Mmpi Scoring Sheet

[Ermelindo Klatt]

TheMMPI was developed in the 1930s and published through the University of Minnesota in 1942 by Stuart Hathaway and Charley McKinley using visitors of patients at the University of Minnesota hospital as a base sample in both theorizing constructs of psychiatric illness and fielding the instrument. Testing is administered through 567 true or false items using a booklet with an accompanying answer sheet. The responses are then hand-scored and plotted on an X-Y graph; a separate version is used for male and female respondents.[3]

The Y-axis statistically standardizes the grading received on each scale in a range of T-scores from 0 to 120. A mean score is 50, and 82% of respondents are considered the normal population falling between 30 and 70. A T-score greater than 70 indicates psychopathy in that category.

The existence of the MMPI has been concurrent with vast reforms in societal convention and increased understanding of behavioral health.[3] Likewise, the instrument has been adapted to reflect such changes. Overarching criticisms to the original test center on its disparity in addressing psychopathy in social and ethnic minorities.[1] This has been attributed to the original sample being a small group, mainly consisting of young rural Caucasian subjects from the Midwestern United States.[4] Studies have established biases in which misunderstanding or failure to identify with the content of questions culturally has led to underreporting or overreporting mental illness.[5][1]

These shortcomings led to the release of the MMPI-2 by James N. Butcher, W. Grant Dahlstrom, John R. Graham, Auke Tellegen, and Beverly Kaemme in 1989.[6] This assessment retains the original total of 567 items with the same corresponding 14 scales with the original number of questions from the test.[6] Test items were revised based upon a larger and more diverse sample size of 2600 attuned to a 6th-grade reading level.[6] Gendered differences were replaced with a nongendered standardized scoring.[6] Despite further advancements, the MMPI-2 is still the most commonly administered version and has been translated into over 40 languages.[1]

The RC scales were devised to provide a streamlined interpretation and less overlap with an increased focus on the growth in understanding within psychiatry over the past 70 years. Combinations of high-scoring categories represent distinct psychiatric constructs rather than the nebulous findings of the original clinical scales tying the patient to a specific diagnosis. Arguments also exist that this information is limited in that it categorizes the responder rather than providing data on an individual patient within a personalized spectrum of behavior.[1]

The RC scales were incorporated into the most current form of the MMPI, known as the Minnesota Multiphasic Personality Inventory-2 Revised Form, or the MMPI-2-RF, which was released in 2008 by Yossef Ben-Porath and Auke Telleger of the University of Minnesota. The MMPI-2-RF is composed of 338 items measured by 51 scales broken into 9 validity scales, 3 higher-order scales, the 9 RC scales, 23 specific problem scales, 2 interest scales, and 5 revised personality psychopathy scales.[1]

It has been suggested that while the MMPI-2-RF has many additional metrics, the reduction in question number limits the amount of information about psychiatric diseases to about 60% of the original test. There has also been considerable debate over whether the new metrics are inaccurate in detecting psychopathy.[1] In separating genuine psychopathy from attempts to feign a diagnosis for personal incentive, some studies have noted the new validity scales to be overly sensitive to overreporting symptoms to achieve a specific result. It has conversely been found that the L-r and K-r scales are particularly reliable at detecting underreporting of mental illness.[7][8] Overall, literature has supported the MMPI-2-RF in identifying the accuracy of reporting psychiatric information in those who complete it.[1]

The MMPI maintains an enduring presence in the field of mental health, and its current adaption has been widely evaluated by the standard of modern behavioral health practices.[1] It continues to receive widespread application as a threshold of determining the presence of psychopathy, as a means of constructing a differential diagnosis for mental health problems, and as a versatile test to achieve transferrable psychological data. These data points indicate a category, which gives behavioral health professionals a starting point to explore plausible diagnoses and initiate appropriate treatment. Completion may also offer therapeutic benefits to patients in reflecting upon their issues and improving personal understanding of their psychology.[3]

In addition to its predominant clinical application, an extensive body of research exists to assess the MMPI in all its versions for the use in criminology, population studies, and prediction of aptitude in a particular role. Several studies on the MMPI-2-RF have compared those with a criminal history to those who have undergone rehabilitation and found that high scores on externalizing scales were predictive of violent behavior.[9] The MMPI-2-RF has also been used to prescreen applicants for law enforcement to obtain baseline mental health or flagging for aggressive tendencies.[1][10] There has also been usage evaluating parenting suitability in custody battles over children and in predicting the course of domestic disputes in couples.[11][12] Interpretations of the test have also been used to establish criminal intent in defendants.[1][9]

A major consensus of the MMPI in its current form is that increased accessibility for being tested improves retention without compromising outcomes. Prevailing criticisms of the original format were the extensive span of questioning and difficulty of paper administration for both completion and grading, with efforts to provide a more efficient medium well-documented since the 1980s.[13] When evaluating the use of tablet devices compared to conventional forms of electronic administration using a home computer or laptop for taking the MMPI-RF-2, the difference in reliability of results between the two mediums was insignificant.[14] There have also been motions to use the MMPI-2-RF to assess psychopathy utilizing an algorithm using a high score on a higher-order scale and then tailoring the remaining assessment to similar questions to the indicated higher order.[15] To aid in administration to pediatric patients, an adolescent form exists known as the Minnesota Multiphasic Personality Inventory-Adolescent-Restructured Form (MMPI-A-RF).[16]

The completion of the MMPI holds value in determining care throughout a variety of treatment considerations. The test should be administered by a licensed psychotherapist, usually a psychiatrist or clinical psychologist, with informed consent obtained by discussing the risks and benefits of completion. Analysis of the results by the psychotherapist interpreting scoring should be attached with a working diagnosis to assess for treatment response. The presence of conditions associated with high-scoring categories will ultimately guide the necessity for pharmacological or non-pharmacological treatment options. This will, in turn, outline the need for referral to appropriate mental healthcare, from continuing outpatient follow-up to institutionalization with fully-staffed nursing and rehabilitative care. Transfer of care should involve appropriate discussion of MMPI data correlated with a summary of interventions. High-scoring in concerning scales such as suicidality highlights an existing need for acute observation or placement. The validity of symptoms should also be corroborated to demonstrate whether a patient is malingering or suffering from organic disorders requiring medical management by a treatment team. The bio-ethical implications of the MMPI should also be identified if the patient is completing the test in concurrence or stipulation with legal charges, and they should be counseled on what findings might hold concerning criminality. The basis for the use of test data in determining adherence has also been documented in a sample consisting of 471 psychiatric patients, with externalizing scales predictive of whether a patient will be more likely to terminate treatment.[1] [Level 3] This illustrates the need for multi-level involvement in facilitating outreach and patient compliance.

The MMPI can be a valuable tool in assessing the psychological status of a patient. It will be ordered by a psychologically trained clinician but can provide crucial information to many members of the interprofessional healthcare team, including family clinicians, psychologically trained nursing staff, social workers, and counselors. Specifics regarding its use will vary depending on the clinical situation, and it needs to be part of a more complete evaluation to help direct therapeutic interventions and drive optimal patient outcomes. [Level 5]

In May 1999, Dr. G. Douglas Talbott stepped down as president of the American Society of Addiction Medicine (ASAM) down as a jury awarded Dr. Leonard Masters a judgment of $1.3 million in actual damages and an undisclosed sum in punitive damages for malpractice, fraud, and false imprisonment. The fraud finding required that the errors in the diagnosis were intentional.

Changes were made; not to the treatment protocol but to the medical record. In order to prevent future malpractice suits for intentional fraud and false imprisonment they would make certain the medical records supported the diagnosis using a variety of tactics including cherry picking, suppression of specific information and deliberate avoidance of key facts, unprovable and un-disprovable statements, and a lot of illogical incomprehensible jabber all designed to make the data fit the diagnosis.

In 2008 I was asked to have an evaluation at Talbott by the Massachusetts PHP. Like Masters I expected a fair evaluation. The evaluation was because of a positive urinalysis for the metabolite of a medication I was taking and there were no other issues. I brought with me a letter from the manufacturer of the medication I was taking stating that it was manufactured from the substance found in my urine. In addition I had two forensic toxicology tests done (fingernail and hair) by an independent lab. My work performance and bedside manner had always been rated as superb. In my 13 years at Harvard Medical School and 10 at Massachusetts General Hospital I had never had or even been threatened with malpractice. And if you talked to any of my supervisors, coworkers, nurses, students or patients they would have nothing negative to say.

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