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An Overview of the Millon Clinical Multiaxial Inventory Third EditionResearch Paper

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Accurately assessing individual personality represents a challenging enterprise in any setting, but there are some useful tools that can facilitate the process, including most especially the Millon Clinical Multiaxial Inventory Third Edition (MCMI-III). This instrument has proven its efficacy for diagnoses, treatment planning and formulating clinical interventions (Grossman, 2004). To determine the facts, this paper provides a review of the relevant literature concerning the MCMI-III to describe the construction of this instrument and how it is typically used to evaluate personality followed by a summary of the research and important findings concerning this instrument in the conclusion.

PERSONALITY ASSESSMENT: EXPLORING THE THEORETICAL BASIS OF THE MCMI-III

This paper reviews the relevant literature concerning the Millon Clinical Multiaxial Inventory Third Edition (MCMI-III), including the construction of this widely used instrument and how it is typically applied in clinical and other settings to evaluate personality. Finally, a summary of the research and important findings concerning this instrument are presented in the conclusion.

Description of the construction of the MCMI-III

Today, the MCMI-III is a widely used tool for evaluating personality in both forensic and clinical settings (Loinaz & Ortiz-Tallo, 2012). According to Grossman (2004), "The instrument possesses multiple levels of information regarding the structure of personality that is accessible via rational and empirical means" (p. xiii). The MCMI-III has been constructed to be closely aligned with the multiaxial structure of the Diagnostic and Statistical Manual of Mental Disorders -- 4th Edition and is based on a sophisticated theory of personality (Grossman, 2004). In this regard, Rossi, Van den Brande, Tobac, Sloore and Hauben (2003).report that, "[D]iagnostic systems are more useful if based on a comprehensive clinical theory. The MCMI-III is an example of such an instrument: each scale is derived from Millon's 'evolutionary theory'" (p. 330). According to Livesley (2002), Millon's evolutionary theory provide a useful framework in which personality development can be assessed and interventions formulated if needed. In this regard, Livesley advises that, "Millon's evolutionary theory posits a content-free dimension which specifies a major pathway along which various personality styles develop and change" (p. 57).

According to Janowski (2002), Millon used a three-stage approach for validate the scales used in the MCMI-III: (a) theoretical -- substantive, (b) internal -- structural, and (c) external -- criterion. Consequently, Janowski notes that this three-stage validation approach was used to construct the MCMI-III, and adds that "[E]very effort was made to maximize the MCMI-III's diagnostic concordance with the DSM-IV. Therefore, its clinical utility in identifying examinees that have particular personality disorders makes it a foremost objective instrument among clinicians" (2002, pp. 23-24). In fact, studies have shown that the MCMI-III is among the most widely applied tests currently being used by mental health professionals and the instrument is also one of the most widely researched personality instruments (Gunsalus & Kelly, 2001). In addition, the MCMI-III has a high degree of test-retest stability (Janowksi, 2002).

The MCMI-III has been lauded for its efficiency in assessing personality in clinical settings as well as its strong alignment with the DSM-IV classification system (Janowski, 2002). In this regard, Janowski (2002) reports that the MCMI-III "provides a clear and accurate measure for diagnosing or evaluating personality disorders and pathological syndromes within the psychiatric population" (p. 21). At present, the primary diagnostic applications of the MCMI-III are as follows: (a) mental hospitals; (b) outpatient clinics; (c) forensic settings; (d) substance abuse evaluations; (e) correctional institutions; (f) marital counseling; (g) clinical and experimental research; and (h) treatment planning and psychotherapy (Jankowski, 2002, p. 22). The MCMI-III, though, has also been used for such esoteric research as assessing Old Order Amish outpatients (Knabb & Vogt, 2011).

Since its original construction, the MCMI-III has been updated twice (Rossi et al., 2003). The validity scales in the MCMI-III are termed modifier indices and these have been shown to strongly correlate with the clinical personality scales (Schoenberg, Dorr & Burke, 2004). The MCMI-III's scales include antisocial, aggressive-sadistic, passive-aggressive, borderline, and paranoid indices that are used to assess aggression for forensic applications (Loinaz & Ortiz-Tallo, 2012).

Beyond the foregoing applications, the MCMI-III has also been widely used for assessing personality for child custody evaluation purposes (Stolberg & Kauffman, 2015), substance abusing behaviors (Hesse, Guldager & Linneberg, 2011; Vanem, Krog & Hartmann, 2008) as well as batterer typologies (Loinaz & Ortiz-Tallo, 2012). In addition, studies using factor analyses have shown that the MCMI-III also strongly correlates on general psychopathological and dissimulation factors (Schoenberg et al., 2004). Some of the other strengths of the MCMI-III include the following: (a) the scales it uses for Axis-I disorders, (b) the inclusion of validity scales, (c) the availability of a computerized scoring system and hand-scoring templates, and (d) the coordination of a number of the instrument's personality disorder scales with Millon's theoretical model (Butcher, 2007, p. 412).

In addition, the MCMI-III has been found to be highly useful for diagnosing Axis II disorders. For instance, Wright (2012) reports that, "The MCMI-III is much more sensitive to personality disorders (Axis II) and character styles than the other measures, because it was developed to characterize how an individual approaches the world, including interpersonally" (p. 66). Likewise, the research to date also indicates that the scales used in the MCMI-III provide accurate assessment of several personality traits (Knabb & Vogt, 2011) as discussed further below.

How the MCMI-III is used to evaluate personality

According to Stolberg and Kauffman (2015), the MCMI-III is comprised of 175-items that are administered in a self-reporting format using 11 Clinical Personality Patterns scales, three Severe Personality Pathology scales, seven Clinical Syndromes scales, three Severe Syndromes scales, and four Modifying Indices for a total of 27 scales together with a validity index. The MCMI-III first 11 scales are used to evaluate Millon's Basic Personality Disorders which comprise a superset of the personality disorders listed in the DSM-IV (Beutler & Groth-Marnat, 2003). The DSM-IV eliminated the self-defeating and sadistic disorder diagnoses that were previously listed in the DSM-III -- R and included a depressive personality disorder diagnosis in the appendix (Beutler & Groth-Marnat, 2003). According to Beutler and Groth-Marnat, "Although the MCMI-I and MCMI-II adhered to the prior editions of the DSM, the MCMI-III has retained all 11 of the personality disorders rather than stay in lockstep with the DSM-IV, which lists nine personality disorders" (2003, p. 195). Consequently, the MCMI-III also lists the self-defeating and sadistic and personality disorders taken from the appendix of DSM-III -- R together with the newly added depressive personality disorder listed in the DSM-IV (Beutler & Groth-Marnat, 2003).

The Validity index (Scale V) is designed to identify random or deviant responses by asking three questions such as, "I have not seen a car in the last ten years" (item 157) that describe events that would be deemed highly unlikely among a normal population; if two or more of these validation questions are marked true, the entire test is considered invalid (Jankowski, 2002). Similarly, personality measures that are identified as having an unacceptably high level of skewness may be regarded as lacking requisite sensitivity at the higher end of the scale and this end of the scale is the most important for making clinical distinctions (Gross, 2004). According to Grossman (2004), "[T]hose scales demonstrating unacceptably high skewness will also be scrutinized" (p. 40).

Besides the validity index, the MCMI-III scales also includes modifying indices (disclosure, desirability and debasement); clinical personality patterns (schizoid, avoidant, depressive, dependent, histrionic, narcissistic, antisocial, sadistic [aggressive], compulsive, negative [passive-aggressive], and masochistic [self-defeating]); severe personality pathology (schizotypal, borderline and paranoid); clinical syndromes (anxiety disorder, somatoform disorder, bipolar, manic disorder, dysthymic disorder, alcohol dependence, drug dependence and posttraumatic stress disorder); and severe clinical syndromes (thought disorder, major depression and delusional disorder) (Janowski, 2002, p. 23).

The MCMI-III uses criterion-based referencing and a base-rate scoring approach because Millon understood that norm-referencing introduced problems for clinicians and he therefore standardized the MCMI-III using this method (Janowski, 2002). In this regard, Hesse et al. (2011) report that, "The base rate scores are a unique feature of the MCMI" (p. 174). The cut-off scores used for evaluation are adjusted by clinicians, with base rate scores of between 75 and 84 corresponding to a trait that is similar to the disorder and base rate scores of more than 85 indicating the disorder is actually present (Hesse et al., 2011).

This rationale in support of this approach is described by Janowski thusly: "Rather than anchoring cutoff scores to an invariable statistic, criterion referencing directly anchors base-rate cutoff scores to the actual prevalence rates of characteristics measured in the psychiatric population" (2002, sp. 28). Nevertheless, there remains a paucity of timely and relevant studies that have evaluated the effectiveness of the base rate scores compared to raw scores (Hesse et al., 2011).

The base-rate anchor prevalence points used in the MCMI-III include: BR 60 (the median score for the psychiatric population), BR 75 (presence of a particular characteristic measured, indicates the presence of a trait and indicates the presence of a syndrome), and BR 85 (the predominant characteristic measured as primary… [END OF PREVIEW]

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