construct validity of mmpi-2-rf scales in a forensic inpatient hospital setting nasreen toorabally...

Construct Validity of MMPI-2-RF Scales in a Forensic Inpatient

Hospital Setting

Nasreen Toorabally & Isabella RomeroSupervised by Dr. Danielle Burchett

California State University, Monterey Bay

In collaboration with Dr. David Glassmire

Patton State Hospital

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

(MMPI-2) one of the most widely used assessment tools by mental health clinicians in the U.S. (Camara, et. al, 2000; Graham, 2011)

• The MMPI-2-RF [Restructured Form] is a 338-item self-report measure. Using 51 scales, it measureso psychopathology (mental illness), personality

constructso accuracy of self-report

2

Research Question

• Can the MMPI-2-RF distinguish between individuals diagnosed with different disorders (construct validity) in a forensic inpatient setting?

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Past Research

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Psychopathology in Mood vs. Psychotic Disorders

• EID and THD scales are especially useful in differentiating between patients diagnosed with schizophrenia or mood disorders (e.g., major depressive disorder) (Sellbom et al., 2012).

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Psychopathology in Sex Offenders

• Paraphilic disorders are assessed by MMPI-2-RF, such as pedophilic disorder

• Sex offenders against children tend to report higher levels of depression, anxiety, and somatic concerns, as well as lower self-esteem (Kalichman, 1991).

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Current Study

*Can the MMPI-2-RF distinguish between patients diagnosed with different disorders (Construct validity) in a forensic inpatient

setting?

Two studies:• Study 1: Mood vs. Psychotic

• Study 2: Pedophilic Disorder vs. Other Paraphilic Disorders

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Study 1Mood vs. Psychotic Disorders

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Study 1Sample Demographics

• 66.7% Male• 57.1% Caucasian• 20% African American• Mean Age = 41 Years (SD = 11.4)

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Study 1 Method

1,111

120

368

508

280

80

43

213

80

Psychotic Disorder

All other Diagnoses

Total Sample

Mood & Psychotic Disorder

Mood Disorder Mood Disorder

Mood & Psychotic Disorder

All other Diagnoses

Psychotic Disorder

Random responders and underreporters

removed (n=119)

Final Sample

Approved by California Committee for the Protection of

Human Subjects10

Study 1Hypothesis 1

Mood/Internalizing-Related Scales

Emotional / Internalizing Dysfunction EID

Demoralization RCdLow Positive Emotions RC2Suicidal Ideation SUIHelplessness HLPSelf-Doubt SFDInefficacy NFCNegative Emotionality NEGE-r

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Study 1Hypothesis 2

Psychoticism-Related Scales

Thought Dysfunction THDIdeas of Persecution RC6Aberrant Experiences RC8Psychoticism PSYC-r

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Mood

[1](n = 80)

Mood/Psychotic

[2](n = 213)

Psychotic[3]

(n = 280)

Other[4]

(n = 43)Hedges’ g Effect Sizes

M M M M g12 g13 g14 g23 g24 g34

EID: Emotional/ Internalizing 54.94 53.30 49.03 53.33 0.13 0.55* 0.13 0.38* 0.00 -0.40

RCd: Demoralization 56.06 55.53 51.42 54.23 0.04 0.43* 0.15 0.37* 0.11 -0.26

RC2: Low Positive Emotions 55.18 53.03 50.27 55.56 0.15 0.42* -0.03 0.22* -0.18 -0.45

SUI: Suicidal/ Death Ideation 54.91 53.93 49.70 53.02 0.06 0.42* 0.11 0.34* 0.06 -0.31

SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27

NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09

NEGE-r: Negative Emotionality 52.96 52.30 48.05 51.12 0.06 0.49* 0.16 0.41* 0.10 -0.29

Study 1 Results & Discussion

Internalizing Scales

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Mood

[1](n = 80)

Mood/Psychotic

[2](n = 213)

Psychotic[3]

(n = 280)

Other[4]


M M M M g12 g13 g14 g23 g24 g34





SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27

NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09




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Mood

[1](n = 80)

Mood/Psychotic

[2](n = 213)

Psychotic[3]

(n = 280)

Other[4]


M M M M g12 g13 g14 g23 g24 g34





SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27

NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09




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Mood

[1](n = 80)

Mood/Psychotic

[2](n = 213)

Psychotic[3]

(n = 280)

Other[4]


M M M M g12 g13 g14 g23 g24 g34





SFD: Self-Doubt 53.51 52.89 49.03 52.37 0.05 0.46* 0.09 0.38* 0.04 -0.27

NFC: Inefficacy 52.01 53.62 50.25 51.16 -0.15 0.17 0.08 0.32* 0.22 -0.09




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Mood[1]

(n = 80)

Mood/Psychotic

[2](n = 213)

Psychotic[3]

(n = 280)

Other[4]


M M M M g12 g13 g14 g23 g24 g34

THD: Thought Dysfunction 54.16 59.00 57.81 53.70 -0.33 -0.25 0.04 0.08 0.34 0.27

RC6: Ideas of Persecution 58.81 62.51 61.46 60.65 -0.23 -0.17 -0.13 0.07 0.11 0.05

RC8: Aberrant Experiences 53.74 55.80 54.68 52.16 -0.16 -0.08 0.14 0.09 0.27 0.20

PSYC-r: Psychoticism 52.11 57.11 56.07 53.56 -0.34* -0.28 -0.12 0.07 0.23 0.17


Psychoticism-Related Scales

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Study 2

Pedophilic Disorder vs. Other Paraphilic Disorders

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Study 2 Hypotheses

Depression Somatic Concerns

Anxiety Interpersonal Deficits/Introversion

RCd RC1 RC7 IPPRC2 MLS STW SAVEID GIC AXY SHYSUI HPC ANP DSFHLP NUC NEGE-rSFD COGNFC

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Study 2 Method

1,111

1,037

5

49

36

20

13

Pedophilic and other paraphilic

disorders

No paraphilic disorders/missing

diagnoses

Total Sample

Pedophilic Disorder

Other Paraphilic Disorders

Did not meet inclusion criteria

Random responders

and overreporters

removed

Other Paraphilic Disorders

Pedophilic Disorder

Final Sample

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Pedophilic Disorder(n = 36)

Other Paraphilic Disorder(n = 13)

Hedges’ g Effect Sizes

M SD M SD gHigher-Order Scales

EID: Emotional/Internalizing Dysfunction 54.31 13.29 46.69 7.31 0.63*

Restructured Clinical Scales RCd: Demoralization 54.33 12.91 50.54 10.34 0.31

RC1: Somatic Complaints 56.25 12.62 52.69 8.54 0.30

RC2: Low Positive Emotions 55.69 16.73 44.92 9.39 0.71*

RC7: Dysfunctional Negative Emotions 50.33 11.67 45.23 8.96 0.46


Depression

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M SD M SD gHigher-Order Scales

EID: Emotional/Internalizing Dysfunction 54.31 13.29 46.69 7.31 0.63*

Restructured Clinical Scales RCd: Demoralization 54.33 12.91 50.54 10.34 0.31

RC1: Somatic Complaints 56.25 12.62 52.69 8.54 0.30

RC2: Low Positive Emotions 55.69 16.73 44.92 9.39 0.71*

RC7: Dysfunctional Negative Emotions 50.33 11.67 45.23 8.96 0.46


Depression

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Somatic Concerns




M SD M SD gSomatic/Cognitive Specific Problems Scales

MLS: Malaise 52.19 10.29 44.54 6.98 0.80*

GIC: Gastrointestinal Complaints 51.61 10.42 51.38 10.40 0.02

HPC: Head Pain Complaints 54.97 13.93 45.92 7.85 0.72*

NUC: Neurological Complaints 59.39 11.96 53.08 14.56 0.49

COG: Cognitive Complaints 52.92 11.85 49.08 8.39 0.35

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Anxiety




M SD M SD gInternalizing Specific Problems Scales

SUI: Suicidal/Death Ideation 49.08 8.43 52.46 12.09 -0.35

HLP:Helplessness/Hopelessness 52.19 14.52 47.15 10.26 0.37

SFD: Self-Doubt 51.61 12.06 47.23 6.03 0.40

NFC: Inefficacy 52.75 10.73 48.85 8.64 0.38

STW: Stress / Worry 49.75 10.31 44.69 6.24 0.54

AXY: Anxiety 53.33 12.53 49.46 8.96 0.33

ANP: Anger-Proneness 53.89 13.94 47.38 10.34 0.49 Personality Psychopathology Five Scales (Revised)

NEGE-r: Negative Emotionality 52.25 12.61 46.15 7.72 0.53

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Anxiety




M SD M SD gInternalizing Specific Problems Scales

SUI: Suicidal/Death Ideation 49.08 8.43 52.46 12.09 -0.35

HLP:Helplessness/Hopelessness 52.19 14.52 47.15 10.26 0.37

SFD: Self-Doubt 51.61 12.06 47.23 6.03 0.40

NFC: Inefficacy 52.75 10.73 48.85 8.64 0.38

STW: Stress / Worry 49.75 10.31 44.69 6.24 0.54

AXY: Anxiety 53.33 12.53 49.46 8.96 0.33

ANP: Anger-Proneness 53.89 13.94 47.38 10.34 0.49 Personality Psychopathology Five Scales (Revised)

NEGE-r: Negative Emotionality 52.25 12.61 46.15 7.72 0.53

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M SD M SD gInterpersonal Specific Problems Scales

IPP: Interpersonal Passivity 52.69 12.24 47.54 7.98 0.45

SAV: Social Avoidance 51.83 12.04 48.38 10.05 0.30

SHY: Shyness 49.53 8.71 44.54 5.58 0.62

DSF: Disaffiliativeness 54.28 13.75 53.85 11.00 0.03


Interpersonal Deficits/Introversion

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M SD M SD gInterest Scales

AES: Aesthetic-Literary Interests 47.19 10.75 55.62 9.22 -0.81*

MEC: Mechanical-Physical Interests

51.81 8.91 58.85 7.24 -0.82*


Unanticipated Differences

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Integrated Discussion

• Extended empirical literature demonstrating the utility of the MMPI-2-RF in differential diagnosis.

• Important to treat mood, anxiety, somatic, and psychotic symptoms throughout many patient groups.

• Future studies: Examine replicability and generalizability of findings in larger samples and other diagnostic groups.

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AcknowledgementsWe would like to thank the following for making both this study possible, and our attendance today:• Grant from the University of Minnesota Press, which supported data

collection• Our mentor, Dr. Danielle Burchett, CSU Monterey Bay• Our collaborator, Dr. David Glassmire, Patton State Hospital• The CSUMB Undergraduate Research Opportunities Center • U.S. Department of Education, McNair Scholars

ReferencesCamara, W.J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: Implications in professional psychology. ProfessionalPsychology: Research and Practice, 31, 141–154.Graham, J. R. (2011). MMPI-2: Assessing personality and psychopathology (3rd ed.).

New York, NY: Oxford.Kalichman, S. C. (1991). Psychopathology and personality characteristics of criminal sexual offenders as a function of victim age. Archives of Sexual Behavior, 20, 187-197.Sellbom, M., Bagby, R. M., Kushner, S., Quilty, L. C., & Ayearst, L. E. (2012). Diagnostic construct validity of MMPI-2 Restructured Form (MMPI- 2-RF) scale scores. Assessment, 19, 176-186.

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MMPI-2-RF Scales

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Validity Indicators

CNS - Cannot SayVRIN-r -Variable Response InconsistencyTRIN-r -True Response InconsistencyF-r - Infrequent ResponsesFp-r - Infrequent Psychopathology ResponsesFs - Infrequent Somatic ResponsesFBS-r - Symptom ValidityRBS - Response BiasL-r - Uncommon VirtuesK-r - Adjustment Validity

Higher-Order (H-O) Scales

EID - Emotional / Internalizing Dysfunction THD - Thought Dysfunction BXD - Behavioral / Externalizing Dysfunction

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Restructured Clinical Scales

RCd-(dem) -Demoralization RC1-(som) -Somatic Complaints RC2-(lpe) - Low Positive Emotions RC3-(cyn) - Cynicism RC4-(asb) - Antisocial Behavior RC6-(per) - Ideas of Persecution RC7-(dne) - Dysfunctional Negative Emotions RC8-(abx) - Aberrant Experiences RC9-(hpm) -Hypomanic Activation

Somatic / Cognitive Scales

MLS - Malaise GIC - Gastro-Intestinal Complaints HPC -Head Pain Complaints NUC -Neurological Complaints COG -Cognitive Complaints

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Internalizing ScalesSUI - Suicidal/Death Ideation HLP - Helplessness/Hopelessness SFD - Self-Doubt NFC -Inefficacy STW -Stress / Worry AXY - Anxiety ANP -Anger Proneness BRF - Behavior-Restricting Fears MSF -Multiple Specific Fears

Externalizing Scales

JCP - Juvenile Conduct Problems SUB - Substance Abuse AGG - Aggression ACT - Activation

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Interpersonal ScalesFML - Family Problems IPP - Interpersonal PassivitySAV - Social Avoidance SHY - Shyness DSF - Disaffiliativeness

Interest Scales

AES - Aesthetic-Literary Interests MEC - Mechanical-Physical Interests

PSY-5 (Personality Psychopathology Five) Scales, Revised

AGGR-r - Aggressiveness-Revised PSYC-r - Psychoticism-Revised DISC-r - Disconstraint-Revised NEGE-r -Negative Emotionality / Neuroticism - Revised INTR-r - Introversion / Low Positive Emotionality-Revised

Statistics

M1 M2

*Independent Samples t-test:• Statistical significance (p < .05)• Comparing means of independent

samples

Hedges' g values• Practical significance• Small: .20-.49• Medium: .50-.79• Large: .80+

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EID

RCd RC2

SUI

HLP

SFD

NFC

RC7

STW

AXY

ANP

BRF

MSF

THD

RC6 RC8

NEGE-r PSYC-r

IPP, SAV, SHY, DSF

Normative:Mean= 50

Clinically Significant:Mean ≥ 65

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Paraphilic Disorders• To be diagnosed with a paraphilic disorder people with

atypical sexual interests must:o feel personal distress about their interest, ORo have a sexual desire or behavior that involves

another person’s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.

• Examples include: exhibitionistic disorder and voyeuristic disorder.

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construct validity of mmpi-2-rf scales in a forensic inpatient hospital setting nasreen toorabally...

Documents

rf scales

validity scales

existing mmpi

mood disorders

rf literature

forensic inpatient setting

dysfunction scales

different disorders