A Restructured MMPI-2: Establishing Incremental Validity and Underlying Patterns of Performance in a Medico-legal Setting Patricia Beaumont Being a report of an investigation submitted as a requirement for the award of Doctor of Philosophy University of Southern Queensland March 4, 2011
ii Statement of Originality I certify that the ideas, experimental work, results, analyses and conclusions reported in this dissertation are currently my own effort, except where due reference is made in the text. I also certify that this dissertation contains no material offered for any other award, except where otherwise acknowledged. Signed: Date: Patricia Beaumont Signed: Date: Dr. Graeme Senior (Principal Supervisor)
iii Abstract The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular assessment tool used for the psychosocial assessment of personal injury litigants. However, there are inherent structural problems found in the MMPI-2 that question the utility of this test. In 2006, Goh restructured the MMPI-2 at the item level in order to provide a more accurate and reliable assessment device. Using a large sample of personal injury litigants, Goh rebuilt the MMPI-2 s scoring and analysis system specifically for the psychosocial assessment of personal injury litigants. Called the Minnesota Multiphasic Personality Inventory-2 for use with personal injury litigants (MMPI-2-PI), the development of the MMPI-2-PI used contemporary methods with the goal of enhancing internal consistency and eliminating item overlap. A unique feature of the MMPI-2-PI were items that were weighted according to the relevance of the constructs they measured which resulted in independently weighted scales and subscales. Since Goh s initial restructuring of the MMPI-2, Ben-Porath and Tellegen (2008) developed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) also using contemporary methods to restructure the MMPI-2. Published in 2008, the MMPI- 2-RF was developed as an alternative version of the MMPI-2 for routine clinical psychosocial evaluation. While the MMPI-2-PI appeared to be a promising new approach for assessing personal injury litigants, it was still in its infancy. As such, the goals of this dissertation were to examine the Incremental validity and clinical utility of the MMPI-2-PI by comparing it to the more traditional MMPI-2 and more contemporary MMPI-2-RF. Using a sample of 2,989 personal injury litigants, analysis of the MMPI-2-PI included two comparisons: one with the MMPI-2-PI and MMPI-2; and the second between the MMPI-2-PI and the MMPI-2-RF. Comparisons between the MMPI-2-PI and the MMPI-2 demonstrated improved Incremental validity and
iv interpretability for the MMPI-2-PI. This comparison not only showed the MMPI-2-PI to be comparable to the MMPI-2, but also to be a better measurement device while demonstrating no evident scale redundancy and clear delineation of the constructs being measured. The second comparison indicated the MMPI-2-PI showed comparability to the MMPI-2-RF in assessing similar constructs. However, given some redundancy issues were evident in the MMPI-2-RF, incremental improvement was indicated for the MMPI-2-PI in assessing personal injury litigants. Further examination of the clinical and interpretive implications of using the MMPI-2-PI provided information on what constructs are more common (and not so common) within a medico-legal setting. Further to this, the majority of MMPI-2-PI scales and subscales demonstrated sensitivity to the constructs they were measuring and the diagnostic groups commonly seen in medico-legal evaluations. Independant interpretation of the majority of the MMPI-2-PI subscales was also demonstrated and recommended given there were different item weightings between the scales and subscales. This was an important consideration, given the subscales of the more traditional MMPI-2 are not recommended for interpretation if the parent scale is not clinically elevated. Finally, the MMPI-2-PI was further evaluated and compared to the MMPI-2 and MMPI-2-RF through two medico-legal case examples. These two case examples illustrated the discriminatory difficulties inherent in making diagnositic (or psychiatric) interpretations as opposed to behavioural (or psychological) interpretations, providing further weight to the argument that self reported psychosocial assessment devices should not be used for, or evaluated as diagnostic tools. Additionally, the MMPI-2-PI demonstrated clear delineation and clarification in identifying the constructs being measured without any notable loss of information while also demonstrating the advantages the weighted items have in effective scale endorsement. While the MMPI-2-PI could not be recommended
v for use outside of a medico-legal setting, this structure demonstrated it could provide a more effective and efficient psychosocial assessment of personal injury litigants when compared to the MMPI-2 and MMPI-2-RF.
vi Acknowledgements I would like to thank Dr. Graeme Senior for his patience, sound advice, and guidance I received throughout this incredibly challenging and rewarding experience you will continue to be someone I look up to and turn to for advice as I continue to strive for excellence within my profession. I would also like to thank Dr. Roger Greene for providing access to his data, Dr. Greene s patience and support was very much appreciated. I would like to thank my sister-in-law Linda, who put aside some of her Christmas holiday time to assist with what seemed like endless data checks. I would also like to acknowledge and thank my friend Narelle, who made herself available for hours, after working all day, to help me with endless data input procedures when I thought I it was all behind me. I must also thank my sister Cheryl for helping me in my final hours of completion...welcome home. And to my father Bill thanks for your support and for believing in me. I could not have completed this project without my mother, June, who was an angel watching over me during some of my more challenging moments when frustration and lack of confidence was a threatening force. I must also thank and remember my dear friend Gloria, who was a source of inspiration for me from the outset of my studies. Finally, I would like to thank my beautiful dog, Halee-girl, who helped create more balance in my life in the final year of my research, and at the time of writing these acknowledgements was chewing on my favourite pot plant. R.I.P. Halee-girl.
vii Table of Contents Statement of Originality... ii Abstract... iii Acknowledgements... vi List of Tables... xv List of Figures... xxiii CHAPTER ONE 1.1 Introduction... 1 1.2 Overview of Thesis.... 5 CHAPTER TWO PERSONALITY TEST CONSTRUCTION AND STRUCTURAL CHANGES TO THE MMPI-2 2.1 Approaches to Personality Test Construction... 8 2.1.1. Rational Approach... 9 2.1.2. Empirical Approach... 10 2.1.3. Internal Consistency Approach... 11 2.1.4. Construct Validation Approach... 13 2.2 Development of the MMPI and MMPI-2... 14 2.2.1. The MMPI... 14 2.2.2. The MMPI-2... 17 2.3 Continued Problems with the Test... 23 2.3.1. Item Overlap.... 23 2.3.2. Heterogeneous Item Content.... 23 2.3.3. Length of Test.... 24 2.3.4. Interpretation Issues.... 24
viii 2.4 MMPI-2 RC Scales... 27 2.5 MMPI-2 RF... 29 CHAPTER THREE THE MMPI-2-PI 3.1 Assessment of Personal Injury Litigants.... 34 3.2 Restructuring the MMPI-2.... 36 3.2.1. The MMPI-2-PI Eliminates Structural Problems.... 40 3.3 Summary.... 42 CHAPTER FOUR PSYCHOMETRIC AND INTERPRETIVE CONSIDERATIONS 4.1 Standardised Scoring... 44 4.2 Demographic Norming... 45 Method... 48 Participants... 48 Materials... 49 Procedure... 50 Results and Discussion... 52 T Score Comparison... 56 Demographic Considerations... 56 Scoring the MMPI-2-PI... 58 4.3 Summary... 59 CHAPTER FIVE INCREMENTAL VALIDITY Method... 70 Participants, Materials, and Procedure... 70
ix Results and Discussion... 77 5.1 Alpha Coefficient... 77 5.2 Reading Level... 78 5.3 MMPI-2-PI and MMPI-2 Principal Components Analysis (PCA)... 79 5.3.1. Assumptions for PCA... 79 5.3.2. PCA Pattern Matrix... 82 5.3.3. Component Analysis... 85 Component 1 - Psychological Distress... 85 Component 2 - Negative Interpersonal Attitude... 89 Component 3 - Health Concerns... 91 Component 4 - Social Anxiety... 93 Component 5 - Psychotic Symptoms... 95 Component 6 - Antisocial Behaviours... 97 Component 7 - Anger Management Difficulties... 98 Component 8 - Social Withdrawal... 101 Component 9 - Family Difficulties... 102 Component 10 - Fears... 103 Component 11 - Lack of Positive Impression Management... 104 Component 12 - Masculinity... 106 Component 13 - Gastrointestinal Complaints... 106 5.3.4. Component Correlations... 107 5.3.5. Parent Scales... 108 5.3.6. Non-Retained Scales... 110 5.4 Summary... 112
x CHAPTER SIX COMPARISON OF THE MMPI-2-PI AND THE MMPI-2-RF Method... 117 Participants, Materials, and Procedure... 117 Results and Discussion... 121 6.1 Alpha Coefficients... 121 6.2 Reading Level... 122 6.3 MMPI-2-PI and MMPI-2-RF Principal Components Analysis (PCA)... 123 6.3.1. Assumptions for PCA... 123 6.3.2. PCA Pattern Matrix... 123 6.3.3. Component Analysis... 125 Component 1 - Psychological Distress... 125 Component 2 - Psychotic Symptoms... 128 Component 3 - Neurological Concerns... 129 Component 4 - Antisocial Behaviours... 131 Component 5 - Passivity... 133 Component 6 - Social Withdrawal... 133 Component 7 - Elation... 135 Component 8 - Negative Interpersonal Attitude... 136 Component 9 - Fears... 137 Component 10 - Positive Impression Management... 138 Component 11 - Masculine Interests... 139 Component 12 - Feminine Interests... 140 Component 13 - Family Difficulties... 141 Component 14 - Gastrointestinal Complaints... 142
xi 6.3.4. Component Correlations... 142 6.3.5. Parent Scales... 143 6.3.6. Non-Retained Scales... 146 6.4 Summary... 147 CHAPTER SEVEN CLINICAL IMPLICATIONS FOR THE MMPI-2-PI 7.1 Structure of the MMPI-2-PI... 149 Method... 151 Participants, Materials, and Procedure... 151 Common theme of each scale.... 152 Demonstrating scale and subscale directionality.... 152 Examining subscale independence.... 154 Representation for each diagnostic category.... 155 Results and Discussion... 155 7.2 Emotional Domain... 155 7.2.1. Psychological Distress (PsD)... 155 7.2.2. Anger (Ang)... 161 7.2.3. Fears (Frs)... 164 7.2.4. Fear of the Dark (FOD)... 167 7.2.5. Irritability (Irr)... 168 7.2.6. Elation (Ela)... 170 7.2.7. Financial Worry (FiW)... 171 7.3 Physiological Domain... 172 7.3.1. Somatic Complaints (SoC)... 172 7.3.2. Gastrointestinal Problems (GaP)... 177
xii 7.3.3. Sexual Concerns (Sex)... 178 7.4 Cognitive Domain... 179 7.4.1. Cognitive Difficulties (CoD)... 179 7.4.2. Psychotic Symptoms (Psy)... 181 7.4.3. Paranoia (Par)... 185 7.5 Behavioural Domain... 186 7.5.1. Alcohol Abuse (Alc)... 186 7.5.2. Delinquency (Del)... 188 7.5.3. Stimulus Seeking (StS)... 189 7.5.4. Disciplined as Child (Dis)... 190 7.6 Interpersonal Domain... 192 7.6.1. Social Withdrawal (SoW)... 192 7.6.2. Negative Interpersonal Attitude (NIA)... 195 7.6.3. Timidity (Tim)... 199 7.6.4. Dissatisfaction with Self (DWS)... 202 7.6.5. Positive Impression (PoI)... 206 7.6.6. Family Relationship Difficulties (FRD)... 210 7.7 Gender Related Interests... 211 7.7.1. Masculinity (Mas)... 211 7.7.2. Femininity (Fem)... 214 7.8 Summary... 218 CHAPTER EIGHT ILLUSTRATIVE CASE EXAMPLES 8.1 Case Illustration of Ms. X... 225 8.1.1. STND Interpretation for Ms. X... 226
xiii Psychiatric interpretation.... 226 Psychological interpretation... 228 8.1.2. RFST Interpretation for Ms. X... 229 8.1.3. PIST Interpretation for Ms. X.... 231 8.1.4. Structural Comparisons and Recommendations for Ms. X.... 233 8.2 Case Illustration of Mr. Y... 237 8.2.1. STND Interpretation for Mr. Y... 238 Psychiatric interpretation.... 238 Psychological interpretation... 240 8.2.2. RFST Interpretation for Mr. Y... 241 8.2.3. PIST Interpretation for Mr. Y.... 244 8.2.4. Structural Comparisons and Recommendations for Mr. Y... 246 8.3 Summary... 249 CHAPTER NINE DISCUSSION AND CONCLUSION 9.1 Evaluating the MMPI-2-PI... 251 9.2 Comparison with the MMPI-2... 253 9.3 Comparison with the MMPI-2-RF... 254 9.4 Clinical Implications for the MMPI-2-PI... 254 9.5 Illustrative Case Examples... 255 9.6 Strengths of the MMPI-2-PI... 256 9.7 Limitations... 258 9.8 Future Directions... 259 References... 260 Appendix A... 275
xiv Appendix B... 281 Appendix C... 302 Appendix D... 311 Appendix E... 314 Appendix F... 327
xv List of Tables Table 2.1. MMPI-2 Scales and Subscales... 19 Table 2.2. MMPI-2-RF Scales... 31 Table 3.1. Components and Facets for the MMPI-2-PI.... 39 Table 3.2. Items in the MMPI-2 and MMPI-2-PI s Suicide Scales... 42 Table 4.1. Diagnostic Representations of 1,842 Profiles in the Analysis in Order of Frequency... 50 Table 4.2. Descriptive Statistics for the MMPI-2-PI Components and Facets... 53 Table 4.3. Significant Correlations and T Test Scores for Demographic Variables... 57 Table 4.4. Gender Adjusted and Non-Gender Adjusted Frequency Rates for Fem, Frs Del, Mas, and StS... 59 Table 5.1. MMPI-2-PI and MMPI-2 Scales and Subscales Used in the PCA... 73 Table 5.2. Average Alpha Coefficients for the MMPI-2-PI and the MMPI-2 (N = 2,989)... 77 Table 5.3. Alpha Coefficient Range for US Normative Sample (N = 2,600)... 78 Table 5.4. Lexile Range for the MMPI-2-PI and MMPI-2 Comparison... 79 Table 5.5. Component Loadings for MMPI-2-PI (45 scales) and MMPI-2 (71 scales) Comparison... 83 Table 5.6. Scales and Loadings Retained in Component One Psychological Distress... 86 Table 5.7. Correlation Matrix for MMPI-2 Scales Retained in Component One Psychological Distress... 87 Table 5.8. Correlation Matrix for MMPI-2-PI Scales Retained in Component One Psychological Distress... 88 Table 5.9. Scales and Loadings Retained in Component 2 Negative Interpersonal Attitude... 89
xvi Table 5.10. Correlation Matrix for MMPI-2 Scales Retained in Component 2 Negative Interpersonal Attitude... 90 Table 5.11. Correlation Matrix for MMPI-2-PI Scales Retained in Component 2 Negative Interpersonal Attitude... 91 Table 5.12. Scales and Loadings Retained in Component 3 Health Concerns... 91 Table 5.13. Correlation Matrix for MMPI-2-PI Scales Retained in Component 3 Health Concerns... 92 Table 5.14. Correlation Matrix for MMPI-2 Scales Retained in Component 3 Health Concerns... 93 Table 5.15. Scales and Loadings Retained in Component 4 Social Anxiety... 94 Table 5.16. Correlation Matrix for MMPI-2 Scales Retained in Component 4 Social Anxiety... 95 Table 5.17. Correlation Matrix for MMPI-2-PI Scales Retained in Component 4 Social Anxiety... 95 Table 5.18. Scales and Loadings Retained in Component 5 Psychotic Symptoms... 96 Table 5.19. Correlation Matrix for MMPI-2-PI Scales Retained in Component 5 Psychotic Symptoms... 96 Table 5.20. Correlation Matrix for MMPI-2 Scales Retained in Component 5 Psychotic Symptoms... 97 Table 5.21. Scales and Loadings Retained in Component 6 Antisocial Behaviours... 97 Table 5.22. Correlation Matrix for MMPI-2 Scales Retained in Component 6 Antisocial Behaviours... 98 Table 5.23. Scales and Loadings Retained in Component 7 Anger Management Difficulties... 99
xvii Table 5.24. Correlation Matrix for MMPI-2 Scales Retained in Component 7 Anger Management Difficulties... 100 Table 5.25. Correlation Matrix for MMPI-2-PI Scales Retained in Component 7 Anger Management Difficulties... 100 Table 5.26. Scales and Loadings Retained in Component 8 Social Withdrawal... 101 Table 5.27. Correlation Matrix for MMPI-2 Scales Retained in Component 8 Social Withdrawal... 102 Table 5.28. Scales and Loadings Retained in Component 9 Family Difficulties... 102 Table 5.29. Correlation Matrix for MMPI-2 Scales Retained in Component 9 Family Difficulties... 103 Table 5.30. Scales and Loadings Retained in Component 10 Fears... 104 Table 5.31. Scales and Loadings Retained in Component 11 Lack of Positive Impression Management... 105 Table 5.32. Correlation Matrix for MMPI-2-PI Scales Retained in Component 11 Lack of Positive Impression Management... 105 Table 5.33. Scales and Loadings Retained in Component 12 Masculinity... 106 Table 5.34. Scales and Loadings Retained in Component 13 Gastrointestinal Complaints... 107 Table 5.35. Component Correlation Matrix for MMPI-2-PI/MMPI-2 Comparison... 108 Table 5.36. Correlation Matrix for MMPI-2-PI and MMPI-2 Parent Scales... 109 Table 5.37. Non-Retained Scales in the MMPI-2/MMPI-2-PI Comparison... 111 Table 6.1. MMPI-2-PI Scales and Subscales and MMPI-2-RF Scales Used in the PCA... 120 Table 6.2. Average Alpha Coefficients for the MMPI-2-PI and the MMPI-2-RF Clinical Sample (N = 2,989)... 121
xviii Table 6.3. Alpha Coefficient Range for US Normative Sample... 122 Table 6.4. Lexile Range for the MMPI-2-PI and MMPI-2-RF Comparison... 122 Table 6.5. Component Loadings for MMPI-2-PI (45 scales) and MMPI-2-RF (43 scales) Comparison... 124 Table 6.6. Scales and Loadings Retained in Component 1 Psychological Distress... 126 Table 6.7. Correlation Matrix for MMPI-2-RF Scales Retained in Component 1 Psychological Distress... 127 Table 6.8. Correlations for MMPI-2-PI Scales Retained in Component 1 Psychological Distress... 128 Table 6.9. Scales and Loadings Retained in Component 2 Psychotic Symptoms... 128 Table 6.10. Correlation Matrix for MMPI-2-RF Scales Retained in Component 2 Psychotic Symptoms... 129 Table 6.11. Scales and Loadings Retained in Component 3 Neurological Concerns... 130 Table 6.12. Correlations for MMPI-2-PI Scales Retained in Component 3 Neurological Concerns... 131 Table 6.13. Correlation Matrix for MMPI-2-RF Scales Retained in Component 3 Neurological Concerns... 131 Table 6.14. Scales and Loadings Retained in Component 4 Antisocial Behaviours... 132 Table 6.15. Correlation Matrix for MMPI-2-RF Scales Retained in Component 4 Antisocial Behaviours... 132 Table 6.16. Scales and Loadings Retained in Component 5 Passivity... 133 Table 6.17. Scales and Loadings Retained in Component 6 Social Withdrawal... 134 Table 6.18. Correlation Matrix for MMPI-2-PI Scales Retained in Component 6 Social Withdrawal... 134
xix Table 6.19. Correlation Matrix for MMPI-2-RF Scales Retained in Component 6 Social Withdrawal... 135 Table 6.20. Scales and Loadings Retained in Component 7 Elation... 136 Table 6.21. Scales and Loadings Retained in Component 8 Negative Interpersonal Attitude... 136 Table 6.22. Scales and Loadings Retained in Component 9 Fears... 137 Table 6.23. Correlations for MMPI-2-PI Scales Retained in Component 9 Fears... 138 Table 6.24. Scales and Loadings Retained in Component 10 Positive Impression Management... 138 Table 6.25. Scales and Loadings Retained in Component 11 Masculine Interests... 139 Table 6.26. Scales and Loadings Retained in Component 12 Feminine Interests... 140 Table 6.27. Scales and Loadings Retained in Component 13 Family Difficulties... 141 Table 6.28. Scales and Loadings Retained in Component 14 Gastrointestinal Complaints... 142 Table 6.29. Component Correlation Matrix for MMPI-2-PI/MMPI-2-RF Comparison... 143 Table 6.30. Correlation Matrix for MMPI-2-PI and MMPI-2-RF Parent Scales... 144 Table 6.31. Non-Retained Scales in the MMPI-2-PI/MMPI-2-RF Comparison... 147 Table 7.1. Proportion of Profiles for the Psychological Distress Scale and Subscales... 158 Table 7.2. Proportion of Individuals within each Diagnostic Category Elevating the Psychological Distress Scale and Subscales (T 65)... 160 Table 7.3. Proportion of Profiles for the Anger Scale and Subscales... 162 Table 7.4. Proportion of Individuals within each Diagnostic Category Elevating the Anger Scale and Subscales (T 65)... 164 Table 7.5. Proportion of Profiles for the Fears Scale and Subscales... 165
xx Table 7.6. Proportion of Individuals within each Diagnostic Category Elevating the Fears Scale and Subscales (T 65)... 167 Table 7.7. Proportion of Individuals within each Diagnostic Category Elevating the Fear of the Dark Scale (T 65)... 168 Table 7.8. Proportion of Individuals within each Diagnostic Category Elevating the Irritability Scale (T 65)... 169 Table 7.9. Proportion of Individuals within each Diagnostic Category Elevating the Elation Scale (T 65)... 171 Table 7.10. Proportion of Individuals within each Diagnostic Category Elevating the Financial Worry Scale (T 65)... 172 Table 7.11. Proportion of Profiles for the Somatic Complaints Scale and Subscales... 174 Table 7.12. Proportion of Individuals within each Diagnostic Category Elevating the Somatic Complaints Scale and Subscales (T 65)... 176 Table 7.13. Proportion of Individuals within each Diagnostic Category Elevating the Gastrointestinal Problems Scale (T 65)... 177 Table 7.14. Proportion of Individuals within each Diagnostic Category Elevating the Sexual Concerns Scale (T 65)... 179 Table 7.15. Proportion of Individuals within each Diagnostic Category Elevating the Cognitive Difficulties Scale (T 65)... 180 Table 7.16. Proportion of Profiles for the Psychotic Symptoms Scale and Subscales... 182 Table 7.17. Proportion of Individuals within each Diagnostic Category Elevating the Psychotic Symptoms Scale and Subscales (T 65)... 184 Table 7.18. Proportion of Individuals within each Diagnostic Category Elevating the Paranoia Scale (T 65)... 186
xxi Table 7.19. Proportion of Individuals within each Diagnostic Category Elevating the Alcohol Abuse Scale (T 65)... 187 Table 7.20. Proportion of Individuals within each Diagnostic Category Elevating the Delinquency Scale (T 65)... 189 Table 7.21. Proportion of Individuals within each Diagnostic Category Elevating the Stimulus Seeking Scale (T 65)... 190 Table 7.22. Proportion of Individuals within each Diagnostic Category Elevating the Disciplined as Child Scale (T 65)... 191 Table 7.23. Proportion of Profiles for the Social Withdrawal Scale and Subscales... 193 Table 7.24. Proportion of Individuals within each Diagnostic Category Elevating the Social Withdrawal Scale and Subscales (T 65)... 195 Table 7.25. Proportion of Profiles for the Negative Interpersonal Attitude Scale and Subscales... 197 Table 7.26. Proportion of Individuals within each Diagnostic Category Elevating the Negative Interpersonal Attitude Scale and Subscales (T 65)... 199 Table 7.27. Proportion of Profiles for the Timidity Scale and Subscales... 200 Table 7.28. Proportion of Individuals within each Diagnostic Category Elevating the Timidity Scale and Subscales (T 65)... 202 Table 7.29. Proportion of Profiles for the Dissatisfaction with Self Scale and Subscales.. 203 Table 7.30. Proportion of Individuals within each Diagnostic Category Elevating the Dissatisfaction with Self Scale and Subscales (T 65)... 206 Table 7.31. Proportion of Profiles for the Positive Impression Scale and Subscales... 207 Table 7.32. Proportion of Individuals within each Diagnostic Category Elevating the Positive Impression Scale and Subscales (T 65)... 209
xxii Table 7.33. Proportion of Individuals within each Diagnostic Category Elevating the Family Relationship Difficulties Scale (T 65)... 211 Table 7.34. Proportion of Profiles for the Masculinity Scale and Subscales... 212 Table 7.35. Proportion of Individuals within each Diagnostic Category Elevating the Masculinity Scale and Subscales (T 65)... 214 Table 7.36. Proportion of Profiles for the Femininity Scale and Subscales... 216 Table 7.37. Proportion of Individuals within each Diagnostic Category Elevating the Femininity Scale and Subscales (T 65)... 218 Table 7.38. Summary of the Clinical Implications for the MMPI-2-PI s Scales and Subscales... 220 Table 8.1. MMPI-2 Profile of Ms. X... 227 Table 8.2. MMPI-2-RF Profile of Ms. X... 230 Table 8.3. MMPI-2-PI Profile of Ms. X... 232 Table 8.4. Items for the PIST and RFST Anxiety Related Scales... 235 Table 8.5. Items for the PIST and RFST Shyness Related Scales... 236 Table 8.6. MMPI-2 Profile of Mr. Y... 239 Table 8.7. MMPI-2-RF Profile of Mr. Y... 242 Table 8.8. MMPI-2-PI Profile of Mr. Y... 245 Table 8.9. Items for the PIST and RFST Social Avoidance Scales... 248 Table 8.10. Items for the PIST and RFST Family Difficulties Scales... 249
xxiii List of Figures Figure 5.1. Flow chart of the MMPI-2-PI/MMPI-2 validation process... 76 Figure 5.2. Scatterplot of Psy-De and SoC-HC.... 80 Figure 6.1. Flow chart of the MMPI-2-PI/MMPI-2-RF validation process.... 118 Figure 7.1. The six domains of the 25 components in the MMPI-2-PI (N = 400 items)... 150 Figure 7.2. Proportion of subscale elevations (T 65) within the Psychological Distress scale... 159 Figure 7.3. Proportion of subscale elevations (T 65) within the Anger scale... 163 Figure 7.4. Proportion of subscale elevations (T 65) within the Fears scale... 166 Figure 7.5. Proportion of subscale elevations (T 65) within the Somatic Complaints scale... 175 Figure 7.6. Proportion of subscale elevations (T 65) within the Psychotic Symptoms scale... 183 Figure 7.7. Proportion of subscale elevations (T 65) within the Social Withdrawal scale... 194 Figure 7.8. Proportion of subscale elevations (T 65) within the Negative Interpersonal Attitude scale... 198 Figure 7.9. Proportion of subscale elevations (T 65) within the Timidity scale... 201 Figure 7.10. Proportion of subscales demonstrating clinical significance (DWS-Fe, T 65 and T 35; DWS-Ap, T 35) within the Dissatisfaction with Self scale... 205 Figure 7.11. Proportion of subscale elevations (T 65) within the Positive Impression scale... 208 Figure 7.12. Proportion of subscale elevations (Mas-SI, T 65; Mas-NI, T = 57-64) within the Masculinity scale... 213 Figure 7.13. Proportion of subscale elevations (T 65) within the Femininity scale... 217