Robert M. Gordon,Ph.D., ABPP, LLC

Summary

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The MMPI-2 Restructured Clinical scales (RC) scales rest on the common behavioral assumption that consistent items can be added to assess all psychopathologies. This may be the case for some unitary symptoms such as anxiety or anger, but not for complex diagnostic conditions such as Hysteria, Post Traumatic Stress Disorder and Borderline Personality Disorder.  These are better understood with a psychodynamic formulation. Psychodynamic theory assumes that internal conflicts and contradictions are a significant feature of many psychopathologies.  For example the new RC3 Cynicism scale is not a replacement or improvement of the MMPI-2 Hysteria scale. The RC3 scale serves as an example of a failure of the behaviorism to account for complex psychopathology. Making scales more internally consistent and distinct from each other has not produced more external validity and useful measures for many of the psychopathologies found in clinical practice.

           
   How much have we really improved the validity of the original MMPI and tests like it?  The research on the new MMPI-2 Restructured Clinical scales (RC) provides a good example of how psychology seems fixated on the behavioral assumption of psychopathology. This has limited our improvement of tests of psychopathology.  Tellegen, Ben-Porath, McNulty, Arbisi, Graham, and Kaemmer (2003) produced the Restructured Clinical scales (RC) to help improve the over all validity of the MMPI-2.  The RC scales are to serve as the distinct core elements of the original clinical scales with high internal consistency and discriminate validity.

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    The authors employed the common behavioral assumption that psychopathology can be reduced to the pure and distinct atoms of personality traits which can be reassembled into various psychopathologies. An example of such an assumption is the restructuring of the MMPI-2 Hysteria Scale into the RC3 Cynicism Scale.  The researchers removed from the Hysteria scale the demoralization items and somatic complaints items and assigned them to their own distinct scales.  That left mainly the items of naively trusting. Naiveté is an aspect of hysteria. They reversed the scoring, and it became a scale of the opposite of Naiveté, that is the RC3 scale of Cynicism.  Cynicism is neither an aspect of nor a substitute for Hysteria. The authors found that RC3 correlated with the MMPI-2 Hysteria scale  -.24 for females and -.18 for males.

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      In their validation research, the Cynicism scale (RC3) had little clinical usefulness other than being a measure of cynicism. RC3 correlated with Histrionic traits in patients .08 with men, and .05 with women. The Hysteria scale correlated with Histrionic traits was .21 with men and .12 with women. The authors concluded that further research was needed on RC3. The authors also felt that the dissolution of the Hysteria scale did not result in the loss of any meaningful information because its correlates are nearly identical to those of the Hypochondriasis scale.

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      The correlation between the Hypochondriasis scale and the Hysteria Scale with the MMPI-2 normative sample for men is .41, and for women is .53 (Butcher, J.N., Graham,J.R., Ben-Porath, Y.S., Tellegen, A., Dahlstrom, W.G., & Kaemmer, B., 2001).  They are not identical scales and Hypochondriasis and Hysteria are recognized in both the DSM-IV and ICD-10 as separate diagnoses.  

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          Graham, Ben-Porath,and McNutly (1999) found that for 89% of 319 female and 88% of 181 male outpatients who had high elevations in Hysteria scale, also had some Axis I diagnosis. This is a good indication of the sensitivity and clinical usefulness of the Hysteria scale. The RC scales are not as sensitive to psychopathology as are the MMPI-2 Clinical scales. Wallace (2005) found that the majority of client MMPI-2 profiles (56%) had fewer scale elevations on the RC scales as compared to the MMPI-2 Clinical scales. Tellegen, et al. (2003) used correlations for the RC validation research and provided no sensitivity and specificity hit rate studies.  The correlations provided for the RC scales’ validation are very low; too low for a meaningful variance in predicting in an ecologically valid context. Correlating simple measures with simple external symptoms may produce good correlations, but this tells us little of the practical utility of a scale. 

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          Dahlstrom, Welsh, and Dahlstrom (1972) stated that the items on the MMPI/MMPI-2 Hysteria scale seem mutually contradictory.  The Hysteria scale has such seemingly unrelated issues such as: somatic complaints, naiveté, denial of aggressive motives, unhappy home life and sexual conflicts. Other objective tests of psychopathology that have high internal consistency have produced scales of somatization and histrionic personality traits.  But researchers following the assumption of the need for internally consistent scales have not been able to produce a scale of conversion hysteria. This has been the case with the RC scales. 

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    For example, “At times I feel like swearing,” is an item on the Hysteria scale.  It is keyed “false.”  This item and other such subtle items, tend not to correlate with psychopathology.  This same item is also on the Lie and K scales.  It assesses defensiveness about aggressive feelings (Gordon, 1989). The repression of aggressive motives is part of the psychoanalytic formulation of hysterical neurosis (Freud 1893a, McWilliams, 1994). Scales derived from populations with functional psychopathology are likely to reflect the conflicts, symptoms and defenses within the scale.  Therefore, these scales should not necessarily have high item consistency, but rather reflect the complex of dynamics typical of the psychopathology.  

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          The restructuring of the MMPI-2 Hysteria Scale into a Cynicism Scale is based on a limited behavioral assumption of psychopathology.  Scales measuring simple symptoms such as anxiety and anger may work well within a behavioral assumption of measurement.  Many diagnoses such as Hysteria, Post Traumatic Stress Disorder and Borderline Personality Disorder are comprised of a complex of unrelated symptoms. Such complex disorders may be better understood with a psychodynamic assumption that does not insist on internal consistency. To insist that scales have internally consistent items creates a reductionism that may sacrifice external validity and clinical utility.

 

References

 Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., Dahlstrom, W. G., & Kaemmer, B. (2001). MMPI-2: Manual for administration and scoring (Revised Edition). Minneapolis: University of Minnesota Press.

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Dahlstrom, W. G., Welsh, G. S., Dahlstrom, L. E. (1972). An MMPI Handbook: Vol. I: Clinical interpretations. Minneapolis, MN: University of Minnesota Press.

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Freud, S.(1953):"On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communications.". In James Strachey (Ed. and Trans.), The Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 2, pp. 3-17). London: The Hogarth Press and The Institute of Psycho-Analysis (Original work published in 1893a).

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Gordon, R.M. (1989). Interpreting MMPI Subtle Scales as Representing Defense Mechanisms. 24th Annual Symposium on Recent Developments in the Use of the MMPI, p.12, Hawaii.

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Graham, J.R., Ben-Porath,Y.S., and McNutly,J.L. (1999) MMPI-2 Correlates for Outpatient Community Mental Health Settings. University of Minnesota Press.

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McWilliams, N. (1994). Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process.: Guilford Press. New York.

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Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi,P.A.,  Graham, J., and Kaemmer, B. (2003). The MMPI-2 Restructured Clinical (RC) Scales. Development, Validation and Interpretation. University of Minnesota Press.

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Wallace, A. L., Laura. (2005). A Comparison of the Correlational Structures and Elevation Patterns of the MMPI-2 Restructured Clinical (RC) and Clinical Scales. Assessment, 12(3), 290-294.

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