Mental Disorder Assessment Mapping the MMPI2 RF Substantive

Mental Disorder Assessment: Mapping the MMPI-2 -RF Substantive Scales onto Internalizing, Externalizing and Thought Dysfunction Dimensions ISABELLA ROMERO SUPERVISED BY DR. DANIELLE BURCHETT CALIFORNIA STATE UNIVERSITY, MONTEREY BAY IN COLLABORATION WITH DR. DAVID GLASSMIRE PATTON STATE HOSPITAL

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 http: //www. fairfaxmentalhealth. com/wpcontent/uploads/2014/08/psychologists-prescribing-medications. jpg http: //www. californiapainmedicinecenter. com/wpcontent/uploads/2015/05/psychotherapy-los-angeles. jpg

Model of Psychopathology � Three Factor Model of Psychopathology: � The internalizing and externalizing dimensions, have received the most empirical support within general populations (Eaton, et al. , 2012, Krueger, 1999) Mania Schizophrenia Attention. Hyperactivity Antisocial Personality Substance Abuse Externalizing Somatic Disorders (? ) Anxiety Depression Internalizing Thought Dysfunction

MMPI-2 -RF � Minnesota Multiphasic Personality Inventory-2 - Restructured Form (MMPI-2 -RF, Ben-Porath & Tellegen, 2008/2011) Emotional Internalizing Dysfunction Behavioral Externalizing Dysfunction Thought Dysfunction

MMPI-2 -RF � Technical Manual of the MMPI-2 -RF (Tellegen & Ben- Porath, 2008/2011) RCd Demoralization EID Emotional/ Internalizing Dysfunction RC 2 Low Positive Emotions Internalizing SP Scales: eg. SUI, HLP, AXY RC 7 Dysfunctional Negative Emotions Interpersonal SP Scales: eg: SHY, SAV Introversion-r Negative Emotionality/ Neuroticism -r RC 1 Somatic Complaints Somatic SP Scales: MLS, HPC Low AES & MEC: Aesthetic-Literary Interests & Mechanical Interests

MMPI-2 -RF BXD Behavioral Externalizing Dysfunction RC 4 Antisocial Behavior Internalizing SP Scales: ANP: Anger Proneness RC 9 Hypomanic Activation Externalizing SP Scales: JCP, SUB AGG-r Aggressiveness Interpersonal SP Scales: FML: Family Problems DISC-r Disconstraint

MMPI-2 -RF THD Thought Dysfunction RC 6 Ideas of Persecution RC 8 Aberrant Experiences PSYC-r Psychoticism

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 Yes (n =320) Total = 1, 110 Internalizing Yes (n =469) Externalizing Valid = 641 No (n =321) No (n = 172) Yes (n = 562) Thought No (n = 69)

Hypotheses Scales Internalizing Externalizing Thought Dysfunction Higher- Order Scales EID BXD THD Restructured Clinical Scales RCd, RC 1, RC 2, RC, 7 RC 4 & RC 9 RC 6 & RC 8 Internalizing, Somatic, Intrapersonal ANP, Externalizing Scales, FML Specific Problems Scales Interest Scales Low AES & MEC Personality Pathology-5 Scales NEGE-r & INTR -r DISC-r & AGG-r PSYC-r

Method: Statistical Analyses *Independent Samples t-test: Comparing means of independent samples Hedges' g values: Comparing size of difference between two means • Small: . 20 -. 49 • Medium: . 50 -. 79 • Large: . 80+ M 1 M 2 Cohen (1988)

Results: Internalizing Diagnosis MMPI-2 -RF Scales Higher-Order Scales Yes (n = 320) No (n = 321) g M SD 53. 9 12. 6 49. 3 10. 5 0. 39* RCd: Demoralization 55. 7 11. 9 51. 6 10. 7 0. 35* RC 1: Somatic Complaints 55. 7 11. 0 51. 7 10. 6 0. 33* RC 2: Low Positive Emotions 53. 8 13. 8 50. 9 11. 6 0. 22* RC 7: Dysfunctional Negative Emotions 51. 5 11. 2 47. 4 10. 7 0. 37* GIC: Gastrointestinal Complaints 53. 92 52. 98 15. 4 11. 92 52. 8 49. 66 10. 7 9. 41 0. 29* 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* AES: 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* EID: Emotional/ Internalizing Dysfunction Restructured Clinical Scales Somatic Specific Problems Scales MLS: Malaise Interest Scales

Yes (n = 320) Internalizing SP Scales No (n = 321) g 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* IPP: 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 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 Interpersonal Specific Problems Scales Personality Pathology- 5 Scales

Results: Externalizing Diagnosis MMPI-2 -RF Scales Higher-Order Scales Yes (n = 469) No (n = 172) g M 58. 60 SD 10. 63 M 53. 72 SD 10. 39 0. 46* RC 4: Antisocial Behaviors 62. 13 11. 43 56. 70 10. 90 0. 48* RC 9: Hypomanic Activation 48. 03 10. 86 46. 95 10. 99 0. 10 49. 19 9. 83 47. 78 9. 18 0. 15 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 51. 59 12. 10 50. 72 12. 45 0. 07 AGGR-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* BXD: Behavioral Externalizing Dysfunction Restructured Clinical Scales Internalizing Specific Problems Scale ANP: Anger Proneness Externalizing Specific Problems Scales Interpersonal Scales FML: Family Problems Personality Pathology-5 Scales

Results: Thought Dysfunction Diagnosis MMPI-2 -RF Scales Higher-Order Scales Yes (n = 572) No (n = 69) g M SD 58. 05 15. 14 53. 96 14. 09 0. 27* RC 6: Ideas of Persecution 61. 72 15. 83 60. 59 15. 75 0. 07 RC 8: Aberrant Experiences 55. 19 12. 57 52. 26 11. 90 0. 23* 56. 22 14. 91 52. 94 13. 65 0. 22* THD: Thought Dysfunction Restructured Clinical Scales Personality Pathology-5 Scales PSYC-r: Psychoticism-Revised

Discussion � Key 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 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) 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/a 0029598 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), 979990.