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ASSESSING PERSONALITY DISORDERS USING THE MMPI-2-RF
A thesis submittedto Kent State University in partial
fulfillment of the requirements for
the degree of Master of Arts
by
Ashley M. Smith
August, 2010
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Thesis written byAshley M. Smith
B.A., Kent State University, 2006
M.A., Kent State University, 2010
Approved by
_________________________________, Advisor
Yossef Ben-Porath
_________________________________, Chair, Department of Psychology
Maria S. Zaragoza
_________________________________, Dean, College of Arts and Sciences
John R. D. Stalvey
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TABLE OF CONTENTS
LIST OF TABLES ............................................................................................................. iv
CHAPTER Page
I INTRODUCION ......................................................................................................1
Criterion Overlap and Disorder Co-morbidity .........................................................5
Assessing Personality Disorders .............................................................................6
The MMPI-2-RF ....................................................................................................11The Current Investigation .....................................................................................14
II METHOD ..............................................................................................................16
Participants .............................................................................................................16
Measures ................................................................................................................17
Procedure ...............................................................................................................21
III RESULTS ..............................................................................................................22
IV DISCUSSION ........................................................................................................32
Limitations .............................................................................................................42
Future Directions ...................................................................................................43
REFERENCES ..................................................................................................................45
APPENDIX A THE MMPI-2-RF SCALES ....................................................................51
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LIST OF TABLES
Table Page
1 Hypotheses .............................................................................................................15
2 Correlations Between Higher-Order (H-O) Scales and Restructured
Clinical (RC) Scales and NEO-PI-R and SCID-II .................................................23
3 Correlations Between Somatic/Cognitive and Internalizing Scales and
NEO-PI-R and SCID..............................................................................................24
4 Correlations Between Externalizing, Interpersonal, and Interest Scalesand NEO-PI-R and SCID-II ...................................................................................25
5 Correlations Between the Personality Psychopathology Five (PSY-5)Scales and NEO-PI-R and SCID-II........................................................................26
6 Hypotheses and Results ........................................................................................34
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CHAPTER I
INTRODUCTION
A Personality Disorder is an enduring pattern of inner experiences and behavior
that deviates markedly from the expectations of the individuals culture, is pervasive and
inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to
distress or impairment (APA, 2000). Consistent with an organizational framework
introduced with DSM-III, the current classification system, DSM-IV-TR (APA, 2000)
categorizes personality disorders into three clusters, A, B, and C, with each including
several personality disorders. The 10 personality disorders are categorized into the
clusters based on descriptive similarities so that the disorders grouped into a particular
Cluster share similarities in their presentations, symptomatology, personality traits, and
behavioral observations (APA, 2000). Although not without its problems and limitations
(c. f. Kraus, 1991; Klonsky, 2000; Mahrer, 2000; Livesley, 1991), this clustering system
is currently the gold standard for diagnostic purposes. The first set of personality
disorders, Cluster A, includes: Paranoid Personality Disorder, Schizoid Personality
Disorder, and Schizotypal Personality Disorder. This cluster includes individuals who
appear to be odd or eccentric when compared with others (APA, 2000). Specifically,
Paranoid Personality Disorder involves a pattern of distrust and suspiciousness, such that
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the motives of others are interpreted as malevolent (APA, 2000). The prevalence rate for
this disorder is 0.5-2.5% in the general population. In addition, both Alcohol and other
Substance Use Disorders commonly co-occur with this diagnosis (APA, 2000). For
example, Chiao-Chicy and colleagues (1999) found that 15.9% of their heroin-addicted
sample obtained a diagnosis of Paranoid Personality Disorder
Schizoid Personality Disorder involves a pattern of detachment from social relationships
and a restricted range of emotional expression by the individual (APA, 2000). Prevalence
rates for this particular disorder are not stated specifically in the DSM; however, it is
uncommon in clinical settings (APA, 2000). Individuals with Schizoid Personality
Disorder often appear to have flattened affect.
Lastly, Schizotypal Personality Disorder is defined by a pattern of discomfort in
close relationships with others, cognitive or perceptual distortions, and eccentricities of
behavior (APA, 2000). The prevalence rate for this disorder is about 3% in the general
population (APA, 2000). Individuals diagnosed with Schizotypal Personality Disorder
may come across to others as socially phobic or as having bizarre experiences. Overall,
individuals with Cluster A disorders are typically disconnected from reality and may
appear paranoid, suspicious, or emotionally detached from others (APA, 2000).
The Cluster B Personality Disorders include Antisocial Personality Disorder,
Borderline Personality Disorder, Histrionic Personality Disorder, and Narcissistic
Personality Disorder (APA, 2000). Overall, individuals with Cluster B Personality
Disorders appear to be dramatic, overly emotional, erratic/reckless, or cold and uncaring
(APA, 2000). More specifically, Antisocial Personality Disorder is defined by a pattern
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of disregard for others and the violation of their rights (APA, 2000). These are
individuals who have typically had much interaction with the law and judicial systems as
both adolescents and adults. This is one of the more frequently occurring personality
disorders at 3% of community samples for men and 1% for women; however, in forensic,
substance abuse treatment and outpatient settings, the prevalence rates for this disorder
increase dramatically (APA, 2000). Further, high rates of comorbidity have been noted
between Antisocial Personality Disorder and Substance Use Disorders (APA, 2000).
More specifically, a study by Craig (2000) found prevalence rates of Antisocial
Personality Disorder ranging from 3 to 62% in an inpatient drug-abusing (i.e.- heroin and
cocaine) population.
Borderline Personality Disorder is classified as a pattern of instability and
problem behaviors in interpersonal relationships, disruptions or fluctuations of the
individuals self-image, and general impulsivity (APA, 2000). In the general population,
individuals are diagnosed with Borderline Personality Disorder at a 2% rate and up to
10% in outpatient treatment settings (APA, 2000). Individuals with a diagnosis of
Borderline Personality Disorder are also likely to have a co-occurring Substance Use
Disorder (APA, 2000). Research has demonstrated that individuals in treatment for a
Substance-related disorder have comorbid diagnoses of Borderline Personality Disorder
with prevalence rates ranging from 22.4% to 28.5% (Morgenstern, et. al., 1997; Skodol,
et. al., 1999).
Histrionic Personality Disorder involves a pattern of excessive emotionality and
attention seeking thoughts, behaviors, and motivations (APA, 2000). Individuals with this
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disorder may threaten to commit suicide, with no true intentions of doing so, to prevent
their partner from ending a relationship with them. They frequently aim to be the center
of attention in social situations as well. The prevalence rate for this disorder ranges from
2-3% in the general population and up to 15% in outpatient settings (APA, 2000).
Narcissistic Personality Disorder is characterized by a pattern of grandiosity, a
specific need for admiration, and a lack of empathy for others. The prevalence of this
disorder is fairly low at less than 1% of the population, but higher in clinical settings at 2-
16% (APA, 2000). In addition, individuals with Narcissistic Personality Disorder are at
an increased risk for a comorbid Substance Use Disorder, especially related to cocaine
abuse or dependence (APA, 2000). Individual with Narcissistic Personality Disorder may
often appear very self-centered and/or selfish. In addition, they may appear very
unempathic and require excessive admiration and praise from others (APA, 2000).
Cluster C Personality Disorders include: Avoidant Personality Disorder,
Dependent Personality Disorder, and Obsessive-Compulsive Personality Disorder.
Individuals with a Cluster C Personality Disorder typically appear to be very anxious or
fearful in a variety of situations (APA, 2000). Avoidant Personality Disorder is
characterized by a pattern of social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation by others (APA, 2000). The prevalence rates for
this disorder are 0.5-1% in the general population and about 10% in clinical settings
(APA, 2000). People diagnosed with this disorder frequently over-react to criticism of
any kind and may seem very down on themselves, believing that they will never be good
enough.
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Dependent Personality Disorder is defined as a pattern of submissive and clinging
behavior that is related to an excessive need to be taken care of by others (APA, 2000).
Despite the fact that there is no specific rate listed, this disorder is one of the most
frequently reported personality disorders in mental health settings (APA, 2000).
Individuals with Dependent Personality Disorder may tolerate excessive negativity in
interpersonal relationships in order to maintain their dependency on others (APA, 2000).
Obsessive- Compulsive Personality Disorder is characterized by a pattern of
preoccupation with orderliness, perfectionism, and control (APA, 2000). This Personality
Disorder occurs in about 1% of the general population and in 3-10% of clinical
populations (APA, 2000). Individuals with Obsessive- Compulsive Personality Disorder
may not be able to keep a steady job because they take several hours to complete a simple
task.
Several flaws and limitations of the DSM-IV personality disorder classification
system have been identified. They include issues of comorbidity between the personality
disorders, related overlap of symptoms or diagnostic criteria, and consequent difficulty in
differential diagnosis of these disorders (Kraus, 1991; Klonsky, 2000).
Criterion Overlap and Disorder Co-morbidity
One of the difficulties with the current Axis II clusters is that some of the
symptoms or criteria within the clusters overlap. Although they may not be described
with identical language, several symptoms from each of the personality disorders are
similar within that same Cluster. In Cluster A, for example, suspiciousness, difficulties
maintaining interpersonal relationships, and inappropriate or constricted affect are
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characteristics of more than one disorder (APA, 2000). Similarly, in Cluster B,
impulsivity, anger, aggressiveness, intense interpersonal relationships, and affective
intensity are present in some form across the four personality disorders (APA, 2000). A
fear of rejection and/or criticism, inhibited interpersonal relationships, cognitive
preoccupation and difficulties in decision-making characterize more than one of the
Cluster C disorders (APA, 2000).
As a result of the overlap both within and between the three clusters of personality
disorders, it is not surprising that there is a significant amount of comorbidity between
the various disorders. In fact, research has demonstrated that an individual diagnosed
with one Personality Disorder is at an increased risk to have a second Personality
Disorder diagnosis (Kraus, 1991). More specifically, individuals diagnosed with any of
the Cluster A Personality Disorders are at an increased risk to develop comorbid Axis II
conditions, including the other Cluster A Personality Disorders, Avoidant, and Borderline
Personality Disorders (APA, 2000). Further, as stated in the DSM-IV-TR (APA, 2000),
an individual with any Cluster B Personality Disorder is at an increased risk to have
another comorbid Cluster B diagnosis. In terms of comorbidity and Cluster C Personality
Disorders, individuals diagnosed with any Cluster C Personality Disorder are also
frequently diagnosed with a comorbid Cluster A Personality Disorder or Borderline
Personality Disorder (APA, 2000).
Assessing Personality Disorders
A variety of methods have been developed to assess Axis II conditions. One
assessment technique that can be used is a structured interview, such as the Structured
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Clinical Interview for the DSM- Axis II (SCID II; First, Gibbon, Spitzer, Williams, &
Benjamin, 1997). This instrument asks standardized questions related to Personality
Disorder symptomatology. Further, the format of the interview corresponds with the
DSM-IV-TR (APA, 2000) criteria for each of the personality disorders (First, Gibbon,
Spitzer, Williams, & Benjamin, 1997).
Two additional assessment methods used to examine Personality Disorder
symptomatology are semi-structured and unstructured (e.g.social history) interviews.
These interviews include both open and closed-ended questions aimed at gathering
information about symptomatology, emotions, and so on. However, these two types of
interviews were not developed specifically for the assessment of personality disorders;
rather, they are also used to assess a wide variety of mental disorders.
Various attempts have been made to assess personality disorders with self-report
inventories. The MMPI (Hathaway & McKinley, 1943) has played a major role in this
area. The Pd (Psychopathic Deviate) scale was one of the early attempts to measure
personality disorder symptomatology. One of the eight original Clinical Scales, Pd was
designed to identify individuals with what would today be labeled Antisocial Personality
Disorder. Scores on this scale are associated with substance use/abuse, familial discord,
and antisocial behaviors (Graham, 2006), which are, as described earlier, associated
features of this disorder.
Building on the work of Hathaway & McKinley (1943), Morey, Waugh, and
Blashfield (1985) developed the first comprehensive set of scales used to measure
personality disorders with the MMPI. These researchers based their conceptualization on
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the Personality Disorder criteria, as defined by the DSM-III (APA, 1980), and used items
from the original MMPI (Hathaway & McKinley, 1943). According to Morey, Waugh,
and Blashfield (1985), two methods were employed during the construction of the scales.
First, the researchers selected four experienced clinical psychologists and asked them to
identify MMPI items that they believed to represent the specific diagnostic criteria of the
DSM-III (APA, 1980). They allowed some of the items to appear on more than one scale
because the diagnostic criteria listed in the DSM-III overlapped as well. These items were
then organized into 11 scales, based on the 11 personality disorders (Morey, Waugh, &
Blashfield, 1985). Secondly, the researchers conducted a series of internal consistency
analyses with the aim of making the items on their scales more homogeneous and
removing items to increase discriminant validity. This scale set contained 251 items with
varying numbers on each scale.
Because item overlap among the scales could be problematic, Morey, Waugh, and
Blashfield (1985) decided to create a second set of scales without overlapping items.
Items were assigned a single scale with which they were most correlated (Morey, Waugh,
& Blashfield, 1985). The non-overlapping scale set also contained 251 items (Morey,
Waugh, & Blashfield, 1985).
Hurt, Clarkin, and Morey (1990) demonstrated that the overlapping Morey et al.
(1985) scale set had adequate stability over a three to four week period in a sample of
individuals in treatment for substance abuse. The correlations between the first and
second time periods ranged from .82 to .93, demonstrating good test-retest reliability.
Overall, the empirical literature on these scales, reviewed by Widiger and Frances (1987)
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indicates that they possess good to excellent convergent validity (Hurt, Clarkin & Morey,
1990; Jones, 2005), but have some limitations in their discriminant validity (Wise, 1996).
Somwaru and Ben-Porath (1994) developed a set of Personality Disorder scales
from the MMPI-2 item pool based on the DSM-IV criteria. . The construction of this
scale set was similar to the development of the Morey et al. scales (1985). However,
Somwaru and Ben-Porath (1994) placed more emphasis on decreasing the amount of item
overlap between the scales (Ben-Porath, 1994), but did not develop a set of non-
overlapping scales. The final results included 266 items assigned to 10 different scales.
Reliability of the Somwaru and Ben-Porath (1994) scales was examined by the
authors. The scales obtained alpha values in the range of .68-.93, indicating that scores on
the scale sets had adequate to very good internal consistency (Somwaru, 1994). The
scale authors also examined test-retest reliability and reported test-retest values ranging
from .76-.92 (Somwaru, 1994).
Hicklin and Widiger (2000) examined the convergent validity of the Somwaru
and Ben-Porath scales using various criterion measures. They also compared them with
the Morey, et, al. (1985) scales. These authors concluded that the MMPI-2 Somwaru and
Ben-Porath scales are generally as valid as the Morey et al. scales (1985) in terms of
convergent validity, but they possessed increased convergent validity for the assessment
of Schizoid, Antisocial, and Borderline Personality Disorders. In examining discriminant
validity, there were no significant differences in the performance of the Somwaru and
Ben-Porath (1994), with discriminant validity coefficients ranging from .15-.52, and the
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Morey (1985) scales demonstrating values from .14-.52. Thus, both scale sets
demonstrated low to adequate discriminant validity (Hicklin & Widiger, 2000).
The MMPI-2 Psychopathology 5 (PSY-5) Scales are also designed to assess
personality disorder features. The five scales are: Aggressiveness (AGGR), Psychoticism
(PSYC), Disconstraint (DISC), Negative Emotionality/Neuroticism (NEGE), and
Introversion/ Low Positive Emotionality (INTR), (Harkness, McNulty, & Ben-Porath,
1995). These scales represent a dimensional approach to assessing personality disorder
symptoms, predicated on the notion that these phenomena are continuous, rather than
taxonic (Graham, 2006).
Using a method they called replicated rational selection, the first step in
developing the PSY-5 Scales was to identify MMPI-2 items that were representative of
those constructs identified by Harkness and McNulty (1994). This was accomplished by
first training a group of college students to understand what the constructs represent.
Then, the students selected MMPI-2 items that they judged to be related to or facets of
those constructs. The items chosen by a majority of the students were then combined to
form the preliminary set of scales.
A second step in scale construction involved the use of expert raters, where the
experts reviewed the items for each of the preliminary scales to ensure that the items
contained within that scale were clearly related to and measures of that particular
construct. Experts could delete, but not add items to the provisional scales.
The third step of scale development involved a series of statistical analyses. More
specifically, items from each scale were correlated with the other scales and if any item
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was too highly correlated with another scale, it was deleted. In addition, the scale authors
also made sure that there was no item overlap between the scales, so that each item was
only scored on one scale.
The PSY-5 scale authors recommend that they be used to aid in the diagnosis of
personality disorders (Harkness, McNulty, & Ben-Porath, 1995). The dimensional nature
of the constructs assessed by these scales is particularly useful as the field of psychology
begins to move towards a more dimensional conceptualization of personality disorders,
such as the Five Factor Model of Personality (Lynam & Widiger, 2001). Recent research
by Bagby, Sellbom, Costa, and Widiger (2008) suggests that the PSY-5 Scales better
predict symptoms of several personality disorders compared to the Five Factor Model. In
particular, the PSY-5 Scales outperformed the NEO-PI-R Scales in the prediction of
personality disorder symptom counts for Paranoid, Schizotypal, Narcissistic and
Antisocial Personality Disorders (Bagby, Sellbom, Costa, & Widiger, 2008). Another
study by Wygant, Sellbom, Graham, & Schenk (2006) also demonstrated the utility of the
PSY-5 Scales in the assessment of personality disorders. These authors illustrated the
incremental validity of the PSY-5 Scales to assess personality pathology above and
beyond the MMPI-2 Clinical and Content Scales. Thus, these scales provide additional
useful information relevant to the assessment of personality disorders not readily
available from other MMPI-2 Scale sets.
The MMPI-2-RF
The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-
RF; Ben-Porath and Tellegen, 2008) is a 338-item revised version of the MMPI-2
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(Butcher, et al., 2001), designed to represent the clinically significant substance of the
MMPI-2 item pool with a comprehensive set of psychometrically adequate measures
(Tellegen & Ben-Porath, 2008, p.1).
The tests consists of a total of 50 scales including: eight Validity scales, three
Higher-Order scales, nine Restructured Clinical (RC) scales, twenty-three Specific
Problems (SP) scales, two Interest scales, and five revised Psychopathology Five (PSY-5)
scales. Appendix A lists and provides a brief description of the 50 scales of the MMPI-2-
RF.
A significant change to the MMPI-2 was the construction of the Restructured
Clinical (RC) Scales (Tellegen, Ben-Porath, McNulty, Arbisi, & Graham, 2003). The RC
Scales were derived from factor analyses of the original Clinical Scales to identify the
major distinctive component of each scale. A large common factor among the clinical
scales was placed into a new scale, Demoralization (RCd). Each of the remaining RC
scales represents a major distinctive component of one of the eight original Clinical
Scales. The authors of the RC Scales indicated that they were not intended to constitute a
comprehensive MMPI-2 assessment of psychopathology and personality characteristics
and that some of the facets of these scales warrant independent assessment. Thus, the
MMPI-2-RF was developed to add substantive scales that assess constructs either not
targeted by the RC scales or warranting more specific assessment (Ben-Porath &
Tellegen, 2008). The methodology used to construct the various substantive scales of the
MMPI-2-RF paralleled the development of the RC Scales to a large extent (Tellegen &
Ben-Porath, 2008).
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The substantive scales of the MMPI-2-RF are organized into a three-tiered
hierarchical structure. The Higher-Order Scales provide a broadband framework with
which to organize information obtained from the test. The three dimensions measured by
these scales, emotional, thought, and behavioral dysfunction, tap psychological factors
relevant to the assessment of personality disorders. Several of the RC Scales can also be
linked to personality disorder criteria as can the more narrowly-focused SP Scales. The
revised PSY-5 scales were designed specifically to assess variables related to personality
disorders.
Several studies provide information on the link between MMPI-2-RF scales and
personality disorder symptoms. Sellbom, Ben-Porath, and Stafford (2007) demonstrated
that RC 4 (compared with the original Clinical Scale 4) was the best MMPI-2 based
measure of Psychopathy, which is closely linked to Antisocial Personality Disorder.
Kamphuis, Arbisi, Ben-Porath, & McNulty (2008) found that the RC scales outperformed
the Clinical Scales in differential prediction of Axis II conditions. The MMPI-2-RF
Manual for Administration, Scoring, and Interpretation (Ben-Porath & Tellegen, 2008)
identifies certain personality disorders as diagnostic considerations (meaning that the
interpreter should consider whether the test-taker meets the actual diagnostic criteria) for
some personality disorder. More specifically, RC3 (Cynicism) may be linked to
personality disorders involving both mistrust of and hostility towards others (e.g.
Paranoid and Antisocial Personality Disorders; Ben-Porath & Tellegen, 2008). RC8
(Aberrant Experiences) may identify individuals with personality disorders associated
with unusual thoughts, perceptions, or experiences, such as Schizotypal Personality
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Disorder (Ben-Porath & Tellegen, 2008). Diagnostic considerations related to personality
disorders are also identified for some Specific Problems (SP) scales. For example,
Juvenile Conduct Problems (JCP) is linked to Antisocial Personality Disorder (Ben-
Porath & Tellegen, 2008), Interpersonal Passivity (IPP) to Dependent Personality
Disorder (elevated scores > 65) and Narcissistic Personality Disorder (low scores < 38)
(Ben-Porath & Tellegen, 2008). Lastly, because they assess the same constructs, the
revised PSY-5 scales similarly provide a dimensional model of personality disorder
symptoms. Ben-Porath & Tellegen (2008) link each of the PSY-5 scales with diagnostic
considerations related to one of the personality disorder clusters. AGGR-r and DISC-r
indicate possible Cluster B disorders, PSYC-r is linked with Cluster A disorders and both
NEGE-r and INTR-r indicate possible Cluster C disorders.
The Current Investigation
Personality disorder-related diagnostic considerations listed by Ben-Porath &
Tellegen (2008) are, for the most part, inferential. The purpose of the current study is to
examine the hypothesized link, empirically. Several hypotheses were developed prior to
conducting statistical analyses. Individual scales from each of the MMPI-2-RF scale sets
were hypothesized to be associated with the various personality disorders based on the
DSM-IV criteria and the diagnostic considerations listed in the MMPI-2-RF manual. One
Higher-Order scale and one PSY-5 scale, along with some RC or SP scales were
hypothesized to be associated with each of the personality disorders. The two Interest
Scales were not included in any hypotheses because they are not measures of
psychopathology. A complete list of the hypotheses is available in Table 1.
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Table 1. Hypotheses
Cluster AParanoid PD Schizoid PD Schizotypal PD
THD EID THD
RC3 RC2 RC2
RC6 SAV RC6
AGG DSF RC8
PSYC-r FML SAV
PSYC-r PSYC-r
Cluster B
Antisocial PD Borderline PD Histrionic PD Narcissistic PD
BXD EID EID BXD
RC4 BXD BXD RC4
RC9 THD RC7 RC9
ANP RC2 RC9 IPP (-)
JCP RC6 ACT AGGR-r
AGG RC7 SHY (-)
AGGR-r RC9 DISC-r
DISC-r SUI
SFD
ANP
AGG
FML
IPP (-)
SHY (-)
DISC-r
NEGE-r
Cluster C
Avoidant PD Dependent PD OCPD
EID EID EID
RC2 RC7 RC7
RC7 HLP RC9
SFD SFD STW
BRF NFC BRF
SAV STW NEGE-r
SHY IPP
INTR-r NEGE-r
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CHAPTER II
METHOD
Participants
Potential participants for this study included 1432 men enrolled in an addictions
treatment program at a Midwestern Veterans Hospital. To be included in this study, the
participants were required to complete all of the criterion measures in the study,
including: the Minnesota Multiphasic Personality Inventory 2, Borderline Syndrome
Index, NEO Personality Inventory Revised, and Structured Clinical Interview for the
DSM, Axis II. If one or more of these measures was missing or incomplete, that
individual was excluded from the final sample. After excluding individuals for missing
data, the sample size decreased to 996 men.
Individuals were also excluded from this study if they produced invalid MMPI-2-
RF protocols, based on the criteria in the MMPI-2-RF Technical Manual: Cannot Say
[CNS] raw score 18, Variable Response Inconsistency [VRIN-r] and/or True Response
Inconsistency [TRIN-r] T 80, Infrequent Responses [F-r] T = 120, or Infrequent
Psychopathology Responses [Fp-r] T 100. A total of 244 individuals (24% of the
sample) were excluded due to invalid protocols.
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After removing invalid protocols and missing criterion measures, the final sample
was made up of 752 men, with ages ranging from 23-75 (M = 44.4; SD = 8.7). The
sample was 57% African American, 37% Caucasian, and 6% had other ethnicities,
including American Indian, and Hispanic. The primary diagnoses in this sample, other
than substance abuse, included: Post-Traumatic Stress Disorder (6% of the sample),
Major Depressive Disorder (5% of the sample), and Pathological Gambling (4.5% of the
sample).
Measures
Minnesota Multiphasic Personality Inventory- 2- Restructured Form (MMPI-2-RF)
The MMPI-2-RF is a 338-item self-report inventory. The scales on the MMPI-2-
RF include: eight validity scales, three higher order scales, nine Restructured Clinical
(RC) scales, and five revised Psychopathology Five (PSY-5) scales. The validity scales
include 7 scales from the MMPI-2 that were revised and the addition of one new scale
(Ben-Porath & Tellegen, 2008). The three higher order scales were developed to measure
personality and psychopathology at their broadest levels. The next level of the hierarchy
includes the Restructured Clinical (RC) scales, which are identical to the RC scales of the
MMPI-2 (Ben-Porath & Tellegen, 2008). The PSY-5 scales are similar to those that
appear on the MMPI-2, but were revised for the MMPI-2-RF. Harkness and McNulty
(2007) used an iterative process consisting of both internal and external analyses. They
removed 22 of the 96 items that transferred from the MMPI-2 to the MMPI-2-RF and
added 30 new items. This resulted in five non-overlapping scales consisting of 104 items.
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According to Harkness and McNulty (2007), the revised PSY-5 scales demonstrated
lower intercorrelations and analogous external validity, compared to the original scales.
However, they still assess the same dimensional models of personality pathology (Ben-
Porath & Tellegen, 2008). The lowest level of the hierarchy includes the 23 Specific
Problems (SP) Scales and two Interest Scales. These scales aim to measure certain
somatic, internalizing facets, externalizing facets, interpersonal problems, and interests of
individuals. Extensive empirical data regarding the psychometric characteristics of the
MMPI-2-RF are provided in the Technical Manual (Tellegen & Ben-Porath, 2008).
NEO Personality Inventory- Revised (NEO-PI-R)
The NEO-PI-R is a 240-item self-report questionnaire designed to assess five
broad domains of personality, including: extraversion, agreeableness, neuroticism,
conscientiousness, and openness. The measure also assesses six specific facets of each of
these five broad domains, where each broad domain contains six facets or subscales. The
facets for Extraversion are Warmth, Gregariousness, Assertiveness, Activity, Excitement
Seeking, and Positive Emotion (Costa & McCrae 1992b). The facets for Agreeableness
include: Trust, Straightforwardness, Altruism, Compliance, Modesty, and
Tendermindedness. Further, the Neuroticism factor contains the facets of Anxiety,
Hostility, Depression, Self-Consciousness, Impulsiveness, and Vulnerability to Stress. In
addition, the Conscientiousness factor includes Competence, Order, Dutifulness,
Achievement Striving, Self-Discipline, and Deliberation facets. Finally, the factor of
Openness contains the facets of Fantasy, Aesthetics, Feelings, Actions, Ideas, and Values.
Costa and McCrae (1992b) report internal consistency estimates for the broad domains
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with alphas ranging from .86 to .92 for the broad domains and .56 to .81 for the thirty
facet subscales. The authors also attribute the lower internal consistency values of the
facets to the fact that each facet only contains eight items. Therefore, it is not
unreasonable to expect lower estimates (Costa & McCrae 1992b). Examination of test-
retest correlations of six years demonstrates that the NEO-PI-R possess adequate to very
good temporal stability estimates, with alphas ranging from .63 to .83.
Lynam and Widiger (2001) developed a method for assessing the DSM-IV
personality disorders using the NEO-PI-R. The authors asked DSM experts to rate
prototype cases using all 30 facets of the Five Factor Model (FFM). Then, they combined
the ratings to identify a pattern of NEO-PI-R prototype scores for each of the DSM-IV
(APA, 2000) personality disorders. Lynam and Widiger (2001) reported good agreement
(i.e., r= .48-.66) among the raters for those prototypes and stated that the prototypes map
onto the DSM-IV personality disorder criteria well. In the present study, we compared
the prototypes generated by Lynam and Widiger (2001) to each participants individual
NEO-PI-R profile. This comparison yields a set of similarity scores. The similarity scores
are generated into the same metric as the prototypes, allowing for the direct comparison
of the individuals NEO-PI-R scores and the Lynam and Widiger (2001) prototypes. An
individual is more likely to have a particular personality disorder as their similarity scores
becomes closer to the prototype for that disorder. Thus, our participants received a NEO-
PI-R prototype similarities score for each of the ten DSM-IV personality disorders.
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The Structured Interview for the DSM, Axis II (SCID-II)
The SCID-II (First, Gibbon, Spitzer, Williams, & Benjamin, 1997) is a highly
structured clinical interview designed specifically to aid in diagnosis of Axis II disorders.
Responses to the interview questions are rated as either present, absent, or sub-threshold.
A study by Smith and colleagues (2003) examined the criterion validity the DSM-IV
SCID-II, and demonstrated poor agreement between the DSM-IV SCID-II and the
Wisconsin Personality Disorders Inventory-IV (WISPI-IV; Klein & Benjamin, 1996)
with kappas at or below .40. While there are no studies examining the reliability of DSM-
IV SCID-II, previous studies have examined the reliability of the instrument with the
DSM-III. For example, the authors of the instrument report interrater reliability with
kappas ranging from .24 to .74 when the instrument was administered to patients (First,
Gibbon, Spitzer, Williams, & Benjamin, 1997).
The Borderline Syndrome Index
The Borderline Syndrome Index (BSI; Conte, Plutchik, Karasu, & Jerrett, 1980) is a
52- item self-report inventory intended to assess features and characteristics of Borderline
Personality Disorder utilizing a true/false response format. More specifically, the measure
focuses on borderline functioning in the areas of poor impulse control, absence of a
consistent self-identity, depression, anhedonia, impaired object relations,
depersonalization, and a number of neurotic symptoms (Sansone, Fine, Seuferer, &
Bovenzi, 1989). The test authors examined reliability by calculating internal consistency
and they demonstrated high internal consistency, with a Chronbachs alpha of .92 (Conte,
Plutchik, Karasu, & Jerrett, 1980). Convergent validity was examined between the BSI
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21
and the Diagnostic Interview for Borderlines (DIS; Gunderson, Kolb, & Austin, 1981).
The results indicated that convergent validity between the two measures is high, with
correlations between the instruments of .88 (DAngelo, 1991).
Procedure
The archival data set was collected at a Midwestern VA medical center in an
addiction treatment unit. The data collection took place over a three-day period upon
admission to the hospitals inpatient addiction treatment program. The addictions that
individuals were being treated for included alcohol, drug, illicit substances, and
gambling. The measures administered during this time include: a computerized version of
the MMPI-2, a demographic questionnaire, and a set of extra-test measures. MMPI-2-RF
scales were scored from individual responses to the MMPI-2 items. Tellegen and Ben-
Porath (2008) demonstrated that individuals completing the two versions of the test
produce interchangeable scores on the MMPI-2-RF scales. Included in this set of extra
test measures were the NEO-PI-R, the SCID-II, and the BSI. Lastly, in accordance with
ethical considerations and patient confidentiality, all identifying personal information was
removed from the data.
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CHAPTER III
RESULTS
Zero-order correlations were calculated between the substantive MMPI-2-RF
scales and NEO-PI-R prototype similarities, the SCID-II personality disorder symptom
counts, and the Borderline Syndrome Index total scores. Tables 2-5 provide results for all
of the correlational analyses that were conducted. The zero-order correlations had to meet
two requirements for interpretation. First, the correlation had to reach statistical
significance, at p .05. In addition, correlations between MMPI-2-RF Scales and the
NEO-PI-R prototype similarities and Borderline Syndrome Index scores had to reach a
magnitude of at least .4, or a medium effect size as defined by Cohen (1981), for
interpretation. Correlations between MMPI-2-RF Scales and the SCID-II symptom
counts had to reach a magnitude of at least .2, or a small effect size (Cohen, 1981). The
magnitude of .4 was selected for the NEO-PI-R because the strength of the correlations
between the MMPI-2-RF scales and the NEO-PI-R were consistently higher than those
with the SCID-II, likely as a result of shared method (self-report) variance. These effect
size requirements were set based on procedures followed in previous empirical research
(e.g., McNulty, Ben-Porath, & Graham, 1999) to narrow the focus of interpretation of the
analyses, as almost every correlation reached statistical significance.
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Table 2. Correlations Between Higher-Order (H-O) Scales and Restructured Clinical (RC) Scales and NEO-PI-R and SCID-II
Higher Order (H-O)
Scales Restructured Clinical (RC) Scales
Criterion Measure EID THD BXD RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9
NEO-PI-R Paranoid PD .53* .22 .30 .46* .28 .46* .31 .32 .29 .48* .21 .24
SCID Paranoid PD .21* .24 .18 .21* .19 .10 .18 .19 .19 .27* .24* .24*
NEO-PI-R Schizoid PD .46 .00 -.12 .37 .20 .61* .05 .00 .06 .26 .00 -.23
SCID Schizoid PD .10 .15 .00 .10 .14 .08 .08 -.02 .12 .13 .13 .05
NEO-PI-R Schizotypal PD .72* .19 .19 .67* .34 .68 .20 .31 .24 .56* .22 .11
SCID Schizotypal PD .16 .27 .04 .18 .13 .10 .08 .06 .24 .22* .26 .11
NEO-PI-R Antisocial PD .19 .11 .50 .23 .08 .08 .21 .43 .16 .22 .13 .41
SCID Antisocial PD .05 .05 .15 .07 .04 .04 -.01 .12 .09 .09 .05 .09
NEO-PI-R Borderline PD .66 .26 .45 .68* .32 .47 .26 .49* .30 .58 .31 .40
SCID Borderline PD .27 .20 .15 .29* .15 .16 .10 .16 .19 .29 .23 .20
BSI Borderline PD .75 .41 .34 .77* .42* .52 .34 .42* .40 .68 .46 .38
NEO-PI-R Histrionic PD .09 .12 .39 .19 .03 -.07 .06 .34 .11 .15 .16 .38
SCID Histrionic PD .09 .09 .09 .11 .04 -.01 .06 .05 .12 .15 .09 .17
NEO-PI-R Narcissistic PD -.03 .14 .44 .01 .02 -.14 .20 .32 .17 .10 .13 .42
SCID Narcissistic PD .14 .19 .17 .18 .07 .02 .14 .16 .19 .23* .21* .26
NEO-PI-R Avoidant PD .66 .14 -.02 .59* .31 .67 .13 .13 .17 .48 .16 -.07
SCID Avoidant PD .29 .13 .01 .27* .12 .24 .04 .05 .13 .25 .15 .03
NEO-PI-R Dependent PD .40 .00 -.23 .39 .16 .45* -.07 -.07 -.01 .24 .03 -.23
SCID Dependent PD .17 .14 .06 .20* .08 .10 .08 .06 .15 .18 .15 .12
NEO-PI-R Obsessive-Compulsive PD -.17 -.07 -.30 -.25 -.04 -.06 -.04 -.29 -.07 -.15 -.12 -.27
SCID Obsessive-Compulsive PD .13 .22* .07 .13 .12 .01 .14 .07 .17 .20 .23* .19
Note: N= 752; Bold & underlining = Supported hypothesis; * = Unanticipated, but significant result; NEO-PI-R= The NEO-PI-R Personality
Inventory Revised; SCID= Structured Clinical Interview for the DSM- Axis II; BSI= Borderline Syndrome Index.23
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Table 3. Correlations Between Somatic/Cognitive and Internalizing Scales and NEO-PI-R and SCID
Somatic/Cognitive Scales Internalizing Scales
Criterion Measures MLS GIC HPC NUC COG SUI HLP SFD NFC STW AXY ANP BRF MSF
NEO-PI-R Paranoid PD .32 .17 .22 .23 .34 .27 .33 .37 .35 .36 .34 .51* .18 .02
SCID Paranoid PD .16 .15 .13 .18 .21* .17 .10 .15 .19 .20 .20 .23* .11 .02
NEO-PI-R Schizoid PD .35 .13 .13 .16 .25 .18 .32 .31 .33 .19 .15 .14 .09 -.02
SCID Schizoid PD .10 .06 .15 .12 .09 .05 .13 .06 .15 .12 .11 .11 .06 -.04
NEO-PI-R Schizotypal PD .48* .21 .28 .24 .48* .38 .40* .59* .57* .50* .38 .40* .26 .06
SCID Schizotypal PD .11 .05 .11 .13 .20* .12 .11 .14 .14 .15 .21* .14 .16 .02
NEO-PI-R Antisocial PD .09 .06 .09 .04 .18 .10 .09 .18 .14 .18 .14 .38 .06 -.04
SCID Antisocial PD .02 .04 .01 .03 .07 .03 .04 .03 .05 .06 .08 .11 -.02 -.05
NEO-PI-R Borderline PD .39 .20 .29 .22 .47 .37 .33 .60 .52* .54* .42* .55 .27 .06
SCID Borderline PD .18 .11 .11 .13 .24 .25 .19 .24 .20* .24* .24* .24 .16 .01
BSI Borderline PD .47* .25 .34 .31 .61 .54 .48* .68 .57* .59* .51* .51 .37 .07
NEO-PI-R Histrionic PD .01 .03 .06 .00 .16 .11 -.01 .17 .14 .19 .13 .20 .11 .02
SCID Histrionic PD .00 .04 .01 .01 .09 .06 .06 .07 .08 .12 .11 .15 .11 .02
NEO-PI-R Narcissistic PD -.06 .01 .04 .02 .05 .02 -.02 .05 -.05 .04 .09 .31 .03 -.04
SCID Narcissistic PD .06 .06 .02 .07 .18 .16 .12 .15 .13 .18 .19 .15 .14 .07
NEO-PI-R Avoidant PD .44* .19 .24 .24 .41* .32 .39 .54 .53* .42* .33 .27 .24 .09
SCID Avoidant PD .16 .06 .09 .11 .22* .24* .15 .25 .25* .21* .17 .13 .12 .02
NEO-PI-R Dependent PD .29 .09 .12 .12 .25 .18 .24 .40 .41 .26 .15 -.04 .16 .12
SCID Dependent PD .09 .02 .08 .09 .17 .12 .13 .16 .17 .19 .14 .12 .13 .03
NEO-PI-R Obsessive-Compulsive PD -.10 .05 -.06 .01 -.17 -.13 -.01 -.24 -.19 -.19 -.10 -.12 -.09 .02
SCID Obsessive-Compulsive PD .07 .06 .10 .08 .16 .13 .13 .09 .12 .16 .12 .15 .15 .02
Note: N= 752; Bold & underlining = Supported hypothesis; * = Unanticipated, but significant result; NEO-PI-R= The NEO-PI-R Personality
Inventory Revised; SCID= Structured Clinical Interview for the DSM- Axis II; BSI= Borderline Syndrome Index. 24
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Table 4. Correlations Between Externalizing, Interpersonal, and Interest Scales and NEO-PI-R and SCID-II
Externalizing Scales Interpersonal Scales Interest Scales
Criterion Measures JCP SUB AGG ACT FML IPP SAV SHY DSF AES MEC
NEO-PI-R Paranoid PD .24 .16 .46 .06 .33 .01 .50* .38 .47* -.21* -.10
SCID Paranoid PD .14 .17 .14 .18 .20* .07 .03 .09 .10 .00 .07
NEO-PI-R Schizoid PD -.02 .00 -.05 .22 .09 .42 .68 .46* .49 -.23* -.22*SCID Schizoid PD .04 .04 .08 .03 .03 .06 .09 .10 .16 -.03 .01
NEO-PI-R Schizotypal PD .19 .18 .31 .01 .36 .34 .56 .55* .44* -.13 -.18
SCID Schizotypal PD .02 .05 .13 .13 .16 .03 .11 .11 .12 .01 .01
NEO-PI-R Antisocial PD .34 .20 .43 .16 .23 -.20 -.04 -.01 .09 -.06 .08
SCID Antisocial PD .13 .06 .19 .04 .10 .01 .06 .03 .05 -.08 .03
NEO-PI-R Borderline PD .34 .27 .50 .19 .45 .08 .24 .36 .25 -.09 -.06
SCID Borderline PD .07 .13 .24 .15 .24 .01 .10 .13 .09 -.10 .00
BSI Borderline PD .23 .29 .46 .25 .49 .12 .25 .46* .38 -.04 -.07
NEO-PI-R Histrionic PD .26 .16 .25 .24 .20 -.15 -.32 -.11 -.18 .14 .10
SCID Histrionic PD .03 .00 .15 .13 .14 .08 -.03 .01 .03 .02 .05
NEO-PI-R Narcissistic PD .28 .12 .39 .20 .16 -.38 -.14 -.16 .03 .03 .15
SCID Narcissistic PD .10 .12 .21* .22* .21* .06 -.02 .03 .05 .02 .06
NEO-PI-R Avoidant PD .06 .09 .14 -.08 .26 .43* .59 .57 .42* -.17 -.24
SCID Avoidant PD .01 .06 .11 .04 .15 .17.23 .27
.14 .00 -.05
NEO-PI-R Dependent PD -.09 -.01 -.17 -.12 .08 .50 .26 .39 .11 -.10 -.23
SCID Dependent PD .02 .10 .12 .09 .13 .04 .00 .10 .02 .01 .01
NEO-PI-R Obsessive-Compulsive PD -.19 -.17 -.18 -.17 -.18 -.01 .21 .00 .12 -.17 - .06
SCID Obsessive-Compulsive PD .01 .10 .15 .20 .16 .07 .00 .09 .02 .03 .06
Note: N= 752; Bold & underlining = Supported hypothesis; * = Unanticipated, but significant result; NEO-PI-R= The NEO-PI-R
Personality Inventory Revised; SCID= Structured Clinical Interview for the DSM- Axis II; BSI= Borderline Syndrome Index.
25
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Table 5. Correlations Between the Personality Psychopathology Five (PSY-5) Scales and NEO-PI-R and SCID-II
Personality Psychopathology Five (PSY-5) Scales
Criterion Measure AGGR-r PSYC-r DISC-r NEGE-r INTR-r
NEO-PI-R Paranoid PD .14 .19 .16 .45* .46*
SCID Paranoid PD .13 .22 .15 .24* .00
NEO-PI-R Schizoid PD -.35 .00 -.17 .20 .70*SCID Schizoid PD -.01 .12 -.04 .12 .11
NEO-PI-R Schizotypal PD -.23 .20 .11 .55* .59*
SCID Schizotypal PD .01 .29 .01 .17 .09
NEO-PI-R Antisocial PD .33 .09 .42 .24 -.02
SCID Antisocial PD .09 .05 .11 .09 .06
NEO-PI-R Borderline PD .06 .26 .35 .63 .28
SCID Borderline PD .07 .20* .09 .29 .09
BSI Borderline PD -.01 .42* .25 .66 .30
NEO-PI-R Histrionic PD .19 .13 .38 .21 -.27
SCID Histrionic PD .12 .11 .05 .15 -.03
NEO-PI-R Narcissistic PD .48 .11 .37 .08 -.19
SCID Narcissistic PD .13 .22* .14 .19 -.06
NEO-PI-R Avoidant PD -.37 .15 -.08 .46* .63
SCID Avoidant PD -.12 .13 -.02 .22* .21
NEO-PI-R Dependent PD -.55* .05 -.20 .25 .36
SCID Dependent PD .00 .14 .03 .20 .03
NEO-PI-R Obsessive-Compulsive PD -.02 -.09 -.32 -.21 .14
SCID Obsessive-Compulsive PD .08 .25 .05 .18 -.04
Note: N= 752; Bold & underlining = Supported hypothesis; * = Unanticipated, but significant result; NEO-PI-R= The NEO-PI-R Personality
Inventory Revised; SCID= Structured Clinical Interview for the DSM- Axis II; BSI= Borderline Syndrome Index. 26
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ForParanoid Personality Disorder, an association was hypothesized with the
Higher-Order Thought Dysfunction (THD) scale. The SCID-II measure of Paranoid
Personality Disorder was significantly associated with THD; however, the NEO-PI-R
measure of this disorder was not significantly associated with this scale, as the correlation
did not reach a medium effect size.
Moving down the hierarchy to the Restructured Clinical (RC) Scales, there were
no interpretable associations between either the NEO-PI-R or SCID-II measures of
Paranoid Personality Disorder and RC3 or RC6, as the correlations did not meet the
required effect size. For the Specific Problems (SP) Scales, Aggression (AGG) was more
strongly associated with the NEO-PI-R measure of this disorder; whereas, the SCID-II
correlation did not meet the effect size requirement. Examination of the PSY-5 Scales
revealed that the SCID-II Paranoid Personality Disorder was significantly associated with
the MMPI-2-RF Psychoticism (PSYC-r) Scale; whereas the correlation with the NEO-PI-
R did not reach the magnitude required for interpretation. There were several unexpected,
significant associations between EID, RCd, RC7, ANP, and NEGE-r and both the NEO-
PI-R and SCID-II measures of Paranoid Personality Disorder.
In examining the results for Schizoid Personality Disorder, a significant
association was found between the NEO-PI-R measure of this disorder and the Higher-
Order EID Scale. In addition, there was a significant association between RC2 and NEO-
PI-R measure. The Interpersonal scales Social Avoidance (SAV) and Disaffiliativeness
(DSF) were also significantly associated with the NEO-PI-R measure of Schizoid
Personality Disorder; however, the Family Problems (FML) scale was not significantly
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associated with this measure as hypothesized. The PSYC-r Scale was not significantly
associated with the NEO-PI-R as anticipated. Finally, there were no interpretable
associations between any selected MMPI-2-RF scales and SCID-II symptom counts, as
the correlations were statistically significant, but failed to meet the effect size
requirement.
For Schizotypal Personality Disordersymptomatology, THD, RC2, RC6, RC8,
SAV, and PSYC-r, were significantly associated with the SCID-II symptom counts and
the NEO-PI-R similarities. Finally, there was also a significant association between RC8
and both the NEO-PI-R similarities and the SCID-II; however, this association was not
initially hypothesized.
ForAntisocial Personality Disordersymptoms, the associations between
hypothesized MMPI-2-RF Scales and NEO-PI-R prototype similarities were much
stronger than the correlations with the SCID-II measure of this disorder. None of the
correlations between select MMPI-2-RF Scales and the SCID-II were interpretable, as
they did not meet the effect size requirement. However, the NEO-PI-R measure of
Antisocial Personality Disorder was significantly associated with BXD, RC4, RC9, AGG,
and DISC-r. Whereas the findings just described were in line with our hypotheses, there
were no interpretable associations between the NEO-PI-R or SCID-II measures of this
disorder and the Specific Problems Scales of Anger Proneness (ANP) and Juvenile
Conduct Problems (JCP), or the PSY-5 Aggressiveness Scale (AGGR-r) as hypothesized.
The results for assessingBorderline Personality Disordersymptomatology
indicate that associations were present across all levels of the MMPI-2-RF measurement
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hierarchy. Beginning with the Higher-Order Scales, EID was significantly associated
with the NEO-PI-R, SCID-II, and BSI measures of this disorder. However, unexpectedly
THD and BXD were also significantly associated with these measures. The Higher-Order
BXD scale was only significantly associated with the NEO-PI-R. In terms of the RC
Scales, the strongest relations were between RC7 and the NEO-PI-R, SCID-II, and BSI.
Significant associations were also demonstrated between RC2 and the NEO-PI-R and
BSI, and RC8 and the SCID-II and BSI. RC9 was also significantly associated with both
the NEO-PI-R and SCID-II. Further, the Specific Problems Scale SFD was most strongly
associated with Borderline symptomatology, as measured by the three criterion measures.
Strong associations were also present for the ANP, AGG, and FML. In addition, a
significant association was demonstrated between the SHY and the BSI. Inconsistent with
the hypotheses, significant relations were not observed between Interpersonal Passivity
(IPP) and any of the three criterion measures. Finally, the Negative
Emotionality/Neuroticism PSY-5 Scale was strongly associated with the NEO-PI-R,
SCID-II, and BSI; however, no significant associations were present for DISC-r, as
hypothesized. There were also unanticipated associations found between RCd, COG,
NFC, STW, and AXY and the NEO-PI-R, SCID-II, and BSI.
In examiningHistrionic Personality Disorder symptomatology, the results
demonstrate that there were statistically significant associations between several of the
predicted MMPI-2-RF scales and the NEO-PI-R and SCID-II measures of this disorder.
However, none of those associations reached the effect size requirement for
interpretation.
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ForNarcissistic Personality Disorder, an association was found between the
NEO-PI-R measure and BXD; whereas the SCID-II results did not have a large enough
effect size for interpretation. RC9 was significantly associated with both the NEO-PI-R
and SCID-II measures of this disorder. The PSY-5 AGGR-r scale was significantly
associated with the NEO-PI-R, but not the SCID-II. Hypotheses were not supported for
RC4 and IPP, which were not significantly associated to either criterion measure as
expected.
ForAvoidant Personality Disordersymptomatology, significant associations were
present between all hypothesized MMPI-2-RF Scales (EID, RC2, RC7, SFD, SAV, SHY,
and INTR-r) and the NEO-PI-R and SCID-II measures of this disorder. However, one
Specific Problems Scale, Behavior-Restricting Fears (BRF) was not meaningfully
associated with either criterion measure as hypothesized. There were also several
associations present that were not initially hypothesized. RCd, COG, NFC, STW, and
NEGE-r were all significantly associated with both the NEO-PI-R and SCID-II. The
magnitude of the correlations was greater between the expected MMPI-2-RF Scales and
the NEO-PI-R measure, compared with the SCID-II.
The results forDependent Personality Disorderdemonstrated significant
associations between EID, SFD, NFC, and IPP and the NEO-PI-R Dependent Personality
Disorder similarity scores. Only one scale, NEGE-r, was meaningfully associated with
the SCID-II, but not the NEO-PI-R. Inconsistent with the hypotheses, RC7 and some of
its facets, such as Helplessness/Hopelessness (HLP) and Stress/Worry (STW) were not
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significantly associated with Dependent Personality Disorder symptomatology, as
assessed by the NEO-PI-R or SCID-II.
Finally, examination of Obsessive-Compulsive Personality Disorder
symptomatology demonstrated a lack of meaningful relations between hypothesized
MMPI-2-RF Scales and the NEO-PI-R and SCID-II measures of this disorder. Only one
association reached the effect size requirement for interpretation, and a significant
association was observed between RC7 and the SCID-II measure. In general, the
magnitude of the correlations was much weaker for OCPD than for any other personality
disorder symptomatology.
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CHAPTER IV
DISCUSSION
The primary objective of this study was to examine associations between MMPI-
2-RF scales and measures of personality disorder symptomatology. The MMPI-2-RF has
several new scales that may be particularly useful in the assessment of personality
disorders. This study examined the link between scores on select MMPI-2-RF scales and
personality disorder symptoms to determine whether the personality disorder-related
diagnostic considerations listed by Ben-Porath & Tellegen (2008) are supported
empirically. In addition, anticipated associations were also derived from the DSM-IV
diagnostic criteria for each personality disorder. Thus, both the DSM-IV and the
personality disorder-related diagnostic considerations (Ben-Porath & Tellegen, 2008)
served as guidelines for which MMPI-2-RF scales would be expected to be related to
each of the criterion measures. A correlational design was utilized and all participants
completed several criterion measures under standardized instructions.
Across the personality disorder clusters the magnitude of the correlation patterns
was much stronger for the NEO-PI-R personality disorder (PD) measures and the
Borderline Syndrome Index scores, in comparison with the SCID-II symptom counts.
The strongest pattern of correlations for the Cluster A personality disorders was found for
Schizotypal Personality Disorder, with all specific hypothesis supported by the results.
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For Cluster B, the strongest pattern of correlations was demonstrated for Borderline
Personality Disorder, where all but two hypotheses were supported. The two hypotheses
that were not supported included a predicted negative association between the
Interpersonal Passivity (IPP) Specific Problems Scale and criterion measures of
Borderline symptomatology, and a predicted association between the PSY-5
Disconstraint Scale and Borderline symptomatology, as measured by the NEO-PI-R,
SCID-II, and BSI. Finally, Avoidant Personality Disorder exhibited the strongest
correlational pattern among the Cluster C personality disorders, with all hypotheses
supported, except for the Behavior-Restricting Fears (BRF) scale. Across the three
personality disorder clusters, Borderline Personality Disorder measures had the strongest
associations with the MMPI-2-RF. Table 6 provides a detailed summary of the support
for the individual hypotheses for each personality disorder.
As mentioned, the associations between select MMPI-2-RF scales and the NEO-
PI-R prototype similarities were generally stronger than those with the SCID-II. One
potential explanation from the stronger findings with the NEO-PI-R has to do with the
dimensionality of the constructs being assessed. The NEO-PI-R is designed to measure
the Five Factor Model (Costa & McCrae, 1992); a dimensional model of personality. The
scales of the MMPI-2-RF are dimensional in nature, as higher scores or elevations are
indicative of greater psychopathology. In addition, the PSY-5 Scales of the MMPI-2-RF
are closely linked to Five Factor Model (Bagby, Sellbom, Costa, & Widiger, 2008);
therefore, there is a strong connection between several of the constructs being measured
by both the MMPI-2-RF and the NEO-PI-R. Thus, one may expect that the MMPI-2-RF
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Table 6.Hypotheses and Results
Cluster A
Paranoid PD Schizoid PD Schizotypal PD
EID EID * THD **
RCd RC2 * RC2 *
THD ** SAV * RC6 **
RC3 DSF * RC7
RC6 FML RC8 **
RC7 PSYC-r COG
ANP INTR-r* SAV *
AGG * PSYC-r **
PSYC-r **
NEGE-r
Cluster B
Antisocial PD Borderline PD Histrionic PD Narcissistic PD
BXD * EID *** EID BXD *
RC4 * THD* BXD RC4
RC9 * BXD ** RC7 RC9 ***
ANP RCd RC9 IPP (-)
JCP RC2 * ACT AGGR-r *
AGG* RC6 SHY (-)
AGGR-r RC7 *** DISC-r
DISC-r * RC9 ***COG
SUI **
SFD ***
NFC
STW
AXY
ANP ***
AGG ***
FML***
IPP (-)
SHY (-)
DISC-r
NEGE-r ***
Note: *= Hypothesis supported for NEO-PI-R only; **= Hypothesis supported for SCID-II only;
***= Hypothesis supported for both NEO-PI-R and SCID-II; = Hypothesis supported for BSIonly; *= Hypothesis supported for NEO-PI-R and BSI only; **= Hypothesis supported forSCID-II and BSI only; = Significant result that was not hypothesized.
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Table 6, continued
Cluster C
Avoidant PD Dependent PD OCPD
EID *** EID * EID
RCd RC7 RC7 **
RC2 *** HLP RC9
RC7 *** SFD * STW
COG NFC * BRF
SFD *** STW NEGE-r
NFC IPP *
STW NEGE-r **
BRFSAV ***
SHY ***
NEGE-r
INTR-r ***
Note: *= Hypothesis supported by NEO-PI-R only; **= Hypothesis supported by SCID-
II only; ***= Hypothesis supported by both NEO-PI-R and SCID-II; = Hypothesissupported by BSI only; *= Hypothesis supported by NEO-PI-R and BSI only; **=Hypothesis supported by SCID-II and BSI only; = Significant result that was nothypothesized.
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36
and NEO-PI-R would be more strongly linked as both measures assess personality from a
dimensional perspective.
In contrast, the SCID-II is a more taxonic-type of assessment tool. The SCID-II
interview questions are closely aligned with the DSM-IV criteria for each personality
disorder, which are also taxonic. Despite the fact that SCID-II symptom counts were
utilized in this study, the symptom counts themselves are taxonic in nature. The rater is
asked to indicate the presence or absence of a given symptom, and they do not rate how
much or how little (i.e. - severity) of that symptom is present. Since the SCID-II and
MMPI-2-RF scales take different perspectives (i.e. - taxonic vs. dimensional) to
assessment of symptomatology, it is, perhaps, not surprising that the associations between
these two measures are generally of smaller magnitude.
Another potential explanation for stronger associations between the MMPI-2-RF
and NEO-PI-R prototype similarities has to do with common method variance. Both the
MMPI-2-RF and NEO-PI-R are self-report instruments. Therefore, the correlations
between the two measures may be somewhat artificially inflated. It is possible that some
of the co-variance between the MMPI-2-RF and NEO-PI-R may be attributed to the
measurement method, rather than the constructs of interest. Thus, the common method
variance shared between the two measures may have increased the systematic
measurement error in this study. To address the common method variance concern,
findings were only interpreted if they reached the magnitude of .4 or greater, which is a
medium effect size, as defined by Cohen (1988).
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Two sets of personality disorder symptoms do not appear to be adequately
assessed by the criterion measures utilized in this study. First, there were no significant
associations between select MMPI-2-RF scales and the NEO-PI-R prototypes or SCID-II
symptom counts for Histrionic Personality Disorder. In fact, none of the hypotheses
associated with Histrionic Personality Disorder were supported in this study. One
potential explanation for the lack of support may relate to the substantial symptom
overlap shared between Histrionic and Borderline Personality Disorders. Blagov and
Westen (2008) examined the relationships between Histrionic and Borderline
symptomatology, as they were skeptical of the validity of diagnosing Histrionic
Personality Disorder. They demonstrated that a large majority of the patients in their
study shared symptoms that overlapped between Histrionic and Borderline Personality
Disorder, as defined by the DSM-IV. For example, both disorders share symptoms
associated with internalizing and externalizing symptoms, such as anxiety, stress, worry,
and acting out behaviorally. In this study, the strongest pattern of correlations, across all
clusters, was demonstrated for Borderline Personality Disorder. However, Histrionic
Personality Disorder demonstrated the weakest pattern of associations, as none of the
hypotheses were supported. Therefore, a potential explanation for the discrepancy in
patterns may have to do with the overlap in shared symptomatology between the
disorders. Since the patterns are so discrepant, it appears that some of the Histrionic
symptomatology may have been misclassified. Furthermore, the pattern of results in this
study is consistent with the findings of Blagov and Westen (2008). The second set of
personality disorder symptomatology that was largely unsupported in this study was for
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Obsessive-Compulsive Personality Disorder. With this disorder, only one significant
association was demonstrated between RC7 and the SCID-II. There were no significant
associations between any MMPI-2-RF scale and the NEO-PI-R. A potential explanation
for the unsupported hypotheses relates to the DSM-IV diagnostic criteria. The
unanticipated associations found between the SCID-II and particular MMPI-2-RF scales,
such as THD, RC8, and PSYC-r, suggest that there is a much larger thought distortion
factor associated with OCPD. Thus, the initial hypotheses conceptualized OCPD as more
of an internalizing disorder; whereas, the results of this study suggest that OCPD may be
more appropriately labeled as a thought disorder. A related potential explanation for
the unsupported hypotheses may also be low base-rates. Most of the participants in this
study did not report significant symptoms associated with OCPD.
As noted in Table 6, the results of this study also demonstrated some unexpected
associations between the MMPI-2-RF scales and the criterion measures for several of the
personality disorders, including: Paranoid, Schizotypal, Borderline, and Avoidant
Personality Disorder. Thus, these unexpected associations occur across all three clusters
of personality disorders. The unanticipated associations (e.g., EID, RCd, RC7, ANP, &
NEGE-r) exhibited for the Cluster A personality disorders all involve scales that assess
symptoms associated with general distress or demoralization and negative emotionality.
For both Clusters B and C, the unexpected associations (e.g., - RCd, COG, NFC, STW,
AXY, and NEGE-r) are related to symptoms of distress, cognitive difficulties, such as
confusion memory problems, and internalizing symptomatology, including anxiety and
worry for example.
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The results of this study suggest that Cluster A and Cluster C personality
disorders are both related to internalizing symptomatology. Further, The Cluster A and
Cluster C personality disorders demonstrate strong associations with measures of
negative emotionality in this study. Thus, it appears that individuals with Cluster A or
Cluster C personality disorders experience significant amounts of negative emotionality,
such as anxiety, worry, and stress.
In addition, Cluster B personality disorder symptoms were found to be linked
more to externalizing symptomatology, which is consistent with the criteria listed in the
DSM-IV-TR (APA, 2000). However, Borderline Personality Disorder appears to
represent a mixture of both internalizing and externalizing symptoms, which is also
consistent with the DSM criteria. Research by Krueger and colleagues (2001)
demonstrated an association between externalizing symptomatology and the construct of
Disconstraint. The results of this study suggest that individuals with Cluster B personality
disorders have a tendency to be more impulsive, act out behaviorally, and are likely to
have difficulty controlling their own behavior. Evidence in support of this notion is
demonstrated by the strong associations noted between the MMPI-2-RF scales of BXD,
RC4, RC9, and DISC-r and the NEO-PI-R, SCID-II, and BSI measures of Cluster B
symptoms.
Evaluation of the personality disorder-related diagnostic considerations
recommended by Ben-Porath & Tellegen (2008) indicated that almost every
consideration was supported in this study. Specifically, support was found for the
consideration of Antisocial Personality Disorder if an elevation on RC 4 is present. In
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addition, the recommendation to consider a personality disorder manifesting unusual
thoughts or perceptions when RC8 is elevated was demonstrated to be accurate as well.
Support was also demonstrated for the consideration that elevations on RC9 are
indicative of Narcissistic Personality Disorder. Furthermore, Ben-Porath and Tellegens
(2008) recommendation to evaluate for Dependent Personality Disorder when
Interpersonal Passivity is elevated was also supported. Elevations on the Social
Avoidance Specific Problems Scales were also associated with Avoidant Personality
Disorder, as Ben-Porath and Tellegen (2008) suggested. Also, according to Ben-Porath
and Tellegen (2008), elevations on the Disaffiliativeness Specific Problems Scales
warrant a consideration of Schizoid Personality Disorder. This recommendation was
upheld by the results of this study as well. Ben-Porath and Tellegen (2008) also provide
personality disorder-related diagnostic considerations for each of the PSY-5 scales and
each consideration was supported by the findings in this study. Thus, the results provided
support for consideration of a Cluster B personality disorder when elevations were
present on both AGGR-r and DISC-r. In addition, elevations on PSYC-r warrant a
consideration of a Cluster A personality disorder. Finally, the results also suggest that
Cluster C personality disorders should be considered when an elevation was present on
NEGE-r or INTR-r.
There were two personality disorder-related diagnostic considerations that this
study failed to support. No significant associations were found between RC3, Cynicism,
and personality disorders characterized by mistrust or hostility (i.e.Paranoid
Personality Disorder). In addition, there was no support for the association between JCP,
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41
the Juvenile Conduct Problems Scale, and Antisocial Personality Disorder. Perhaps the
association between JCP and Antisocial Personality Disorder may not be present due to
the fact that the NEO-PI-R does not assess criminal behaviors.
If replicated, the results of this study indicate that the personality disorder-related
diagnostic considerations by Ben-Porath and Tellegen (2008) are clinically useful and
empirically supported. While a majority of the considerations suggested are supported by
the results of this study, there are several associations between the criterion measures that
were not initially anticipated. More specifically, the Cluster A personality disorders
appear to be characterized by more internalizing-type symptomatology than initially
hypothesized, as significant associations were demonstrated between RC7 and Paranoid
and Schizotypal Personality Disorders, for example. In general, it appears that individuals
with personality disorder symptomatology are reporting more distress than is reflected in
the DSM-IV and the diagnostic considerations stated by Ben-Porath and Tellegen (2008).
Thus, it is likely that the unanticipated correlations found in this study reflect associated
features, rather than the core components of a given personality disorder Therefore, a
combination of the personality disorder-related diagnostic considerations (Ben-Porath &
Tellegen, 2008) plus elevations on scales assessing distress and internalizing
psychopathology is more likely to indicate the presence of a given personality disorder.
By using this combination of scale elevations, the potential exists to make test
interpretation more accurate and clinically useful.
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Limitations
The current study has several limitations. First, the DSM-IV-TR (APA, 2000)
diagnostic criteria for each personality disorder were used to develop the set of
hypotheses utilized in this study. Currently, the DSM-IV-TR (APA, 2000) is the gold
standard used by psychologists to diagnose personality disorders. Thus, the hypotheses
utilized in this study were developed based on the most prominent set of criteria
available. However, the criteria provided by the DSM are not without their own
limitations and flaws. More specifically, empirical research has suggested that there are
alternative methods of defining personality disorder symptomatology (Lynam & Widiger,
2001), such as examining symptoms on a continuum of severity, rather than a dichotomy.
Thus, there are alternative methods and criteria that may have been used to develop the
hypotheses for this study.
Another potential limitation of this study relates to the sample. This study utilized
an all- male sample and women were not included due to their small number. Previous
research has demonstrated differences between men and women with a variety of
disorders diagnoses (e.g., depression) and on a variety of different psychological
constructs (e.g., aggression). Personality disorders also appear to be consistent with this
pattern of differences between men and women as well. For example, differences
between men and women have also been noted in the DSM-IV-TR (APA, 2000)
prevalence rates of personality disorders. Men are more likely than women to be
diagnosed with Antisocial Personality Disorder (APA, 2000). It appears that the opposite
effect also exists, where women may be diagnosed with a particular personality more
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often than men. For example, research by Bornstein (1996) demonstrated that Dependent
Personality Disorder was diagnosed more often for women than men. Thus, it is unclear
as to whether the results of this study would generalize to women in the same setting.
The final potential limitation of this study also relates to the sample and
generalizability of findings. The sample utilized in this study was enrolled in treatment in
an addictions unit at a VA medical center. Individuals participating in the addictions
treatment had a variety of addictions, including alcohol, drug, and gambling addictions.
All of the participants also had Axis I conditions as well. Thus, there were tremendous
rates of comorbidity between psychological diagnoses and substance abuse and/or
dependence diagnoses, which could impact the ability of these results to generalize across
outpatient treatment settings where not all individuals receiving mental health treatment
have primary co-morbid substance abuse difficulties. In addition, the participants were
veterans of various military branches. The generalizability of the results may also be
influenced by the nature of the veteran sample as well.
Future Directions
Future research should be conducted to evaluate the link between elevated MMPI-
2-RF scales and personality disorder symptomatology using samples of women, other
outpatient samples, and samples from inpatient settings. Thus, it would be important to
replicate the findings of this study with women, as the sample in this study is all men. In
addition, it is unclear whether the results of this study would generalize to other
outpatient samples where individuals are not enrolled in addictions treatment; therefore,
future research should examine this link in outpatient settings that do not include
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addictions treatment. Replicating the results of this study in inpatient settings would also
be important for future research, as individuals in inpatient settings are likely to
experience different symptoms of psychopathology. In addition, these associations should
also be explored in forensic and medical settings, as personality pathology may impact
diagnosis and treatment planning in those particular settings.
Finally, future research should also examine the use of other criterion measures to
assess personality disorder symptomatology. The criterion measures utilized in this study
are not the only self-report or interview measures of personality disorder
symptomatology available. Research in this area could be strengthened by implementing
the use other criterion measures to examine the link between elevations on MMPI-2-RF
and personality disorder symptomatology. For example, the Dimensional Assessment of
Personality Pathology- Brief Questionnaire (DAPP-BQ; Livesley & Jackson, in press)
and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1992) are two
self-report measures that may be particularly useful in assessing personality disorder
symptomatology, as both measures were developed with a focus on Axis II symptoms. In
addition, therapist ratings of personality disorder symptomatology may also offer another
alternative method of assessment as well.
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