Millon™ Clinical Multiaxial Inventory-III
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The MCMI™(Millon™ Clinical Multiaxial Inventory) is distinguished from other inventories primarily by its brevity, its theoretical anchoring, multiaxial format, tripartite construction and validation schema, use of base rate scores, and interpretive depth.
Each generation of the MCMI inventory has attempted to keep the total number of items small enough to encourage its use in all types of diagnostic and treatment settings, yet large enough to permit the assessment of a wide range of clinically relevant multiaxial behaviors. At 175 items, the MCMI inventory is much shorter than comparable instruments.
READING LEVEL AND ADMINISTRATION TIME
Terminology is geared to an eighth-grade reading level. The inventory is almost self-administering. The great majority of patients can complete the MCMI-III™ in 20 to 30 minutes, facilitating relatively simple and rapid administrations while minimizing patient resistance and fatigue.
Diagnostic instruments are more useful when they are linked systematically to a comprehensive clinical theory. Unfortunately, assessment techniques and personality theory have developed almost independently. As a result, few diagnostic measures have either been based on or have evolved from clinical theory. The MCMI-III™ is different. Each of its Axis II scales is an operational measure of a syndrome derived from a theory of personality (Millon, 1969, 1981, 1986a, 1986b, 1990; Millon & Davis, 1996). The scales and profiles of the MCMI-III™ thus measure these theory-derived and theory-refined variables directly and quantifiably. With a firm foundation in measurement, scale elevations and configurations can be used to suggest specific patient diagnoses and clinical dynamics, as well as testable hypotheses about social history and current behavior.
No less important than its link to theory is the coordination between a clinically-oriented instrument and official diagnostic constructs. Few diagnostic instruments currently available have been constructed to be as consonant with the official nosology at the MCMI-III™.
With the advent of DSM-III, DSM-III-R, and DSM-IV, diagnostic categories were precisely specified and operationally defined. The structure of the MCMI inventory parallels that of the DSM at a number of levels. First, the scales of the MCMI inventory are grouped into the categories of personality and psychopathology, to reflect the DSM distinction between Axis II and Axis I. Thus, separate scales distinguish the more enduring personality characteristics of patients (Axis II) from the more acute clinical disorders they display (Axis I). Profiles based on all 24 clinical scales may be interpreted to illuminate the interplay between long-standing characterological patterns and the distinctive clinical symptoms currently manifest.
Beyond the simple DSM distinction between psychiatric symptoms and enduring personality dispositions, the scales within each Axis are further grouped according to their level of psychopathologic severity. The Schizotypal, Borderline, and Paranoid syndromes, for example, represent greater levels of personality pathology, and have been set off from the eleven basic personality scales, Schizoid through Masochistic. Similarly, the moderately severe or neurotic clinical syndromes are separated from and independently assessed of those with a presumably more psychotic nature, Thought Disorder, Major Depression, and Delusional Disorder.
Item selection and scale development progressed through a sequence of three validation steps: (1) theoretical-substantive; (2) internal-structural; and (3) external-criterion.
In the theoretical-substantive stage, items for each syndrome were generated to conform both to theoretical requirements and to the substance of DSM criteria. In the internal-structural stage, these "rational" items were subjected to internal consistency analyses. Items having higher correlations with scales for which they were not intended were either dropped entirely or re-examined against theoretical criteria and reassigned or reweighted. Only items surviving each successive validation stage were included in subsequent analyses. In the external-criterion phase, items were examined in terms of their ability to discriminate between clinical groups, rather than between clinical groups and normal subjects.
This tripartite model of test construction attempts to synthesize the strengths of each construction phase by rejecting items that are found to be deficient in particular respects, thus ensuring that the final scales do not consist of items which optimize one particular parameter of test construction, but instead conjointly satisfy multiple requirements, increasing the generalizability of the end product.
An important feature which distinguishes the MCMI inventory from other inventories is its use of actuarial base rate data, rather than normalized standard score transformations. T-scores implicitly assume the prevalence rates of all disorders to be equal, that is, there are equal numbers of depressives and schizophrenics, for example.
In contrast, the MCMI inventory seeks to diagnose the percentages of patients that are actually found to be disordered across diagnostic settings. These data not only provide a basis for selecting optimal differential diagnostic cutting lines, but also ensure that the frequency of MCMI-III™ generated diagnoses and profile patterns will be comparable to representative clinical prevalence rates.
COMPUTER SCORING AND INTERPRETATION
Computer programs are available for rapid and convenient machine scoring in all major computing environments.
Interpretive reports are available at two levels of detail. The PROFILE REPORT presents the patient's MCMI-III™ scores and profile, and is useful as a screening device to identify patients that may require more intensive evaluation or professional attention.The NARRATIVE REPORT integrates both personological and symptomatic features of the patient, and are arranged in a style similar to those prepared by clinical psychologists. Results are based on actuarial research, the MCMI's theoretical schema, and relevant DSM diagnoses within a multiaxial framework. Therapeutic implications are included.
The primary intent of the MCMI inventory is to provide information to clinicians, that is, psychologists, psychiatrists, counselors, social workers, physicians, and nurses, who must make assessments and treatment decisions about persons with emotional and interpersonal difficulties.
Because of its simplicity of administration and the availability of rapid computer scoring and interpretation, the MCMI inventory can be used on a routine basis in outpatient clinics, community agencies, mental health centers, college counseling programs, general and mental hospitals, as well as independent and group practice offices, and in the courts.
Over 400 research studies have used the MCMI™ inventory in a significant manner. Objective, quantified, and theory-grounded individual scale scores and profile patterns can be used to generate and test a variety of clinical, experimental, and demographic hypotheses. Research support is also available through NCS Assessments.
The MCMI-III™ consists of a total of twenty-four scales: Fourteen Clinical Personality Patterns scales (Axis II), three Severe Personality Pathology scales (Axis II), seven Clinical Syndrome Scales (Axis I), three Severe Clinical Syndrome scales (Axis I), three Modifying Indices and a Validity scale. The personality scales parallel the personality disorders of the DSM-III-R and DSM-IV, as refined by theory. They are grouped into two levels of severity, the Clinical Personality Patterns scales and Severe Personality Scales. The Axis I scales represent clinical conditions frequently seen in clinical settings. They are also grouped into two levels of severity, the Clinical Syndromes scales and the Severe Syndrome Scales. The three Modifying Indices - Disclosure, Desirability, and Debasement - assess response tendencies which are connected with particular personality patterns or Axis I conditions. Scale descriptions are give below.
A X I S I I : C L I N I C A L P E R S O N A L I T Y P A T T E R N S
1. Schizoid Personality. Noted by their lack of desire and incapacity to experience either pleasure or pain in depth, these individuals tend to be apathetic, listless, distant, and asocial. Since affectionate needs and emotional feelings are minimal, the individual functions as a passive observer detached from the rewards and affections of human relationships, as well as from their demands.
2A. Avoidant Personality. Basically fearful and vigilant, these individuals are perennially on guard, ever ready to distance themselves because of anxious anticipation of painful and humiliating experiences. By actively withdrawing they protect themselves in spite of deep desires to be close to others.
2B. Depressive Personality. These individuals believe that pain as a permanent and stable part of live, and that pleasure is no longer possible. A disconsolate family, a barren environment, and hopeless prospects can all shape the Depressive character style.
3. Dependent Personality. Turn primarily to others as a source of nurturance and security, these persons wait passively for others to provide affection, security, guidance, and leadership, while often submitting willingly to the wishes of others in order to maintain their affection. Lack of both initiative and autonomy is often a consequence of parental overprotection.
4. Histrionic Personality. Facile and manipulating, these individuals seek to maximize the amount of attention and favorable treatment they receive while minimizing the disinterest and disapproval of others. Their clever and often artful social behaviors give the appearance of an inner confidence and independent self-assurance. Beneath this guise, however, lies a fear of genuine autonomy and a need for repeated signs of acceptance and approval from every interpersonal source and in every social context.
5. Narcissistic Personality. Noted by their egotistic self-involvement, these individuals overvalue their self-worth, often maintaining confidence and superiority that is unsustainable by real or mature achievements. Nevertheless, they blithely assume that others will recognize their specialness and exhibit an air of arrogant self-assurance. A sublime confidence that things always work out provides with little incentive to engage in the reciprocal give-and-take of social life.
6A. Antisocial Personality. Engaging in duplicitous or illegal behaviors designed to exploit their environment for self-gain, these individuals are irresponsible and impulsive, judge others to be unreliable and disloyal, and use insensitivity and ruthlessness to head off abuse and victimization.
6B. Sadistic Personality. Although deleted from the DSM-IV manual, this construct remains part of the MCMI-III™. Subjects are are generally hostile, pervasively combative, and appear indifferent to or pleased by the destructive consequences of their contentious, abusive, and brutal behaviors. Although many cloak their more malicious and power-oriented tendencies in publicly approved roles and vocations, they give themselves away in their dominating and antagonistic, actions.
7. Compulsive Personality. Prudent, controlled, and perfectionistic, high scorers experience a conflict between hostility and fear of social disapproval, typically suppressing resentment by overconforming and by placing high demands on themselves. Their disciplined self-restraint controls intense, though hidden, oppositional feelings, resulting in an overt passivity and seeming public compliance.
8A. Negativistic Personality. These individuals struggle between loyalty to their own needs and those of others, vacillating between deference and obedience, and defiance and aggressive opposition. Behaviorally they display an erratic pattern of explosive anger or stubbornness intermingled with periods of guilt and shame.
8B. Masochistic Personality. Relating to others in an obsequious and self-sacrificing manner, these persons allow, and perhaps encourage, others to exploit or take advantage of them. Focusing on their very worst features, many assert that they deserve being shamed and humbled. Typically acting in an unassuming and self-effacing way, they often intensify their deficits and place themselves in an inferior light or abject position.
A X I S I I : S E V E R E P E R S O N A L I T Y P A T H O L O G Y
S. Schizotypal Personality. Socially isolated with minimal personal attachments and obligations, these persons are inclined to be either autistic or cognitively confused, tangential, self-absorbed or ruminative. Their behavioral eccentricities cause others to perceive them as strange or different.
C. Borderline Personality. Experiening intense moods punctuated by recurring periods of dejection and apathy and spells of anger and anxiety, borderlines are defined by a dysregulation of affect, most clearly seen in the instability and lability of their moods. Many have recurring self-mutilating and suicidal thoughts, appear overly preoccupied with securing affection, have difficulty maintaining a clear sense of identity, and display a cognitive-affective ambivalence evident in conflicting feelings of rage, love, and guilt toward others.
P. Paranoid Personality. Displaying a vigilant mistrust of others and an edgy defensiveness against anticipated criticism and deception, these persons evidence an abrasive irritability and a tendency to precipitate exasperation and anger in others, fear of losing independence, and vigorously resist external influence and control.
A X I S I : C L I N I C A L S Y N D R O M E S
A. Anxiety High scorers often report feeling either vaguely apprehensive or specifically phobic. They are is typically tense, indecisive, and restless, and tends to complain of a variety of physical discomforts, such as tightness, excessive perspiration, ill-defined muscular aches, and nausea. Most give evidence of a generalized state of tension, manifested by an inability to relax, fidgety movements, and a readiness to react and be easily startled. Somatic discomforts¾ for example, clammy hands or upset stomach¾ are also characteristic. Also notable are worrisomeness and an apprehensive sense that problems are imminent, a hyperalertness to one’s environment, edginess, and generalized touchiness.
H. Somatoform. High scorers express psychological difficulties through somatic channels, notably, persistent periods of fatigue and weakness, and a preoccupation with ill health and a variety of dramatic but largely nonspecific pains in different and unrelated regions of the body. Some give evidence of a primary somatization disorder that is manifested by recurrent, multiple somatic complaints, often presented in a dramatic, vague, or exaggerated way. Others have a history that may be best considered hypochondriacal, since they interpret minor physical discomforts or sensations as signifying a serious ailment. If realistic diseases are factually present, they tend to be overinterpreted, despite medical reassurance. Typically, somatic complaints are employed to gain attention.
N. Bipolar: Manic. High scorers evidence periods of superficial elation, inflated self-esteem, restless overactivity and distractibility, pressured speech, and impulsiveness and irritability. Also evident is an unselective enthusiasm; excessive planning for unrealistic goals; an intrusive, if not domineering and demanding quality to interpersonal relations; decreased need for sleep; flights of ideas; and rapid and labile shifts of mood. Very high scores may signify psychotic processes, including delusions or hallucinations.
D. Dysthymia. High scorers remain involved in everyday life but have been preoccupied over a period of years with feelings of discouragement or guilt, lack initiative, possess low self-esteem, and frequently voice futile and self-deprecatory comments. During periods of dejection, there may be tearfulness, suicidal ideation, a pessimistic outlook toward the future, social withdrawal, poor appetite or overeating, chronic fatigue, poor concentration, a marked loss of interest in pleasurable activities, and a decreased effectiveness in fulfilling ordinary and routine life tasks.
B. Alcohol Dependence. High scorers probably have a history of alcoholism. They have made efforts to overcome this problem with minimal success, and, as a consequence, experience considerable discomfort in both family and work settings.
T. Drug Dependence. High scorers are likely to have had a recurrent or recent history of drug abuse, tend to have difficulty in restraining impulses or keeping them within conventional social limits, and display an inability to manage the personal consequences of these behaviors.
R. Posttraumatic Stress Disorder. High scorers have experienced an extremely threatening event involving the threat to life, together with intense fear and feelings of helplessness. Images and emotions associated with the trauma are reexperienced through distressing recollections and nightmares. Symptoms of anxious arousal may also be present, along with an avoidance of circumstances associated with the trauma.
A X I S I : S E V E R E C L I N I C A L S Y N D R O M E S
SS. Thought Disorder. Depending on the length and course of the problem, these patients are have often been classified as "schizophrenic," "schizophreniform," or as "brief reactive psychosis." They may periodically exhibit incongruous, disorganized, or regressive behavior, often appearing confused and disoriented and occasionally displaying inappropriate affect, scattered hallucinations, and unsystematic delusions. Thinking may be fragmented or bizarre. Feelings may be blunted, and there may be a pervasive sense of being isolated and misunderstood by others. Withdrawn and seclusive or secretive behavior may be notable.
CC. Major Depression. High scorers are severely depressed, express a dread of the future, suicidal ideation, and a sense of hopeless resignation. They may be incapable of functioning in a normal environment. Some exhibit a marked motor retardation, whereas others display an agitated quality, incessantly pacing about and bemoaning their sorry state. Several somatic processes are often disturbed during these periods—notably, a decreased appetite, fatigue, weight loss or gain, insomnia, or early rising. Problems of concentration are common, as are feelings of worthlessness or guilt. Repetitive fearfulness and brooding are frequently in evidence.
PP. Delusional Disorder. High scorers are frequently considered acutely paranoid, may become periodically belligerent, voicing irrational but interconnected sets of delusions of a jealous, persecutory, or grandiose nature. Depending on the constellation of other concurrent syndromes, there may be clear-cut signs of disturbed thinking and ideas of reference. Moods usually are hostile, and feelings of being picked on and mistreated are expressed. A tense undercurrent of suspiciousness, vigilance, and alertness to possible betrayal are typical concomitants.
The MCMI-III™ and MACI™ are available through NCS Assessments at 1-800-627-7271 (voice) or 1-800-632-9001 (fax).