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AssessingPersonalityDisorderswiththeMMPI-2-RF®

MartinSellbom,PhDAssociateProfessor

DepartmentofPsychologyUniversityofOtago

Dunedin,NewZealand

Agenda

• IntroductiontoPersonalityDisorders• MMPI-2-RFScalesandPersonalityDisorderCriteria• MMPI-2-RFandPersonalityDisorderResearch• DSM-5AlternativeModelforPersonalityDisorders• Cases

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Cluster A

Paranoid Schizoid

Schizotypal

Cluster B

Antisocial Borderline Histrionic

Narcissistic

Cluster C

Avoidant Dependent

Obsessive-Compulsive

CurrentSystem–DSM-5SectionII• 10PDsorganizedintothreeclusters

Empirically-ValidatedConceptualModel• MappingMMPI-2-RFscalesontoPDcriteria

• Testingofhypothesesinaseriesofresearchstudies

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DiagnosticCriteriafor301.0ParanoidPersonalityDisorder

Apervasivedistrustandsuspiciousnessofotherssuchthattheirmotivesareinterpretedasmalevolent,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Suspects,withoutsufficientbasis,thatothersareexploiting,harming,ordeceivinghimorher

– Preoccupiedwithunjustifieddoubtsabouttheloyaltyortrustworthinessoffriendsorassociates– Reluctanttoconfideinothersbecauseofunwarrantedfear

thattheinformationwillbeusedmaliciouslyagainsthimorher– Readshiddendemeaningorthreateningmeaningsintobenign

remarksorevents– Persistentlybearsgrudges,i.e.,isunforgivingofinsults,injuries,

orslights– Perceivesattacksonhisorhercharacterorreputationthatarenotapparenttoothersandis

quicktoreactangrilyortocounterattack– Recurrentsuspicions,withoutjustification,regardingfidelityof

spouseorsexualpartner

ParanoidPersonalityDisorderApervasivedistrustandsuspiciousnessofotherssuchthattheirmotivesareinterpretedasmalevolent,beginningbyearlyadulthoodand

presentinavarietyofcontexts…

• Suspects,withoutsufficientbasis,thatothersareexploiting,harming,ordeceivinghimorher;– MMPI-2-RF:PSYC,RC6

• Ispreoccupiedwithunjustifieddoubtsabouttheloyaltyortrustworthinessoffriendsorassociates;Isreluctanttoconfideinothers;hasrecurrentsuspicions,withoutjustification,regardingfidelityofspouseorsexualpartner– MMPI-2-RF:PSYC,RC6,NEGE,RC7,(RC3)

• Readshiddendemeaningorthreateningmeaningsintobenignremarksorevents;Persistentlybearsgrudges,i.e.,isunforgivingofinsults,injuries,orslights;Perceivesattacksonhisorhercharacterorreputationthatarenotapparenttoothersandisquicktoreactangrilyortocounterattack– MMPI-2-RF:PSYC,AGGR,ANP(RC4,RC9)

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DiagnosticCriteriafor301.20SchizoidPersonalityDisorder

Apervasivepatternofdetachmentfromsocialrelationshipsandarestrictedrangeofexpressionofemotionsininterpersonalsettings,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Neitherdesiresnorenjoyscloserelationships,includingbeingpartofafamily– Almostalwayschoosessolitaryactivities– haslittle,ifany,interestinhavingsexualexperienceswithanotherperson– Takespleasureinfew,ifany,activities– Lacksclosefriendsorconfidantsotherthanfirst-degreerelatives– Appearsindifferenttothepraiseorcriticismofothers– Showsemotionalcoldness,detachment,orflattenedaffectivity

SchizoidPersonalityDisorder“Apervasivepatternofdetachmentfromsocialrelationshipsandarestrictedrangeofexpressionofemotionsininterpersonalsettings,beginningby

earlyadulthoodandpresentinavarietyofcontexts…”

• Neitherdesiresnorenjoyscloserelationships,includingbeingpartofafamily;Almostalwayschoosessolitaryactivities;Lacksclosefriendsorconfidantsotherthanfirst-degreerelatives– MMPI-2-RF:INTR,SAV,DSF

• Haslittle,ifany,interestinhavingsexualexperienceswithanother person; Takes pleasure in few, if any, activities– MMPI-2-RF:INTR,RC2;(LowRC9,lowACT)

• Appearsindifferenttothepraiseorcriticismofothers– MMPI-2-RF:Lookfornon-elevatedscoreonNEGE,RC7,andSHYtodifferentiatefrom

AvoidantPD

• Showsemotionalcoldness,detachment,orflattenedaffectivity– MMPI-2-RF:INTR,DSF

Note: Sellbom & Smith, 2017– potential concerns with discriminant validity

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DiagnosticCriteriafor301.22SchizotypalPersonalityDisorder

Apervasivepatternofsocialandinterpersonaldeficitsmarkedbyacutediscomfortwith,andreducedcapacityfor,closerelationshipsaswellasbycognitiveorperceptualdistortionsandeccentricitiesofbehavior,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Ideasofreference(excludingdelusionsofreference)– Oddbeliefsormagicalthinkingthatinfluencesbehaviorandisinconsistentwithsubculturalnorms(e.g.,superstitiousness,beliefinclairvoyance,telepathy,or"sixthsense";inchildrenandadolescents,bizarrefantasiesorpreoccupations)– Unusualperceptualexperiences,includingbodilyillusions– Oddthinkingandspeech(e.g.,vague,circumstantial,metaphorical,overelaborate,orstereotyped)– Suspiciousnessorparanoidideation– Inappropriateorconstrictedaffect– Behaviororappearancethatisodd,eccentric,orpeculiar– Lackofclosefriendsorconfidantsotherthanfirst-degreerelatives– Excessivesocialanxietythatdoesnotdiminishwithfamiliarityandtendstobeassociatedwithparanoidfearsratherthannegativejudgmentsaboutself

SchizotypalPersonalityDisorder“Apervasivepatternofsocialandinterpersonaldeficitsmarkedbyacutediscomfortwith,andreducedcapacityfor,closerelationshipsaswellasby

cognitiveorperceptualdistortionsandeccentricitiesofbehavior,beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Ideasofreference(excludingdelusionsofreference);Oddbeliefsormagicalthinking;Unusualperceptualexperiences,includingbodilyillusions;oddthinkingandspeech;Inappropriateorconstrictedaffect;Behaviororappearancethatisodd,eccentric,orpeculiar– MMPI-2-RF:THD,PSYC,RC8,NUC

• Suspiciousnessorparanoidideation– MMPI-2-RF:PSYC,RC6

• Lackofclosefriendsorconfidantsotherthanfirst-degreerelatives– MMPI-2-RF:SAV,INTR,RC2,DSF

• Excessivesocialanxiety– MMPI-2-RF:NEGE,RC7,SHY– DifferentiatesfromAvPDbasedonPSYC;AvPDalsolikelyhigheronSHY

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DiagnosticCriteriafor301.7AntisocialPersonalityDisorder

Thereisapervasivepatternofdisregardforandviolationoftherightsofothersoccurringsinceage15years,asindicatedbythree(ormore)ofthefollowing:

– Failuretoconformtosocialnormswithrespecttolawfulbehaviors

– Deceitfulness– Impulsivityorfailuretoplanahead

– Irritabilityandaggressiveness– Recklessdisregardforsafetyofselforothers– Consistentirresponsibility– Lackofremorse

AntisocialPersonalityDisorder”Apervasivepatternofdisregardforandviolationoftherightsofothers…”

• Failuretoconformtosocialnormswithrespecttolawfulbehaviors;Irresponsibility;Impulsivityorfailuretoplanahead;Recklessdisregardforsafetyofselforothers– MMPI-2-RF:BXD,DISC,RC4,JCP,SUB

• Deceitfulness,Conning/Manipulative– MMPI-2-RF:AGGR,RC9;lowIPP,lowSHY

• Irritabilityandaggressiveness– MMPI-2-RF:RC9,ANP,AGG

• Lackofremorse– MMPI-2-RF:AGGR,RC9,DSF;lowRC7

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DiagnosticCriteriafor301.83BorderlinePersonalityDisorder

Apervasivepatternofinstabilityofinterpersonalrelationships,self-image,andaffects,andmarkedimpulsivitybeginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Franticeffortstoavoidrealorimaginedabandonment.Note:Donotincludesuicidalorself-mutilatingbehaviorcoveredinCriterion5.– Apatternofunstableandintenseinterpersonalrelationshipscharacterizedbyalternatingbetweenextremesofidealizationanddevaluation– Identitydisturbance:markedlyandpersistentlyunstableself-imageorsenseofself– Impulsivityinatleasttwoareasthatarepotentiallyself-damaging(e.g.,spending,sex,substanceabuse,recklessdriving,bingeeating).Note:Donotincludesuicidalorself-mutilatingbehaviorcoveredinCriterion5.– Recurrentsuicidalbehavior,gestures,orthreats,orself-mutilatingbehavior– Affectiveinstabilityduetoamarkedreactivityofmood(e.g.,intenseepisodicdysphoria,irritability,oranxietyusuallylastingafewhoursandonlyrarelymorethanafewdays)– Chronicfeelingsofemptiness– Inappropriate,intenseangerordifficultycontrollinganger(e.g.,frequentdisplaysoftemper,constantanger,recurrentphysicalfights)– Transient,stress-relatedparanoidideationorseveredissociativesymptoms

BorderlinePersonalityDisorder“Apervasivepatternofinstabilityofinterpersonalrelationships,self-image,andaffects,andmarkedimpulsivitybeginningbyearlyadulthoodand

presentinavarietyofcontexts…”

• Franticeffortstoavoidrealorimaginedabandonment;Apatternofunstableandintenseinterpersonalrelationshipscharacterizedbyalternatingbetweenextremesofidealizationanddevaluation– MMPI-2-RF:EID,NEGE,RC7,FML

• Identitydisturbance:markedlyandpersistentlyunstableself-imageorsenseofself– MMPI-2-RF:NEGE,RC7,SFD

• Impulsivityinatleasttwoareasthatarepotentiallyself-damaging(e.g.,spending,sex,substanceabuse,recklessdriving,bingeeating)– MMPI-2-RF:BXD,DISC,RC4,SUB

• Recurrentsuicidalbehavior,gestures,orthreats,orself-mutilatingbehavior– MMPI-2-RF:NEGE,RCd,SUI

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BorderlinePersonalityDisorder“Apervasivepatternofinstabilityofinterpersonalrelationships,self-image,andaffects,andmarkedimpulsivitybeginningbyearlyadulthoodandpresent

inavarietyofcontexts…”

• Affectiveinstabilityduetoamarkedreactivityofmood– MMPI-2-RF:EID,NEGE,RC7,RCd,STW,AXY,ANP

• Chronicfeelingsofemptiness– MMPI-2-RF:INTR,RC2

• Inappropriate,intenseangerordifficultycontrollinganger(e.g.,frequentdisplaysoftemper,constantanger,recurrentphysicalfights)– MMPI-2-RF:NEGE,RC7,ANP,AGG

• Transient,stress-relatedparanoidideationorseveredissociativesymptoms– MMPI-2-RF:THD,PSYC,RC8,RC6

Note: Very setting dependent – forensic vs. clinical Externalizing + Emotional lability vs. Psychoticism

DiagnosticCriteriafor301.50HistrionicPersonalityDisorder

Apervasivepatternofexcessiveemotionalityandattentionseeking,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing

– Uncomfortableinsituationsinwhichheorsheisnotthecenterofattention

– Interactionwithothersisoftencharacterizedbyinappropriatesexuallyseductiveorprovocativebehavior

– Displaysrapidlyshiftingandshallowexpressionofemotions

– Consistentlyusesphysicalappearancetodrawattentiontoself

– Styleofspeechthatisexcessivelyimpressionisticandlackingindetail

– Showsself-dramatization,theatricality,andexaggeratedexpressionofemotion

– Suggestible,i.e.,easilyinfluencedbyothersorcircumstances

– Considersrelationshipstobemoreintimatethantheyactuallyare

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HistrionicPersonalityDisorder“Apervasivepatternofexcessiveemotionalityandattentionseeking,beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Isuncomfortableinsituationsinwhichheorsheisnotthecenterofattention;Interactionwithothersisoftencharacterizedbyinappropriatesexuallyseductiveorprovocativebehavior;Consistentlyusesphysicalappearancetodrawattentiontoself– MMPI-2-RF:LowINTR,lowRC2,lowSHY,lowSAV

• Displaysrapidlyshiftingandshallowexpressionofemotions– MMPI-2-RF:NEGE,RC7

• Hasastyleofspeechthatisexcessivelyimpressionisticandlackingindetail;Showsself-dramatization,theatricality,andexaggeratedexpressionofemotion;Considersrelationshipstobemoreintimatethantheyactuallyare– MMPI-2-RF:RC9,ACT,lowSAV

• Issuggestible,i.e.,easilyinfluencedbyothersorcircumstances– MMPI-2-RF:LowRC3

DiagnosticCriteriafor301.81NarcissisticPersonalityDisorder

Apervasivepatternofgrandiosity(infantasyorbehavior),needforadmiration,andlackofempathy,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Hasgrandiosesenseofself-importance(e.g.,exaggeratesachievementsandtalents,expectstoberecognizedassuperiorwithoutcommensurateachievements)– Preoccupiedwithfantasiesofunlimitedsuccess,power,brilliance,beauty,orideallove– Believesthatheorsheis"special"anduniqueandcanonlybeunderstoodby,orshouldassociatewith,otherspecialorhigh-statuspeople(orinstitutions)– Requiresexcessiveadmiration– Hasasenseofentitlement,i.e.,unreasonableexpectationsofespeciallyfavorabletreatmentorautomaticcompliancewithhisorherexpectations– Interpersonallyexploitative,i.e.,takesadvantageofotherstoachievehisorherownends– Lacksempathy:isunwillingtorecognizeoridentifywiththefeelingsandneedsofothers– Oftenenviousofothersorbelievesthatothersareenviousofhimorher– Showsarrogant,haughtybehaviorsorattitudes

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NarcissisticPersonalityDisorder“Apervasivepatternofgrandiosity(infantasyorbehavior),needforadmiration,andlackofempathy,beginningbyearlyadulthoodandpresentina

varietyofcontexts…”

• Hasagrandiosesenseofself-importance(e.g.,exaggeratesachievementsandtalents,expectstoberecognizedassuperiorwithoutcommensurateachievements);Believesthatothersareenviousofhim/her

– MMPI-2-RF:AGGR,RC9,lowSFD

• Ispreoccupiedwithfantasiesofunlimitedsuccess,power,brilliance,beauty,orideallove;Believesthatheorsheis"special"anduniqueandcanonlybeunderstoodby,orshouldassociatewith,otherspecialorhigh-statuspeople(orinstitutions)

– MMPI-2-RF:PSYC

• Requiresexcessiveadmiration;Isoftenenviousofothers– MMPI-2-RF:NEGE,RC7,SFD

• Hasasenseofentitlement;Isinterpersonallyexploitative;lacksempathy– MMPI-2-RF:AGGR,RC9,lowIPP,AGG

• Showsarrogant,haughtybehaviorsorattitudes– MMPI-2-RF:AGGR,lowIPP

Note: Empirical data in forensic setting; more grandiose manifestations

DiagnosticCriteriafor301.82AvoidantPersonalityDisorder

Apervasivepatternofsocialinhibition,feelingsofinadequacy,andhypersensitivitytonegativeevaluation,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Avoidsoccupationalactivitiesthatinvolvesignificantinterpersonalcontact,becauseoffearsofcriticism,disapproval,orrejection

– Unwillingtogetinvolvedwithpeopleunlesscertainofbeingliked– Showsrestraintwithinintimaterelationshipsbecauseofthefearofbeingshamedorridiculed

– Preoccupiedwithbeingcriticizedorrejectedinsocialsituations– Inhibitedinnewinterpersonalsituationsbecauseoffeelingsofinadequacy– Viewsselfassociallyinept,personallyunappealing,orinferiortoothers– Unusuallyreluctanttotakepersonalrisksortoengageinanynewactivitiesbecausetheymayproveembarrassing

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AvoidantPersonalityDisorder“Apervasivepatternofsocialinhibition,feelingsofinadequacy,hypersensitivitytonegativeevaluation…”

• Hypersensitivitytocriticism;Fearofnegativeevaluationandrejection– MMPI-2-RF:NEGE,RC7,SHY

• Extremesocialwithdrawalandalienation– MMPI-2-RF:INTR,SAV,DSF

• Feelingsofinadequacyandineptitude– MMPI-2-RF:NEGE,SFD,NFC

• Emotionalindicators,suchasRCdandRC2arelikelytobecommonaswell,andsupportedbydata• NEGEshouldbeviewedasdifferentiatingAvPDfromSchizoidPD

DiagnosticCriteriafor301.6DependentPersonalityDisorder

Apervasiveandexcessiveneedtobetakencareofthatleadstosubmissiveandclingingbehaviorandfearsofseparation,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Difficultymakingeverydaydecisionswithoutanexcessiveamountofadviceandreassurancefromothers– Needsotherstoassumeresponsibilityformostmajorareasofhisorherlife– Difficultyexpressingdisagreementwithothersbecauseoffearoflossofsupportorapproval.– Difficultyinitiatingprojectsordoingthingsonhisorherown(becauseofalackofself-confidenceinjudgmentorabilitiesratherthanalackofmotivationorenergy)– Goestoexcessivelengthstoobtainnurturanceandsupportfromothers,tothepointofvolunteeringtodothingsthatareunpleasant– Feelsuncomfortableorhelplesswhenalonebecauseofexaggeratedfearsofbeingunabletocareforhimselforherself– Urgentlyseeksanotherrelationshipasasourceofcareandsupportwhenacloserelationshipends– Unrealisticallypreoccupiedwithfearsofbeinglefttotakecareofhimselforherself

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DependentPersonalityDisorder“Apervasiveandexcessiveneedtobetakencareofthatleadstosubmissiveandclingingbehaviorandfearsofseparation,beginningbyearly

adulthoodandpresentinavarietyofcontexts…”

• Hasdifficultymakingeverydaydecisions;needsotherstoassumeresponsibilityformostmajorareasofhisorherlife;goestoexcessivelengthstoobtainnurturanceandsupportfromothers

– MMPI-2-RF:LowAGGR,NFC,IPP

• Hasdifficultyexpressingdisagreementwithothersbecauseoffearoflossofsupportorapproval– MMPI-2-RF:LowAGGR;highNEGE,RC7,SHY,IPP

• Feelingsofinadequacy– MMPI-2-RF:LowAGGR;highNEGE,SFD

• Feelsuncomfortableorhelplesswhenalone;isunrealisticallypreoccupiedwithfearsofbeinglefttotakecareofhimselforherself

– MMPI-2-RF:NEGE,RC7,HLP,NFC,BRF

• LookforIntroversionindicators(INTR)aspotentialfordifferentialdiagnosisforAvPD• Emotionalindicators,suchasEID,RCdarelikelytobecommonaswell

Diagnosticcriteriafor301.4Obsessive-CompulsivePersonalityDisorder

Apervasivepatternofpreoccupationwithorderliness,perfectionism,andmentalandinterpersonalcontrol,attheexpenseofflexibility,openness,andefficiency,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Preoccupiedwithdetails,rules,lists,order,organization,orschedulestotheextentthatthemajorpointoftheactivityislost– Showsperfectionismthatinterfereswithtaskcompletion(e.g.,isunabletocompleteaprojectbecausehisorherownoverlystrictstandardsarenotmet)– Excessivelydevotedtoworkandproductivitytotheexclusionofleisureactivitiesandfriendships(notaccountedforbyobviouseconomicnecessity)– Overconscientious,scrupulous,andinflexibleaboutmattersofmorality,ethics,orvalues(notaccountedforbyculturalorreligiousidentification)– Unabletodiscardworn-outorworthlessobjectsevenwhentheyhavenosentimentalvalue– Reluctanttodelegatetasksortoworkwithothersunlesstheysubmittoexactlyhisorherwayofdoingthings– Adoptsamiserlyspendingstyletowardbothselfandothers;moneyisviewedassomethingtobehoardedforfuturecatastrophes– Showsrigidityandstubbornness

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Obsessive-CompulsivePersonalityDisorder“Apervasivepatternofpreoccupationwithorderliness,perfectionism,andmentalandinterpersonalcontrol,attheexpenseof

flexibility,openness,andefficiency…”

• Ispreoccupiedwithdetails,rules,lists,order,organization,orschedulestotheextentthatthemajorpointoftheactivityislost;Showsperfectionismthatinterfereswithtaskcompletion

– MMPI-2-RF:LowDISC,lowRC4,RC7,COG

• Isexcessivelydevotedtoworkandproductivitytotheexclusionofleisureactivitiesandfriendships– MMPI-2-RF:SAV,DSF

• Isoverconscientious,scrupulous,andinflexibleaboutmattersofmorality,ethics,orvalues;Showsrigidityandstubbornness

– MMPI-2-RF:LowDISC,lowRC4;NEGE,RC7,NFC

• Isunabletodiscardworn-outorworthlessobjectsevenwhentheyhavenosentimentalvalue;Adoptsamiserlyspendingstyletowardbothselfandothers;Moneyisviewedassomethingtobehoardedforfuturecatastrophes

– MMPI-2-RF:RC7,NFC,STW

• Isreluctanttodelegatetasksortoworkwithothersunlesstheysubmittoexactlyhisorherwayofdoingthings

– MMPI-2-RF:NEGE,RC7,STW

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PD MMPI-2-RF Scales

Paranoid RC scales: RC3, RC6, RC7

SP scales: ANP, AGG

PSY-5 scales: AGGR-r, PSYC-r, NEGE-r

Schizoid RC scales: RC2, RC9(-)

SP scales: SAV, DSF, ACT(-)

PSY-5 scales: INTR-r

Schizotypal H-O scales: EID, THD

RC scales: RC2, RC6, RC7, RC8

SP scales: NUC, STW, SAV, SHY, DSF

PSY-5 scales: PSYC-r, NEGE-r, INTR-r

Antisocial H-O scales: BXD

RC scales: RC4, RC7(-), RC9

SP scales: ANP, JCP, SUB, AGG, IPP(-), SHY(-), DSF

PSY-5 scales: AGGR-r, DISC-r, NEGE-r(-)

Borderline H-O scales: EID, THD, BXD

RC scales: RCd, RC2, RC4, RC6, RC7, RC8

SP scales: SUI, SFD, STW, AXY, ANP, SUB, AGG, FML

PSY-5 scales: PSYC-r, DISC-r, NEGE-r

PD MMPI-2-RF Scales

Histrionic RC scales: RC2(-), RC3(-), RC7, RC9

SP scales: ACT, SAV(-), SHY(-)

PSY-5 scales: NEGE-r, INTR-r(-)

Narcissistic RC scales: RC7*, RC9

SP scales: SFD*, NFC*, AGG, IPP(-)

PSY-5 scales: AGGR-r, PSYC-r, NEGE-r*

Avoidant H-O scales: EID

RC scales: RCd, RC2, RC7

SP scales: SFD, NFC, SAV, SHY, DSF

PSY-5 scales: NEGE-r, INTR-r

Dependent H-O scales: EID

RC scales: RCd, RC7

SP scales: HLP, SFD, NFC, BRF, IPP, SHY

PSY-5 scales: AGGR-r(-), NEGE-r

Obsessive-

Compulsive

RC scales: RC2, RC4(-), RC7, RC9(-)

SP scales: COG, NFC, STW, SAV, DSF

PSY-5 scales: DISC-r(-), NEGE-r, INTR-r

SummaryofResearchFindings

Note:Boldscaleshavebeenconfirmedinonestudy;Boldanditalicizedin2+studies;(-)=lowscoresexpected

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StayTuned:PersonalityDisorderSpectraScales

• Sellbom,Waugh,and Hopwood(2018)

• NotyetavailableontheMMPI-2-RF

• Promisingvalidity&incrementalvalidityoverthePSY-5

DSM-5ALTERNATIVEMODELOFPERSONALITYDISORDERS(AMPD)

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DSM-5AlternativeModelofPersonalityDisorders

• ListedinSectionIIIinDSM-5

• CriterionA:Impairment

• CriterionB:Personalitytraits

• PersonalityDisorderTypes:Antisocial,Avoidant,Borderline,Narcissistic,Obsessive-Compulsive,andSchizotypal– PersonalityDisorder:TraitSpecified

DSM-5AMPD–TraitModel• Negativeaffectivity

– EmotionalLability– Perseveration– Anxiousness– SeparationInsecurity– Submissiveness– Hostility*– Suspiciousness*– Depressivity*– (Lackof)RestrictedAffectivity*

• Detachment– RestrictedAffectivity*– Anhedonia– Depressivity*– Withdrawal– IntimacyAvoidance– Suspiciousness*

• Antagonism– Manipulativeness– Deceitfulness– Callousness– Grandiosity– AttentionSeeking– Hostility*

• Disinhibition– (Lackof)RigidPerfectionism– Impulsivity– Irresponsibility– Distractibility– RiskTaking

• Psychoticism– PerceptualDysregulation– Eccentricity– UnusualThoughtsorBeliefs

* Facet is conceptually associated with multiple domains

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DSM-5AMPDandMMPI-2-RF

• Similarideatowhatisjustdescribed

• PSY-5domainsshouldbeusedasanchors

– OtherMMPI-2-RFscalescanbeusedtofurtherdelineate

– Researchsupport,e.g.,

• Anderson,Sellbometal.(2013)

• Anderson,Sellbometal.(2015)

• Sellbom,Anderson,&Bagby(2013)

Assessment20(3) 286 –294© The Author(s) 2012Reprints and permissions: sagepub.com/journalsPermissions.navDOI: 10.1177/1073191112471141asm.sagepub.com

It has long been recognized that the current model for per-sonality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000) is problematic (e.g., Clark, 2007; Livesley, 2001; Watson, Clark, & Chmielewski, 2008; Widiger & Mullins-Sweatt, 2010). Since the advent of the DSM-III, researchers have noted that the APA has not fully considered empirical work conducted by clinical and per-sonality researchers regarding dimensional models of per-sonality, and have instead continued to use a model guided by clinical impressions and categorizations (Schroeder, Wormworth, & Livesley, 1992). The limitations of this model include (but are not limited to) inadequate coverage of personality psychopathology variance, excessive diag-nostic comorbidity, excessive within-diagnosis heterogene-ity, diagnostic rubrics that do not resemble empirically driven factor structures, marked temporal instability, a lack of clear boundary between normal and pathological person-ality, and poor convergent and discriminant validity across

diagnostic categories (see, e.g., Clark, 2007; Skodol et al., 2011; Widiger & Trull, 2007, for reviews). For this reason, many investigators have developed alternative models and approaches to assessing personality psychopathology that circumvent many of the above-referenced limitations (see, e.g., Oldham & Skodol, 2000; Trull & Durrett, 2005; Tyrer & Johnson, 1996; Westen & Shedler, 2000; Widiger, Lives-ley, & Clark, 2009).

471141 ASM20310.1177/1073191112471141AssessmentAnderson et al.© The Author(s) 2011

Reprints and permissions:sagepub.com/journalsPermissions.nav

1University of Alabama,Tuscaloosa,AL, USA2University of Toronto,Toronto, Ontario, Canada3Center for Addiction and Mental Health,Toronto, Ontario, Canada4Kent State University, Kent, OH, USA5University of Iowa, Iowa City, IA, USA6University of Minnesota, Minneapolis, MN, USA

Corresponding Author:Martin Sellbom,The University of Alabama, 348 Gordon Palmer,Tuscaloosa,AL 35487-0348, USA.Email: [email protected]

On the Convergence Between PSY-5 Domains and PID-5 Domains and Facets: Implications for Assessment of DSM-5 Personality Traits

Jaime L. Anderson1, Martin Sellbom1, R. Michael Bagby2, Lena C. Quilty3, Carlo O. C. Veltri4, Kristian E. Markon5, and Robert F. Krueger6

AbstractThe DSM-5 Personality and Personality Disorders workgroup and their consultants have developed the 220-item, self-report Personality Inventory for the DSM-5 (PID-5) for direct assessment of the proposed personality trait system for DSM-5; however, most practicing clinical psychologists will likely continue to rely on separate omnibus measures to index symptoms and traits associated with psychopathology. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is one such measure and assesses the Personality Psychopathology Five (PSY-5) domains, which are conceptual cognates of the DSM-5 trait domains. The current study examined the associations between the MMPI-2-RF PSY-5 scales and the DSM-5 trait domains and facets indexed by the PID-5. A clear pattern of convergence was found indicating that each of the PSY-5 scales was most highly correlated with its conceptually expected PID-5 counterpart (rs = .44-.67; Mdn r = .53) and facet correlations generally showed the same pattern. Similarly, when each of the PSY-5 scales was regressed onto the PID-5 domains, the conceptually expected pattern of associations emerged even more clearly. Finally, a joint exploratory factor analysis with the PSY-5 and PID-5 trait facet scales indicated a five-factor solution that clearly resembled both of the PSY-5/DSM-5 trait domains. These results show clear evidence that the MMPI-2-RF has utility in the assessment of dimensional personality traits proposed for the upcoming DSM-5.

Keywordspersonality disorders, DSM-5, MMPI-2-RF, PSY-5

Article

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ThePSY-5andDSM-5AMPDTraitsPSY-5 DSM-5SectionIIIdomains

Aggressiveness Antagonism

Psychoticism Psychoticism

Disconstraint Disinhibition

NegativeEmotionality/Neuroticism

NegativeAffectivity

Introversion/LowPositiveEmotionality Detachment

PSY-5 & PID-5 Domain Correlations Anderson, Sellbom, Bagby, Quilty, Veltri, Markon, & Krueger, 2013

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Assessment20(6) 709 –722© The Author(s) 2013Reprints and permissions: sagepub.com/journalsPermissions.navDOI: 10.1177/1073191113508808asm.sagepub.com

Article

The Diagnostic and Statistical Manual for Mental Disorders, text revision (DSM-IV-TR; American Psychiatric Association [APA], 2000) provides diagnostic criteria for each of the 10 personality disorders (PDs) that appear in the main text of the manual. The method of diagnosis uses a polythetic, categorical approach in which a specified num-ber of pathological personality symptoms or traits from a larger list of symptoms must be present to indicate a PD diagnosis. For example, to confer the diagnosis of Borderline PD, at least five symptoms/traits from a list of nine must be present. The problems and rather significant shortfalls of this PD diagnostic system are well documented and widely recognized (see, e.g., Clark, 2007; Widiger & Mullins-Sweatt, 2010); problems include (but are not limited to) excessively high rates of comorbidity with other PDs, inad-equate coverage of personality pathology, extensive within-diagnosis heterogeneity, poor convergent and discriminant validity of measurement tools designed to assess PDs, marked temporal instability, and poor scientific research base for many disorders (e.g., Clark, 2007; Skodol et al., 2011; Widiger & Simonsen, 2005).

To address these concerns, many scholars have argued for the adoption of an alternative model and approach to conceptualize, assess, and diagnose PDs and a number of different models have been proposed. The proponents of most of these models argue compellingly for the use of dimensional personality traits to characterize PDs (see, e.g.,

Widiger, Simonsen, Sirovatka, & Regier, 2006). Along these lines, the DSM-5 Personality and Personality Disorders (P&PD) workgroup, charged with the task of revising or developing a new system for conceptualizing and diagnosing PDs, proposed 25 “lower order” trait-facets, which, in turn, combine into five “higher order” dimen-sional trait domains (negative affectivity, detachment, antagonism, disinhibition, and psychoticism). These 25 facet traits form the basis for the conceptualizing and assessing personality pathology in Section III (e.g., APA, 2011, 2012; Krueger, Derringer, Markon, Watson, & Skodol, 2012; Skodol, 2012). The P&PD workgroup also proposed six PDs, each based on a specific and mostly unique trait-facet profile that results in or “co-occurs” with noted impairment in self and interpersonal functioning (Skodol et al., 2011). The six PDs are Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-Compulsive, and Schizotypal. A seventh PD diagnosis is also possible—Personality Disorder–Trait Specified (PD-TS)—in which

508808 ASMXXX10.1177/1073191113508808AssessmentSellbom et al.research-article2013

1The Australian National University, Canberra, ACT, Australia2The University of Alabama, Tuscaloosa, AL, USA3University of Toronto, Toronto, Ontario, Canada

Corresponding Author:Martin Sellbom, Research School of Psychology, Building 39, The Australian National University, Canberra, ACT 0200, Australia. Email: [email protected]

Assessing DSM-5 Section III Personality Traits and Disorders With the MMPI-2-RF

Martin Sellbom1, Jaime L. Anderson2, and R. Michael Bagby3

AbstractAn alternative model for diagnosing personality disorders (PDs) appears in DSM-5 Section III. This model includes a set of dimensional personality traits, which along with impairment in personality functioning can be configured to represent one of six PDs. Although specific assessment instruments for these personality traits have already been developed (e.g., the Personality Inventory for DSM-5 [PID-5]), clinicians will likely continue to use omnibus measures of psychopathology that are familiar to them to inform diagnostic decision making. One such measure, the Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI-2-RF), will likely remain in the test armamentarium of many practitioners and be employed to assess the DSM-5 dimensional traits. In the current investigation, we examined the associations between MMPI-2-RF scale scores and the PID-5 trait scores and DSM-5 Section III PDs in a combined sample of university students (n = 668) from the United States and Canada. Our results indicated that the MMPI-2-RF scale scores mostly converge with PID-5 dimensional traits as well as the Section III PDs in a conceptually expected manner. As such, we conclude that the MMPI-2-RF is a potentially useful instrument in assessing personality psychopathology as conceptualized in DSM-5 Section III.

KeywordsMMPI-2-RF, PID-5, DSM-5, personality traits

at Australian National University on May 25, 2014asm.sagepub.comDownloaded from

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Summary• MMPI-2-RFScalescanmapontotheDSM-5AMPDtraitstructure

– GoodcorrespondenceforPSY-5àDSM-5AMPDHigher-Orderdomains– Somecorrespondencewithlower-orderfacetstructure

• Imperfectbutcaptureimportantsimilarvarianceinsomewhatdifferentways

• MMPI-2-RFscalescaptureDSM-5AMPDTrait-DefinedPDsinsimilarwaysasDSM-5SectionIIPDs– Dimensionaltrans-diagnosticscalesdirectlyrelevanttoPDsfrombothsystems

CASES

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Case1• 40-year-oldNZMaorimanseekingparole• Convictedofaggravatedmurderandaggravatedrobbery• Incarceratedfor19years

– Deniedparoleforpast9years

• Longhistoryofseverejuveniledelinquency• Numerousformalcitationsformisconductinprison• Completedseveralprograms• Improvedoverthepast5years

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Case2

• 30-year-oldWhitewomanchargedwithaDUI• Hitanothervehicleanddroveaway• Significanthistoryofphysicalandsexualabuse

– Biologicalfather(physical),stepfather(both)• Unstableromanticrelationshiphistory

– Reportsbisexual;threeofherpreviousrelationships,menandwomen,were“trueloves”

• Neverheldajobforlongerthantwoyears• Significantsuicidalideation,attempts,andhospitalizationssinceage11

– Initiallyinresponsetosexualabuse• Extensivealcoholandmarijuanausehistorysinceage18• FourpreviousconvictionsofDUI

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Case3

• Starteddrinkingalcoholandsmokingmushroomsandcocaineinuniversityinanunsuccessfulefforttomakefriends;hequitafterhewasexpelled

• Difficultemploymenthistory;beenfiredfromtwojobsbecauseoftardiness;onebecausehefailedtoadequatelyperformhisduties– Afraidofbees–havehadtoquitoutdoorjobsbecauseofbees

• Interviewinformation– Generallycomfortableexceptwhendiscussinglackoffriendshipsandisolation– Veryfidgetyduringinterview– Deniedcurrentsuicidalideation

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Score Report

MMPI-2-RF®

Minnesota Multiphasic Personality Inventory-2-Restructured Form™

Yossef S. Ben-Porath, PhD, & Auke Tellegen, PhD

Copyright © 2008 by the Regents of the University of Minnesota. All rights reserved.Distributed exclusively under license from the University of Minnesota by NCS Pearson, Inc. Portions reproduced from theMMPI-2-RF test booklet. Copyright © 2008 by the Regents of the University of Minnesota. All rights reserved. Portionsexcerpted from the MMPI-2-RF Manual for Administration, Scoring, and Interpretation. Copyright © 2008 by the Regents ofthe University of Minnesota. All rights reserved.MMPI-2-RF and the MMPI-2-RF logo are registered trademarks and Minnesota Multiphasic PersonalityInventory-2-Restructured Form is a trademark of the University of Minnesota. Pearson, the PSI logo, and PsychCorp aretrademarks in the U.S. and/or other countries of Pearson Education, Inc., or its affiliate(s).

TRADE SECRET INFORMATIONNot for release under HIPAA or other data disclosure laws that exempt trade secrets from disclosure.

[ 1.4 / 1 / 2.5.7 ]

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Case 3

MMPI-2-RF Validity Scales

20

100

90

80

70

60

50

40

30

K-rL-rFBS-rFsFp-rF-rTRIN-rVRIN-r

Raw Score:

Response %:

VRIN-rTRIN-rF-rFp-r

Variable Response InconsistencyTrue Response InconsistencyInfrequent ResponsesInfrequent Psychopathology Responses

6

63

100

FsFBS-rL-rK-r

Infrequent Somatic ResponsesSymptom ValidityUncommon VirtuesAdjustment Validity

1

50

100

3

68

100

8

79

100

11

50

100

13

67

100

6

45

100

3

52

100

120

110

The highest and lowest T scores possible on each scale are indicated by a "---"; MMPI-2-RF T scores are non-gendered.

Cannot Say (Raw): 0

T Score:

42Percent True (of items answered): %

---

--- ---

---

---

---

---

---

---

---

---

---

---

---

---

MMPI-2-RF® Score Report ID:00209/17/2010, Page 2

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MMPI-2-RF Higher-Order (H-O) and Restructured Clinical (RC) Scales

20

100

90

80

70

60

50

40

30

RC9RC8RC7RC6RC4RC3RC2RC1RCdBXDTHDEID

Raw Score:

T Score:

Response %:

EIDTHDBXD

Emotional/Internalizing DysfunctionThought DysfunctionBehavioral/Externalizing Dysfunction

31

79

100

RCdRC1RC2RC3RC4

DemoralizationSomatic ComplaintsLow Positive EmotionsCynicismAntisocial Behavior

RC6RC7RC8RC9

Ideas of PersecutionDysfunctional Negative EmotionsAberrant ExperiencesHypomanic Activation

5

56

100

20

79

100

6

50

100

1

48

100

10

73

100

7

57

100

1

38

100

0

43

100

3

56

100

16

73

100

8

43

100

120

110


Higher-Order Restructured Clinical

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---


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MMPI-2-RF Somatic/Cognitive and Internalizing Scales

20

100

90

80

70

60

50

40

30

NFC ANPAXYSTW MSFBRFNUCGIC HPC HLPCOG SFD

Raw Score:

T Score:

Response %:

MLSGICHPCNUCCOG

MalaiseGastrointestinal ComplaintsHead Pain ComplaintsNeurological ComplaintsCognitive Complaints

5

69

100

AXYANPBRFMSF

AnxietyAnger PronenessBehavior-Restricting FearsMultiple Specific Fears

SUIHLPSFDNFCSTW

Suicidal/Death IdeationHelplessness/HopelessnessSelf-DoubtInefficacyStress/Worry

3

58

100

2

59

100

0

42

100

0

46

100

2

100

4

76

100

2

60

100

6

64

100

3

80

100

7

81

100

3

54

100

1

42

100

2

63

100

Somatic/Cognitive Internalizing

120

110


---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

------

--- ---

---

---

---

---

---

---

---

---

---

MLS

79

SUI


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MMPI-2-RF Externalizing, Interpersonal, and Interest Scales

20

100

90

80

70

60

50

40

30

SAV MECAESACTAGGSUBJCP FML DSFIPP SHY

Raw Score:

T Score:

Response %:

FMLIPPSAVSHYDSF

Family ProblemsInterpersonal PassivitySocial AvoidanceShynessDisaffiliativeness

1

50

100

JCPSUBAGGACT

Juvenile Conduct ProblemsSubstance AbuseAggressionActivation

AESMEC

Aesthetic-Literary InterestsMechanical-Physical Interests

2

49

100

1

39

100

2

51

100

1

50

100

5

52

100

7

75

100

10

80

100

3

78

100

6

65

100

0

33

100

InterpersonalExternalizing Interest

120

110


---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---

---


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MMPI-2-RF PSY-5 Scales

20

100

90

80

70

60

50

40

30

INTR-rNEGE-rDISC-rPSYC-rAGGR-r

Raw Score:

T Score:

Response %:

AGGR-rPSYC-rDISC-rNEGE-rINTR-r

Aggressiveness-RevisedPsychoticism-RevisedDisconstraint-RevisedNegative Emotionality/Neuroticism-RevisedIntroversion/Low Positive Emotionality-Revised

5

41

100

18

87

100

15

77

100

8

54

100

1

47

100

120

110


---

---

---

---

---

---

---

---

---

---


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Thankyou!

QUESTIONS?

[email protected]

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