ISABELLA ROMEROS U P E RV I S E D B Y D R . D A N I E L L E B U R C H E T T

C A L I F O R N I A S TAT E U N I V E R S I T Y, M O N T E R E Y B AY

I N C O L L A B O R AT I O N W I T H D R . D AV I D

G L A S S M I R E

PAT T O N S TAT E H O S P I TA L

Mental Disorder Assessment:Mapping the MMPI-2-RF Substantive

Scales onto Internalizing, Externalizing and Thought Dysfunction Dimensions

Why Validate Assessments?

Tools which inform important processes for mental health practitioners Give clinical picture Must be accurate to inform effective treatment plan

Diagnostic construct validity

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psychotherapy-los-angeles.jpg

Model of PsychopathologyThree Factor Model of Psychopathology: The internalizing and externalizing dimensions, have

received the most empirical support within general populations (Eaton, et al., 2012, Krueger, 1999)

Internalizing ExternalizingThought

Dysfunction

Schi

zoph

reni

a

Man

ia

Subs

tanc

e Ab

use

Antis

ocia

l Pe

rson

ality

Atte

ntio

n-H

yper

activ

ity

Dep

ress

ion

Anxi

ety

Som

atic

D

isor

ders

(?)

MMPI-2-RF Minnesota Multiphasic Personality Inventory-2-

Restructured Form (MMPI-2-RF, Ben-Porath & Tellegen, 2008/2011)

Emotional Internalizing Dysfunction

Behavioral Externalizin

g Dysfunction

Thought Dysfunction

MMPI-2-RF Technical Manual of the MMPI-2-RF (Tellegen & Ben-

Porath, 2008/2011)

Internalizing SP Scales: eg. SUI,

HLP, AXY

Somatic SP Scales: MLS,

HPC

Introversion-r

RCd Demoralizatio

n

Interpersonal SP Scales: eg:

SHY,SAV

Negative Emotionality/ Neuroticism -r

EID Emotional/ Internalizi

ng Dysfunctio

nRC1 Somatic Complaints

RC2 Low Positive

Emotions

RC7Dysfunctional

Negative Emotions

Low AES & MEC: Aesthetic-Literary Interests & Mechanical Interests

MMPI-2-RF

Externalizing SP Scales: JCP, SUB

AGG-r Aggressiveness

RC4 Antisocial Behavior

RC9 Hypomanic Activation

DISC-r Disconstraint

Interpersonal SP Scales: FML:

Family Problems

Internalizing SP Scales:

ANP: Anger Proneness

BXD Behavioral

Externalizing

Dysfunction

MMPI-2-RF

PSYC-r Psychoticism

RC6 Ideas of Persecution

THDThought

Dysfunction

RC8 Aberrant Experiences

Current Study: Research Question

Past MMPI-2-RF Research: Compared mean scores for specific diagnostic

groups (eg. Bipolar disorder, v. schizophrenia, Sellbom, et al., 2012)

Current Study: Does the MMPI-2-RF distinguish between forensic

inpatients with and without 1. Internalizing Disorders 2. Externalizing Disorders 3. Thought Dysfunction Disorders ?

Method

Participants 641 forensic inpatients, Males (72.1 %) Mean Age =

40.96 years

Total =

1,110

Valid =

641

Internalizing

Externalizing

Yes (n =320)

No (n =321)

Yes (n =469)

Thought

No (n = 172)

Yes (n = 562)

No (n = 69)

Hypotheses

Scales Internalizing Externalizing Thought Dysfunction

Higher- OrderScales

EID BXD THD

Restructured Clinical Scales

RCd, RC1, RC2, RC,7

RC4 & RC9 RC6 & RC8

Specific Problems Scales

Internalizing, Somatic,

Intrapersonal

ANP, Externalizing Scales, FML

Interest Scales Low AES & MEC

Personality Pathology-5 Scales

NEGE-r & INTR-r

DISC-r &AGG-r

PSYC-r

Method: Statistical Analyses

M1 M2

*Independent Samples t-test:Comparing means of independent samples Hedges' g

values:Comparing size of difference between two means

• Small: .20-.49• Medium: .50-.7

9• Large: .80+

Cohen (1988)

Results: Internalizing DiagnosisMMPI-2-RF Scales Yes (n = 320) No (n = 321) g

Higher-Order Scales M SD M SDEID: Emotional/ Internalizing Dysfunction

53.9 12.6 49.3 10.5 0.39*

Restructured Clinical ScalesRCd: Demoralization 55.7 11.9 51.6 10.7 0.35*RC1: Somatic Complaints 55.7 11.0 51.7 10.6 0.33*RC2: Low Positive Emotions 53.8 13.8 50.9 11.6 0.22*RC7: Dysfunctional Negative Emotions 51.5 11.2 47.4 10.7 0.37*Somatic Specific Problems Scales

MLS: Malaise 53.92 15.4 52.8 10.7 0.29* GIC: Gastrointestinal Complaints 52.98 11.92 49.66 9.41 0.31*

HPC: Head Pan Complaints 51.88 10.52 50.36 9.48 0.15*

NUC: Neurological Complaints 59.91 12.57 55.45 12.58 0.35*

COG: Cognitive Complaints 54.77 12.95 51.57 11.49 0.26*

Interest ScalesAES: Aesthetic-Literary Interests 50.08 10.04 49.97 11.24 0.01

MEC: Mechanical Interests 53.81 10.70 56.05 10.68 -0.21*

Yes (n = 320) No (n = 321) g

Internalizing SP Scales M SD M SD

SUI: Suicidal/Death Ideation 53.92 15.39 49.98 10.59 0.30*

HLP: Helplessness 52.52 13.63 49.36 11.27 0.25*SFD: Self-Doubt 52.96 11.50 49.46 9.69 0.33*NFC: Inefficacy 53.18 10.60 50.46 10.83 0.25*STW: Stress and Worry 51.13 11.15 47.70 9.59 0.33*AXY: Anxiety 55.50 14.11 52.15 12.88 0.25*ANP: Anger Proneness 50.50 10.12 47.13 8.91 0.35*BRF: Behavior restricting Fears 55.75 13.47 52.43 11.64 0.26*MSF: Multiple Specific Fears 51.71 9.32 49.11 9.20 0.28*Interpersonal Specific Problems ScalesIPP: Interpersonal Problems 48.43 10.43 48.52 9.72 -0.01

SAV: Social Avoidance 50.66 10.85 49.34 10.94 0.12

SHY: Shyness 49.36 9.42 47.69 8.44 0.19*

DSF: Disafiliativeness 54.46 12.66 53.40 12.08 0.09

Personality Pathology- 5 Scales

NEGE-r: Negative Emotionality/Neuroticism-Revised

52.51 10.78 48.28 10.30 0.40*

INTR-r: Introversion-Revised 52.13 11.73 51.42 11.68 0.06

Results: Externalizing DiagnosisMMPI-2-RF Scales Yes (n = 469) No (n = 172) g

Higher-Order Scales M SD M SDBXD: Behavioral Externalizing Dysfunction

58.60 10.63 53.72 10.39 0.46*

Restructured Clinical ScalesRC4: Antisocial Behaviors 62.13 11.43 56.70 10.90 0.48*

RC9: Hypomanic Activation 48.03 10.86 46.95 10.99 0.10

Internalizing Specific Problems Scale

ANP: Anger Proneness 49.19 9.83 47.78 9.18 0.15

Externalizing Specific Problems Scales

JCP: Juvenile Conduct Problems 61.34 13.11 55.60 12.64 0.44*

SUB; Substance Abuse 57.11 10.35 50.49 9.96 0.65*

AGG: Aggression 49.78 10.97 48.20 9.95 0.15*

ACT: Activation 47.36 12.17 46.03 11.55 0.11

Interpersonal ScalesFML: Family Problems 51.59 12.10 50.72 12.45 0.07

Personality Pathology-5 ScalesAGGR-r: Aggressiveness-Revised 51.48 10.43 51.13 9.48 0.03

DISC-R: Disconstraint-Revised 57.07 10.15 52.78 9.75 0.43*

Results: Thought Dysfunction Diagnosis

MMPI-2-RF Scales Yes (n = 572) No (n = 69) g

Higher-Order Scales M SD M SD

THD: Thought Dysfunction 58.05 15.14 53.96 14.09 0.27*

Restructured Clinical ScalesRC6: Ideas of Persecution 61.72 15.83 60.59 15.75 0.07

RC8: Aberrant Experiences 55.19 12.57 52.26 11.90 0.23*

Personality Pathology-5 Scales

PSYC-r: Psychoticism-Revised 56.22 14.91 52.94 13.65 0.22*

DiscussionKey Findings:

Higher-Order (H-O) scales demonstrated strong construct validity

Somatic problems are significantly associated with Internalizing domain

Interestingly, Ideas of Persecution scores were similar across groups; may be result of controlled settings (Morgan, Rozycki, & Wilson, 2004)

Strengths: High base rates of severe mental illness across all three domains

Limitations & Future Directions Overlapping vs. pure diagnostic groups

VS.

Acknowledgements & References Eaton, N. R., Krueger, R. F., Markon, K. E., Keyes, K. M., Skodol, A. E., Wall, M., Grant, B. F. (2012). The structure and predictive validity of the internalizing disorders. Journal of Abnormal Psychology, 122(1), 86–92. doi: 10.1037/a0029598

Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56(10), 921–926. doi: 10.1001/archpsyc.56.10.921

Tellegen, A., & Ben-Porath, Y. S. (2008/2011). MMPI-2-RF (Minnesota Multiphasic Personality Inventory-2 Restructured Form): Technical manual. Minneapolis, MN: University of Minnesota Press.

Weinborn, M., Orr, T., Woods, S. P., Conover, E., & Feix, J. (2003). A validation of the Test of Memory Malingering in a forensic psychiatric setting. Journal of Clinical and Experimental Neuropsychology, 25(7), 979-990.

Thanks to the following for making this study possible:University of Minnesota

Press, which supported data collection

Dr. Glassmire of Patton State Hospital

Dr. Danielle Burchett CSUMB Undergraduate

Research Opportunities Center (UROC)