysis and clinical practice. Chapter 5 presents the methodology for the present study including participants, measures and procedure as well as the conceptually relevant RC and NEO-PI-R domain scales that are expected to be predictors of specific personality disorders. Chapter 5 also explains that the personality disorder raw scores from the Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire (SCID-II PQ; First, Gibbon, Spitzer, Williams & Benjamin, 1997) will be used as the dependent variable. Chapter 6 presents the results including the zero-order correlations between the RC scales, NEO-PI-R domain and facet scales and the SCID-II PQ personality disorder raw scores. Chapter 6 also includes the backward elimination regression results between the RC scales and the SCID-II PQ and between the NEO-PI-R domain scales and the SCID- II PQ. Chapter 7 presents the discussion with particular attention paid to the clinical utility of the RC scales and the assessment of personality disorders in a forensic population. Chapter 7 also compares the validity of the RC and NEO-PI-R domains scales and the assessment of personality disorders in a forensic sample. The study continues by exploring whether the aims have been achieved and surmises whether the RC scales have achieved their intended purpose of being a more distinctive, homogenous and precise measure of the core psychological constructs of the Clinical scales. The study concludes by discussing the broader implications of the use of the RC scales in MMPI-2/MMPI-2-RF interpretive analysis, the limitations of the current study and what this may imply about the results.

4 CHAPTER 2 INTRODUCTION This study will investigate the potential construct validity of the Restructured Clinical (RC) scales (Tellegen et al., 2003) of the MMPI-2 (Butcher et al., 1989) and MMPI-2-RF (Ben-Porath & Tellegen, 2008a) and the assessment of personality disorders. The RC scales are a recent development of the MMPI-2 and were designed to address the psychometric limitations of the Clinical scales originally constructed for the MMPI (Hathaway & McKinley, 1940; 1943). The 10 Clinical scales from the MMPI and MMPI-2 have been extensively researched and empirically validated over the past 70 years (Butcher, 2010). The Clinical scales have remained relatively unchanged from the original MMPI in order to preserve the research base supporting the scales and continue to form an integral part of MMPI-2 analysis, despite the development of numerous other content and Supplementary scales that are currently used to analyse numerous forms of psychopathology. 2.1 The Clinical Scales The 10 Clinical scales were developed to measure various clinically important phases of personality (Hathaway & McKinley, 1942, p. 73) and were constructed using an empirical keying method, which involved having a criterion group (patients with the psychiatric condition the scale was intended to measure) and a comparison group (people from the general population) answer the MMPI items. Hathaway & McKinley (1940; 1943) then constructed the scales based on the differences in how the criterion and comparison groups answered the selected items for the psychiatric condition the Clinical

5 scale was designed to measure, with the aim of being able to differentiate a normal population from a psychiatric population. Early research on the Clinical scales focused on factor analysis to investigate the underlying constructs the scales were measuring. Wheeler, Little and Lehner (1951) investigated the internal structure of the Clinical scales and found four factors that represented the psychological constructs the scales measured. The first factor was interpreted as representing an excessive concern with one s self (p.139) which involved low self-esteem and social withdrawal. It had significant positive loadings with Clinical scales 1 Hypochondriasis (Hs), 2 Depression (D), 4 Psychopathic- Deviate (Pd), 6 Paranoia (Pa), 7 Psychasthenia (Pt) and 8 Schizophrenia (Sc). The second factor was labelled the neurotic factor (p. 139) with significant positive loadings on Hs, D, scale 3 Hysteria (Hy) and Pa. The third factor was labelled the masculinityfemininity (p. 139) variable and had significant positive loadings with scale 5 Masculinity-Femininity (M-f) and Pa. Wheeler et al. had difficulty interpreting the fourth factor, stating only that it indicates a mood independent of the schizoid and neurotic patterns reflected in Factors I and II (p. 139). The fourth factor was found to have a significant positive loading with D and a significant negative loading with scale 9 Hypomania (Ma). Welsh (1956) conducted what is still considered to be the most significant factor analysis of the Clinical scales when he identified two general factors that permeate the scales. The first factor was labelled anxiety and was defined as a lack of ego resiliency culminating in a general state of psychological distress. The anxiety factor had the highest positive loadings with Pt and Sc. Welsh s anxiety factor would become universally known as the first factor of the Clinical scales (Graham, 2006; Greene, 2011;

6 Johnson, Butcher, Null & Butcher, 1984; Nichols, 2001). The second factor identified by Welsh was labelled repression and involves introversion, submissiveness, passivity and conventionality. There were moderate positive loadings for repression with scales D, Hy, M-f, Pa and scale 0 Social Introversion (Si) and a moderate negative loading with Ma. Further factor analytic studies on the Clinical scales (Block, 1965; Dahlstrom, Welsh & Dahlstrom, 1975; Eichman, 1962; Finn, 1986; Kassebaum, Couch & Slater, 1959) have supported Welsh s anxiety and repression factors as influencing scores on the Clinical scales independently of the core psychological constructs the scales were designed to measure. In conjunction with the factor analytic studies investigating the general factors that influence scores and interpretations of the Clinical scales, other studies focused on the construct validity of the Clinical scales in a variety of different settings when compared against external correlates. Research has supported the construct validity of the Clinical scales in a normative sample (Butcher, Tellegen, Graham, Dahlstrom, & Bowman 1990), psychiatric populations (Archer, Griffin, & Aiduk, 1995; Hedlund, 1977), mental health centres (Graham, Ben-Porath, & McNulty, 1999), personnel selection (Butcher, 1979) and forensic settings (Megargee, Carbonell, Bohn, & Sliger, 2001). Despite research supporting the construct validity of the Clinical scales, there were concerns about the accuracy of interpretations due to the diversity of constructs the scales measure (Helmes & Redden, 1993; Tellegen et al., 2003). Internal consistency coefficients for the Clinical scales vary greatly from as low as.34 to as high as.85 for men and.37 to.87 for women (Butcher et al., 1989). However, Hathaway & McKinley (1940) did not intend all the Clinical scales to be homogenous but multidimensional in their structure, leading to a set

7 of scales that measure a diversity of psychological constructs (Butcher et al., 1989; Greene, 2011; Nichols, 2001; 2006). Regardless, clinicians still could not be confident interpreting the Clinical scales due to the range of constructs the scales measure. This lead to Harris and Lingoes (1955, 1968) developing specific subscales for Clinical scales D, Hy, Pd, Pa, Sc and Ma. Subscales were not developed for scales Hs and Pt as Harris and Lingoes viewed the scales as being relatively homogenous in the constructs they measure. Harris and Lingoes also decided not to develop subscales for M-f and Si as they did not consider them to be measuring fundamental aspects of psychopathology (Graham, 2006). Serkownek (1975) later attempted to develop subscales for Si but the scales were judged to have major methodological flaws and did not reach acceptable levels of internal consistency so they were deleted from the MMPI until Ben-Porath, Hostetler, Butcher, and Graham (1989) successfully constructed subscales for the release of the MMPI-2. The aim of the subscales was to aid mental health clinicians in gaining a more specific interpretation of elevated scores on the Clinical scales. The subscales developed by Harris and Lingoes and Ben-Porath et al. continue to be used routinely in MMPI-2 analysis (Greene, 2011). 2.2 Criticism of the Clinical Scales Mental health professionals have used the Clinical scales extensively since the release of the original MMPI; however limitations with the psychometric properties of the scales have been noted for a variety of reasons. Dahlstrom and Welsh (1960) scrutinized the 10 Clinical scales, noting that many of the scales are highly correlated, which is partially a result of item overlap. High intercorrelations suggest some of the Clinical scales are

8 assessing similar psychological constructs, which has ramifications for discriminant validity (Graham, 2006). Another criticism of the Clinical scales is based on the early factor analytic studies, particularly Welsh (1956). Tellegen et al. (2003) argued that the first factor (p. 12) of the MMPI-2 Clinical scales which is best represented by Welsh s anxiety factor exaggerated scores, making it difficult for mental health professionals to interpret whether a high score on a Clinical scale was due to the primary psychological constructs the scale was designed to measure or because of the influence of the first factor. Tellegen et al. stated that whilst the first factor is an important psychological construct, it jeopardises the convergent and particularly the discriminant validity of the scales and also contributes to the high correlations among a number of the Clinical scales which should be more independent of each other. Wiggins (1966) was critical of the empirical keying method and argued that scale development should focus primarily on the content of individual items. Whilst Hathaway and McKinley originally selected items because they were representative of the constructs the scales were designed to measure, items were finally assigned to a scale based on the differences in how the criterion and comparison groups answered the items with the specific content virtually ignored, compromising construct validity (Butcher et al., 1989; Greene, 2011). Tellegen et al. (2003) also criticised the empirical keying method for allowing the inclusion of subtle items (p.5). Their factor analysis of the Clinical scales identified subtle items that did not accurately represent the psychological constructs the Clinical scale was designed to measure. They concluded that this also compromised convergent validity. The concerns regarding the construct validity of the

9 Clinical scales would lead to research aimed at providing additional sets of scales that addressed the perceived psychometric limitations of the Clinical scales and measured psychological constructs that were not accounted for specifically by the 10 Clinical scales. 2.3 The Content Scales Mental health clinicians relied entirely on the Clinical scales for analysis in the immediate years after the release of the MMPI. Wiggins (1966) decided to address his own concerns relating to the failure of the Clinical scales to address specific item content and developed a set of 13 Content scales based on the MMPI item pool that were more adept at capturing the attitudes that test takers had to the content of individuals items. Butcher, Graham, Williams and Ben-Porath (1990) would later construct a set of 15 revised Content scales for the MMPI-2. The Content scales were also developed to improve scale homogeneity when compared to the Clinical scales with item overlap eliminated. Internal consistency for the Content scales was higher than the Clinical scales, ranging from.72 to.86 for men and.68 to.86 for women (Butcher et al., 1989). Research provided evidence of the construct validity of the Content scales in college settings (Ben-Porath, McNulty & Amagor, 1993), psychiatric inpatient samples (Archer, Aiduk, Griffin, & Elkins, 1996) and mental health settings (Graham, Ben-Porath, & McNulty, 1999). Investigation of the Content scales found that despite the improved level of homogeneity, the scales were still measuring multiple psychological constructs. Ben- Porath and Sherwood (1993) developed subscales for 12 out of the 15 Content scales with