minnesota multiphasic personality inventory-2: an evaluation of the strengths and weaknesses of the...

Running head: MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2 1

Minnesota Multiphasic Personality Inventory-2

Tammy Daniel Coles

Walden University

MINNESOTA MULTIPHASIC PERSONALITY INVENTORY-2

Abstract

The MMPI-2 is an assessment tool that is very popular with psychologists and clinicians alike. It

is one of the most widely used assessments, but isn’t often critically evaluated in clinical

practice. It is a strong assessment tool with comprehensive empirical support, but it also has

substantial weaknesses in both research and practice that make it difficult to qualify using for the

general population. It is one of a battery of assessments that make up good clinical practice and

can be used as one of the tools to diagnose a client, but should not be used as the only tool in

practice.

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Minnesota Multiphasic Personality Inventory-2

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is the current revision of

the Minnesota Multiphasic Personality Inventory. The MMPI-2 is a clinical testing instrument

that is a 567-item self-reported personality inventory that is used in evaluation and diagnosis of

psychological conditions (Gregory, 2011). There has been a lot of debate regarding the MMPI-2

and its validity, especially in the early stages of the instrument’s development. Although the

initial Minnesota Multiphasic Personality Inventory (MMPI) was a well-developed and strictly

empirically based inventory, there was a great deal of difficulty finding a publisher for the

assessment. Despite the difficulties with the introduction of the MMPI, by 1982 the personality

inventory became the 2nd most popular psychological assessment used by clinicians. Hathaway,

McKinley & Butcher (1990) call the rise of the MMPI phenomenal, adding that a 1978 study

found that 84% of all psychological research surrounding personality used the MMPI as the

primary assessment tool (Hathaway, McKinley & Butcher, 1990).

Given all of the research and development, the more current revision of the MMPI, the

MMPI-2 has become the standard for personality assessment in clinical practice. In this paper,

we review the history, the psychometric qualities, the strengths and weaknesses of the

instrument, and how the MMPI-2 can be best used in a counseling practice. Theoretically the

MMPI-2 is one of the best testing instruments available for clinicians to establish empirically

based differential diagnoses with psychiatric clients. Although it doesn’t directly align with

diagnostic codes found in the DSM-IV TR, it is a favorite tool of clinicians worldwide. The use

of the MMPI-2 in a counseling practice to help evaluate personality disorders has become a

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professional standard in the psychological profession. That familiarity and commonality makes

the MMPI-2 a tool that needs to be researched and reviewed. Often times, when something in a

professional field of study becomes standard and familiar, it is no longer subject to the critical

evaluation that newer assessments face. The goal of this paper is to further critical evaluation of

the MMPI-2 in an effort to limit professional acquiescence related to using familiar assessments

blindly in a clinical practice.

MMPI-II History

The MMPI-2 is the 1989 revision of the original MMPI. The original MMPI was

developed to provide a self-report method for assessing psychopathology (Maruish, 2004).

Published in 1943 by Stark Hathaway and J.C. McKinley, the MMPI quickly became one of the

top 20 assessments used in professional practice (Hathaway, McKinley & Butcher, 1990). The

original personality inventory consisted of 566-item true-false questions and measured 10

clinical scales (Gregory, 2011). Amongst those scales, Drayton (2009) suggests that the real

purpose of the assessment was to help distinguish those with psychiatric conditions from the

“normals” by creating scales of normalcy (Drayton, 2009). The original MMPI assessment faced

a great deal of criticism, because the initial control group consisted only of relatives and visitors

to medical patients at the University of Minnesota Hospital. All of the control subjects were

White/Caucasian, young (approx. average age 35), married and from a small town or rural area

in Minnesota (Gregory, 2011). Although the control group was large enough to be a valid

sample (724 subjects), the lack of diversity or homogenization in the sample demonstrates a

major weakness in the validity of the test. The chosen sample was clearly not representative of

the general population in the United States.

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Another issue with the MMPI that raised concern was the individual item content of the

assessment. Gregory conveys that there were many obsolete archaic and offensive terms used in

the original assessment. There were references to games and slang terminology that is not

familiar in modern times. The MMPI also included sexist language and many Christian religious

references that were sources of lawsuits and privacy concerns when administered to modern

subjects (Gregory, 2011).

In 1989, the revised and standardized MMPI-2 was released. The revision worked to

correct many of the weaknesses of the original assessment including eliminating some scales and

updating the item content. The goal of the revision was to make the assessment stronger without

sacrificing the original empirical strength. According to Maurish, the major change with in the

items on the MMPI-2 was the deletion of 13 items that contained objectionable or outdated

content. Another change that Maurish discusses is the new content scales that were developed for

the MMPI-2. The new scales were devised in order to offer clinicians an empirical and rational

scale to help standardize test interpretation (Maruish, 2004). Drayton provides further support

for this interpretation change and concludes that the MMPI-2 revision has limited clinician’s

assumptions in favor empirically supported interpretation guidelines (Drayton, 2009). By

reducing or eliminating result assumptions, scoring the assessment could become more

standardized and hence empirically stronger.

Psychometric Qualities

In terms of standardization, reliability, and validity, The MMPI-2 has been thoroughly

investigated. The MMPI-2 consists of 567 true/false items. The inventory is a self-report

measure of an individual’s psychopathology. The assessment has nine validity scales built in.

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These scales assess for lying, defensiveness, and faking good or bad answers. There is also a

symptom validity scale designed to exclude symptom exaggeration and reduce false-positive

rates. Drayton points out that these scales make it very difficult for results to be faked (Drayton,

2009). Helmes (2008) on the other hand, is concerned about the underreporting of skipped items

on the inventory and issues of acquiescence. He points out that there is a great deal of research

about “faking” answers, but very little in regards to inconsistent or random response. Helmes

criticizes the validity scales that are sensitive to content nonresponsiveness (CNR) because they

may not be sensitive enough to detect individual sections of the assessment that were completed

at random versus. He argues that the CNR scales are only designed to detect when the entire

inventory is completed with random response patterns (Helmes, 2008).

The MMPI-2 is designed for adults, but adolescents may be tested as well. The inventory

requires a 6th grade reading level and generally takes individuals between 1 and 1 ½ hours to

complete (Gregory, 2011). Nichols and Kaufman point out that the MMPI-2 testing manual

recommends an 8th grade reading level and that many items on scale 9 of the test require a 9th

grade reading level (Nichols & Kaufman, 2011). This high reading level is one of biggest

weaknesses in terms of format for the MMPI-2. According the U.S. Department of Education

(2007), the average reading score for adults in the United States is around mid-7th grade level

(U.S. Department of Education, 2007). This evidence suggests that the MMPI-2 would not be

appropriate for the general population. In terms of the incarcerated population, a U.S.

Department of Education study found the average reading level to be about 5th grade (Kolstad,

1994.) Helmes points out that the test was not designed for use with offenders and this evidence

supports his findings. The reading level of the MMPI-2 is high for the general population and

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given the prevalence of learning disabilities in the prison population, even the length of the test

may make the MMPI-2 inappropriate for the population (Helmes, 2008).

This concept of population exclusion comes as no surprise, because the MMPI-2 was

validated in a study that used 2600 adults who were “loosely” representative of the general

population. A major weakness that Gregory points out with this sample is that higher educational

levels are overrepresented (Gregory, 2011). Rushton and Irwing support these findings. Rushton

and Irwin go beyond Gregory in order to demonstrate additional issues with the chosen 2600

adult sample including an underrepresentation of Hispanics and Asian-Americans and an

overrepresentation of college educated and higher socioeconomic groups (Rushton & Irwing,

2009). In terms of the incarcerated offender population, this evidence supports Helmes

arguments that the sample utilized is not representative of the prison population and hence the

MMPI-2 may be more difficult to validate when used in forensic assessment of prison

populations (Helmes, 2008).

Cultural Concerns

Cultural concerns are a major issue with standardized testing and the original MMPI

items showed significant cultural bias (Gregory, 2011). The revised MMPI-2 used a more

representative sample of the general population and demonstrates a major improvement in

lessening cultural bias issues (Maurish, 2004). A study of African American individuals found

no significant evidence of testing bias with the MMPI-2. The research conducted by McNulty,

Graham, Ben-Porath & Stein (1997) did find major differences in the comparison of results for

African American and Caucasian participants. Mcnulty et al. found that African American men

scored significantly higher on the Lie scale and Fears content scale than did their Caucasian

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counterparts. The research also found that African American women scored higher than

Caucasian women on Hypomania and that Caucasian women scored higher on the Low Self

Esteem content scale. McNulty et al. attribute this discrepancy to actual client psychopathology

as opposed to test bias. McNulty found correlations between the MMPI-2 and patient

descriptions were not significantly different and found no evidence of testing bias based on

results (McNulty, Graham, Ben-Porath & Stein, 1997). The same couldn’t be said when

comparing the results of adult men and women. Blaha, Merydith, Wallbrown and Dowd (2001)

found that Scale 3 was significantly different when comparing men and women (Blaha,

Merydith, Wallbrown & Dowd, 2001). These findings are preliminary and conducted only in an

initial study. This means further research is necessary to decipher if the discrepancy is due to an

issue of test bias or rather is the result of actual client psychopathology.

Test Administration

Specifics that Nichols and Kaufman suggest that will greatly improve the overall validity

of individual assessments include the examiner’s ability to build a strong rapport with

participants, his or her ability to assess the examinees willingness, his or her affiliation to a third

party test requester, his or her ability to provide a proper practical overview and the examiner’s

ability to recognize sensory, motor, and learning barriers prior to administration (Nichols &

Kaufman, 2011). A well-trained examiner is key to ensuring a valid and proper assessment. The

administration of the MMPI-2 is actually quite complex, despite common misconceptions

regarding the ease of test administration. Nichols and Kaufman believe that test administrators

that are well trained and are able to build a good rapport with test takers are essential to ensuring

a valid test result (Nichols & Kaufman, 2011).

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One other concern regarding test administration is administering individual scales out of

context. This is becoming more common in terms of the Post Traumatic Stress Disorder (PTSD)

Scale and MacAndrew Alcoholism Scale being used independently and out of context. Butcher,

Graham and Ben-Porath (1995) suggest several problems that arise when scales are administered

separately. The first problem they discuss is the administration of highly similar items with

obvious content that are administered together in close sequence. Butcher et al. warn that this

type of testing method can alter the mental set of the participant. In plain language, the lack of

variability in the assessment may incline a participant to answer differently during this type of

administration than from that during the completion of the entire MMPI-2, in which the items

are intermingled together. Butcher et al. suggest that altered stimuli (i.e., only the Depression

scale items) could produce a different response attitude than if all of the items had been

administered. The examinee may be influenced to answer questions in a different way, hence

biasing the results (Butcher, Graham & Ben-Porath, 1995).

Another problem associated with extracted scales is that the researchers may not able to

examine the MMPI-2 validity scales to exclude invalid data from their studies (Butcher,

Graham & Ben-Porath, 1995). Without the validity scales in place, the participant could

potentially “fake” or randomize their answers undetected, giving an invalid result. All the data

seems to suggest that administering scales individually ultimately sacrifices the validity of the

results.

Validity and Reliability

Validity is one of the largest strengths of the MMPI-2. Butcher, Mineka and Hooley

(2010) support this by calling the MMPI-2 the most validated and widely adaptable personality

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test available (Butcher, Mineka & Hooley, 2010). A great deal of research suggests that the

validity scales built into the assessment adequately correct for many of the potential issues that

can bias subject results. On the inverse, reliability is one of the biggest weaknesses of the

MMPI-2 (Nichols & Kaufman, 2011). In terms of reliability, Vacha-Haase, Kogan, Tani,

Woodall and Thompson (2001) argue that tests aren’t reliable. Vacha-Haase et al. attribute this

to score variability and sample composition. Both of these influence reliability, causing changes

across administration. Looking at the data, the reliability coefficient of the MMPI-2 statistically

falls below generally accepted levels, showing the reliability the MMPI-2 to be very low

(Vacha-Haase, Kogan, Tani, Woodall & Thompson, 2001). In most scientific studies, this

would invalidate the results. In a self-report psychological inventory, the results can’t be

measured as rigorously and multiple administrations are often a more effective way to validate

reliable results. Vacha-Haase, Henson and Caruso (2002) argue for the use of Reliability

Generalization in terms of assessing this type of test reliability. Vacha-Hasse’s suggests that her

model of score reliability is a more effective validation method for this type of assessment,

because it relies on multiple administrations as opposed to the traditional test/retest scientific

methodology (Vacha-Haase, Henson & Caruso, 2002).

Looking at the issue of validity, Meyer et al. (2001) argue that the validity of

psychological tests is comparable to the validity of medical tests. In terms of client knowledge in

a clinical practice, Meyer et al. maintain that the best knowledge is obtained from the

sophisticated integration of information derived from a multimethod assessment battery even in

the absence of the hard empirical data that many scientific studies look for (Meyer et al., 2001).

The validity of the MMPI-2 is one of the assessments strengths and the build in validity scales

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are an essential part of the empirical evidence that suggests that the MMPI-2 is one of the

stronger personality assessment tools available in clinical practice.

MMPI-2 Critique

Some of the greatest strengths of the MMPI-2 include validity and versatility. As we

discussed in the last section, in terms of validity, the greatest strength of the MMPI-2 lies in the

nine validity scales that are built-in to assessment instrument. A small study that consisted of 74

individuals conducted by Arbisi and Ben-Porath (1998) found that the validity scales were very

successful in detecting “fake bad” participant responses when participants tried to outsmart the

assessment (Arbisi & Ben-Porath, 1998). In terms of overreporting or “fake good” responses,

Sellbom and Bagby (2010) found the MMPI-2 to also be successful in differentiating between

individuals who were asked to overreport mental health problems and patients with genuine

psychopathology. The validity scales were able to detect patterns regardless of whether

dissimulating individuals had been coached (Sellbom & Bagby, 2010). Sellbom and Bagby’s

finding are supported by the results of a study conduced by Tolin, Steenkamp, Marx and Litz.

(2010). Tolin et al. found that symptom exaggeration could be adequately detected using the

validity scales with veterans being evaluated for PTSD (Tolin, Steenkamp, Marx & Litz, 2010).

Derksen (2006) points to the self-reporting format of the MMPI-2 as a benefit in getting accurate

and honest responses from participants and the validity scales help ensure that underreported,

overreported, and acquiescence are adequately detected (Derksen, 2006).

In terms of versatility, the MMPI-2 has many different faucets. Looking at

administration, the MMPI-2 can be administered in a clinical setting with a traditional pen and

paper format, on a computer, or even sent home with a trusted client (Forbey and Ben-Porath,

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2007). In terms of formats for different cultures and languages, Zapata-Sola, Kreuch,, Landers,

Hoyt and Butcher (2009) found that Spanish-Speaking participant taking a Spanish Language

version of the MMPI-2 had scores that were highly similar to English-Speaking Participants

taking an English Language version of the same MMPI-2 (Zapata-Sola, Kreuch, Landers, Hoyt,

& Butcher, 2009). This evidence serves to further support the versatility of the MMPI-2 and the

ability of the assessment to be administered in different formats and languages without

sacrificing the standardization, reliability, or integrity of the test.

Helmes and Reddon (1993) point to some of the weaknesses of the MMPI-2. Earlier on

we discussed reading level comprehension issues with the MMPI-2 assessment. Helmes and

Reddon take the argument a bit further to point out that obsolete and cumbersome language still

remains in the current revision of the MMPI-2. Helmes and Reddon also point out that the scales

of the assessment are of unbalanced lengths and that there is a high prevalence of unscored

items. With approximately 30% of the questions unscored, Helmes and Reddon argue for their

omission from the test (Helmes & Reddon, 1993). Helmes and Reddon also argue for more

balanced items for each scale.

One major weakness Pinsoneault (2007) points out is that the MMPI-2 still retains a

level of insensitivity to random answers. While overall the MMPI-2 performed well, the validity

scales failed to detect 37% of the items that scored ≥80 on the Variable Response Inconsistency

scale (Pinsoneault, 2007). This means that if a majority of the assessment had random answers,

the Validity Scales were able to detect them, but if items in one or two scales were answered

randomly, than the Validity Scales may not be sensitive enough to detect them. This could cause

issues in a participant’s ability to bias the exam results.

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MMPI-2 Use In A Counseling Setting

In terms of using the MMPI-2 in a counseling practice, the findings suggest that the

MMPI-2 should be used as a supplementary tool in conjunction with a battery of other

comprehensive tests. The MMPI-2 is a very similar assessment to the MMPI, but isn’t equivalent

(Bolinskey & Nichols, 2011). The MMPI-2 also doesn’t directly correlate with diagnoses found

in the DSM-IV TR. In a counseling setting, the MMPI-2 would best be utilized to help map

patterns of more or less disturbed personality traits and behavioral styles for different individuals

as opposed to establishing differential diagnoses (Derksen, 2006). As a clinician, it is important

to be properly trained in the administration of the MMPI-2 in order ensure the validity of results

and limit both intentional and unintentional examiner bias (Nichols & Kaufman, 2011). Under

the APA Code of Ethics, Psychologists do not promote the use of psychological assessment

techniques by unqualified persons (A.P.A., 2010). As a clinician in a counseling practice, it is

important to insure that anyone administering the MMPI-2 is properly trained, and that includes

yourself.

Discussion and Conclusion

The findings of this paper support the importance of really critically evaluating any

testing instrument that you choose to utilize with clients. Looking at the MMPI-2, it is a very

strong instrument, well rooted in empirical research. That said, the MMPI-2 still has many

weaknesses in terms of it being an assessment tool. Looking at the history of the MMPI-2, it has

undergone many revisions and has been revised again since the 1989 creation of the MMPI-2.

Each revision is intended to make the testing instrument stronger, but not equivalent to the

previous edition of the test. Keeping issues of reading comprehension and proper testing

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administration in mind should help ensure valid results that will provide accurate information

about a client’s psychopathology. It is important to remember that there isn’t one all-inclusive

personality assessment tool that will give a comprehensive picture of an individual’s personality.

Proper diagnoses require a comprehensive assessment using a battery of tests as to ensure that

the results are accurate and in the client’s best interest. Staying up-to-date on current testing

practices and critically evaluating commonly used assessments is important to serving

psychiatric clients well.

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