Chapter 8: MCMI

• MCMI


  Standardized, self-report questionnaire that assesses a wide range of information related to a client's personality, emotional adjustment, and attitudes toward taking tests
• MCMI


  • Designed for adults (18 years and older)
  • Have a minimum of an eight-grade level
• Scales of the MCMI III

  • Modifying indices
  • Clinical personality patterns
  • Severe personality pathology
  • Clinical syndromes
  • Severe syndromes
• The scales, along with the items that comprise the scales, are closely aligned to both Millon's theory of personality and the DSM-IV
• Many of the scales have both theoretical and item overlap—an important fact to keep in mind when conceptualizing the client and interpreting the scales
• MCMI


  Alternative or even a competitor to the MMPI
• MMPI


  Focuses primarily on Axis I disorders
• MCMI


  Specifically designed to assist in diagnosing Axis II disorders
• MCMI is shorter than the MMPI-2 (175 vs. 567 items) and yet provides a wide range of information
• The MCMI takes only 20 to 30 minutes to complete; however, the research base, validity studies, and options for interpretations are clearly more extensive for the MMPI than for the MCMI
• Neither instrument should be considered to provide diagnosis
• Tests (or computer reports) don't diagnose (or make decisions); only practitioners can perform this function
• The MCMI is intended for psychiatric populations and should not be used with normal persons or those who are merely mildly disturbed
• Interpretations should be restricted to persons who scored at or above the designated cutoff scores (75 and 85)
• History and Development of the MCMI

  1. Initial form developed in 1972: the Millon–Illinois Self-Report Inventory (MI-SRI)

  2. Renamed the Millon Clinical Multiaxial Inventory

  3. Formal development used a combination of rational theory-based, as well as empirical, procedures
• Development of the MCMI-II

  1. Motivated by a need to incorporate additional research and theory on personality disorders while remaining aligned with the criteria outlined in DSM-III and DSM-III-R

  2. Two new scales added: Passive-Aggressive, Self-Defeating
• Development of the MCMI-III


  1. Provisional 325-item test developed

  2. Depressive and PTSD scales added

  3. Self-Defeating and Sadistic Personality Disorder scales maintained, although these diagnoses were eliminated from the DSM-IV
• Millon's theories of personality

  • Use of the polarities of pleasure-pain, active-passive, and self-other
  • Relate to the fundamental evolutionary tasks of each person in that they must struggle to exist/survive (pleasure-pain), use various efforts to adapt to their environment or adapt their environment to themselves (passive-active), and invest in other people as well as themselves (other-self)
• The personality styles are not mutually exclusive
• Personality "style" vs. personality "disorder"

  • If a person can find an appropriate niche where the expression of his or her personality style is not dysfunctional, that person should not be considered "disordered"
  • If there is no or little distress or impairment, a personality disorder should not be diagnosed
• The different categories of scales (Clinical Personality Patterns, Severe Personality Pathology, Clinical Syndrome, Severe Syndrome) are conceptually and clinically related
• Clinical Personality Patterns and Severe Personality Pathology scales

  Relate to Axis II diagnoses but are separated to designate the greater levels of severity for the schizotypal, borderline, and paranoid conditions
• Clinical Syndrome and Severe Syndrome scales

  Intended to measure the type and level of distress and thus relate more to Axis I levels of diagnoses
• This difference underlies the essential interrelationship between Axis I and Axis II diagnoses
• Reliability and validity of the MCMI


  • Measures of internal consistency have been particularly strong
  • Test-retest reliabilities have been moderate to high
  • Personality scales theoretically represent enduring, ingrained characteristics and should have greater stability than the clinical scales, which are based on more changeable symptomatic patterns
• One central issue when evaluating the validity of the MCMI is the extent to which validity studies on previous versions can be generalized to the newer versions
• Assets of the MCMI

  • Time-efficient test that potentially produces a wide range of information
  • Focuses not only on clinical symptomatology (Axis I), but also on the more enduring and potentially more problematic personality disorders (Axis II)
• Limitations of the MCMI

  • Some of the diagnostic criteria incorporated into the MCMI items are closely tied to the DSM criteria, whereas others are more closely linked to Millon's theories
  • Difficulty in distinguishing state and trait
  • Extensive item overlap between some scales
  • Potential for overdiagnosis and overpathologizing
  • Does not perform well on normal or only mildly disturbed populations
  • Tends to emphasize a client's deficiencies without balancing these out with the client's strengths
  • Performs poorly when assessing persons with psychotic disorders
• Effective interpretation of the MCMI requires considerable sophistication and knowledge related to psychopathology in general and personality disorders in particular
• The MCMI does not provide DSM-IV diagnosis; it should be used only with clinical populations; it is not particularly helpful in assessing a person's strengths; and there is a possibility that it might overdiagnose personality disorders and be overinterpreted by clinicians
• One consideration in interpreting the MCMI is the possible influence of gender, age, and ethnicity
• Interpretation Procedures for the MCMI

  1. Determine Profile Validity

  2. Interpret the Personality Disorder Scales

  3. Interpret Clinical Syndrome Scales

  4. Review Noteworthy Responses (Critical Items)

  5. Provide Diagnostic Impressions

  6. Elaborate on Treatment Implications and Recommendations
• Modifying Indices (Validity Scales)


  • Adequate at detecting random responding, fake bad, and fake good profiles
  • Fake bad profiles are more accurately detected than fake good (defensive) profiles
• Validity Index (Scale V)


  Composed of three items that, if endorsed as true, indicate absurd responses and strongly suggest random responding
• Disclosure Index (X)


  • Measures whether a client's responses were open and revealing as opposed to defensive and secretive
  • MCMI-III raw score below 34 indicates defensive underreporting of psychopathology
  • MCMI-III raw score above 178 indicates extensive exaggeration of symptoms
• Desirability Index (Y)


  • Measure of defensive responding
  • Scores above BR 75 indicate the individual has presented in an unusually moral, interpersonally attractive, emotionally stable, gregarious, organized, and rule-abiding manner
• Debasement Index (Z)


  Reflects the extent to which a person is describing himself or herself in negative, pathological terms
• Schizoid Personality Disorder (Scale 1)


  • Core characteristic is little or no interest in other people
  • Detached, impersonal, withdrawn, unsociable, seclusive, passive, and distant, with few, if any, friends
  • Interpersonal distance is not based on a defense stemming from fear of rejection but is their natural and most comfortable way of functioning
  • An asset is that they typically do not become particularly disturbed by anything
• Frequent Code Types for Schizoid

  • Anxiety
  • Thought Disorder
  • Avoidant
  • Passive-Aggressive (Negativistic)
  • Dependent
  • Compulsive
• Treatment Implications for Schizoid


  The two major goals are to help the client develop greater interpersonal skills and to increase their motivation to become more socially involved