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Learning to interpret a multiaxial instrument at the item, scale, and profile configuration levels is a time consuming task. From a purely practical standpoint, automated interpretive reports provide a significant saving of professional time and effort. However, automatic reports have their own intrinsic limitations. MCMI™ reports are normed on patients who were in the early phases of assessment or psychotherapy because of emotional discomforts or social difficulties. Respondents who do not fit this normative population or who have inappropriately taken the MCMI™ for nonclinical purposes may have distorted reports. To optimize clinical utility, the report highlights pathological characteristics and dynamics rather than strengths and positive attributes. This focus should be kept in mind by the referring clinician reading the report.
Based on theoretical inferences and probabilistic data from actuarial research, the MCMI™ report cannot be judged definitive. It must be viewed as only one facet of a comprehensive psychological assessment, and should be evaluated in conjunction with additional clinical data (for example, current life circumstances, observed behavior, biographic history, interview responses, and information from other tests). To avoid its miscontrual or misuse, the report should be evaluated by mental health clinicians trained in recognizing the strengths and limitations of psychological test data. Given its limited data base and pathologic focus, the report should not be shown to patients or their relatives.
MCMI-III™ Profile Report Theodore Millon, PhD
ID Number 43463 Female Age 40 Remarried Mental Hospital Inpatient 1/25/97
Copyright © 1994 DICANDRIEN, INC. All
rights reserved. "Millon Clinical Multiaxial
Inventory-III" and "MCMI-III" are trademarks of DICANDRIEN, INC. |
| CAPSULE SUMMARY MCMI-III™ reports are normed on patients who were in the early phases of assessment or psychotherapy for emotional discomfort or social difficulties. Respondents who do not fit this normative population or who have inappropriately taken the MCMI-Ill for nonclinical purposes may have distorted reports. The MCMI-III™ report cannot be considered definitive. It should be evaluated in conjunction with additional clinical data. The report should be evaluated by a mental health clinician trained in the use of psychological tests. The report should not be shown to patients or their relatives. Interpretive Considerations This patient's response style may indicate a tendency to magnify illness, an inclination to complain, or feelings of extreme vulnerability associated with a current episode of acute turmoil. The patient's scale scores may be somewhat exaggerated, and the interpretations should be read with this in mind. Profile Severity Possible Diagnoses Axis I clinical syndromes are suggested by the client's MCMI-III™ profile in the areas of Major Depression (recurrent, severe, without psychotic features) and Generalized Anxiety Disorder. Therapeutic Considerations |
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| RESPONSE TENDENCIES This patient's response style may indicate a broad tendency to magnify the level of experienced illness or a characterological inclination to complain or to be self-pitying. On the other hand, the response style may convey feelings of extreme vulnerability that are associated with a current episode of acute turmoil. Whatever the impetus for the response style, the patient's scale scores, particularly those on Axis I, may be somewhat exaggerated, and the interpretation of this profile should be made with this consideration in mind. The BR scores reported for this individual have been modified to account for the psychic tension and dejection indicated by the elevations on Scale A (Anxiety) and Scale D (Dysthymia). AXIS II: PERSONALITY PATTERNS The following paragraphs refer to those enduring and pervasive personality traits that underlie this woman 5 emotional, cognitive, and interpersonal difficulties. Rather than focus on the largely transitory symptoms that make up Axis I clinical syndromes, this section concentrates on her more habitual and maladaptive methods of relating, behaving, thinking, and feeling. There is reason to believe that at least a moderate level of pathology characterizes the overall personality organization of this woman. Defective psychic structures suggest a failure to develop adequate internal cohesion and a less than satisfactory hierarchy of coping strategies. This woman's foundation for effective intrapsychic regulation and socially acceptable interpersonal conduct appears deficient or incompetent. She is subjected to the flux of her own enigmatic attitudes and contradictory behavior, and her sense of psychic coherence is often precarious. She has probably had a checkered history of disappointments in her personal and family relationships. Deficits in her social attainments may also be notable as well as a tendency to precipitate self-defeating vicious circles. Earlier aspirations may have resulted in frustrating setbacks and efforts to achieve a consistent niche in life may have failed. Although she is usually able to function on a satisfactory basis, she may experience periods of marked emotional, cognitive, or behavioral dysfunction. The MCMI-III™ profile of this woman is suggestive of marked dependency needs, anxious seeking of reassurance from others, and her melancholic fear of separation from those who provide support. Dependency strivings push her to be overly compliant, to be self-sacrificing, to downplay her personal strengths and attributes, and to place herself in inferior or demeaning positions. Significant relationships appear to have become increasingly insecure and unreliable. This has resulted in increased moodiness, prolonged periods of futility and dejection, episodes of obstructive anger, and a seeking of situations in which she may act out as a martyr. She is mostly seen as submissive and cooperative. At other times, she is thought of as alternately petulant, self-debasing, and pessimistic. She may vacillate between being socially agreeable, sullen, aggrieved, despondent, obstructive, and contrite. She may often complain of being treated unfairly, yet she also may undermine herself and appear to court blame and criticism, behavior that keeps others on edge, never knowing if she will react in an apologetic, agreeable, or sulky manner. She may often undo the efforts of |
| others to be helpful, frequently
provoking rejection and then feeling hurt. Although struggling to be obliging and
submissive, she may anticipate disillusioning relationships and often creates the expected
disappointment by testing the behavior of others and questioning the genuineness of their
interest and support. Self-defeating habits and an attitude that she deserves to suffer
may exasperate and eventually alienate those on whom she depends. 'When threatened by
separation and disapproval, she may express guilt and self-condemnation in the hope of
regaining support, reassurance, and sympathy. This woman may exhibit helplessness as well as experiencing anxious periods and prolonged depressive moods. Fearing that others may grow weary of her plaintive and aggrieved behavior, she may have begun to alternate between voicing self-deprecation and remorse and being petulant and bitter. A struggle between being dependently acquiescent and inducing guilt in others over what she sees as their abuse and lack of interest may now intrude into most relationships. Her seeming inability to control her sorrowful state and her feelings of being treated unjustly and being misunderstood may contribute to a persistent attitude of discontent and affective dysthymia. AXIS I: CLINICAL SYNDROMES The features and dynamics of the following Axis I clinical syndromes appear worthy of description and analysis. They may arise in response to external precipitants but are likely to reflect and accentuate several of the more enduring and pervasive aspects of this woman's basic personality makeup. The self-demeaning comments and feelings of inferiority that mark this woman's major depression are part of her overall and enduring characterological structure, a set of chronic self-defeating attitudes and depressive emotions that are intrinsic to her psychological makeup. Feelings of emptiness and loneliness and recurrent thoughts of death and suicide are accompanied by expressions of low self-esteem, preoccupations with failures and physical unattractiveness, and assertions of guilt and unworthiness. Although she complains about being aggrieved and mistreated, she is likely to assert that she deserves anguish and abuse. Such self-debasement is consonant with her self-image, as is her tolerance and perpetuation of relationships that foster and aggravate her misery. Irritable and depressed much of the time, this woman appears to be experiencing a level of dysphoria that is sufficient to justify characterizing her current state as an anxiety disorder. Behavioral symptoms such as restlessness, edginess, and distractibility probably coexist with somatic signs of anxiety, such as ill-defined pains, insomnia, and exhaustion. She vacillates between keeping her dysphoric feelings in check and voicing them, thus preventing herself from stabilizing her emotions. This, in turn, precludes the opportunity for her disquiet to subside. NOTEWORTHY RESPONSES The client answered the following statements in the direction noted in parentheses. These items suggest specific problem areas that the clinician may wish to investigate. |
| Health Preoccupation 1. Lately, my strength seems to be draining out of me, even in the morning. (True) 4. I feel weak and tired much of the time. (True) 55. In recent weeks I feel worn out for no special reason. (True) 75. Lately, I've been sweating a great deal and feel very tense. (True) Interpersonal Alienation 10. What few feelings I seem to have I rarely show to the outside world. (True) 69. I avoid most social situations because I expect people to criticize or reject me. (True) 99. In social groups I am almost always very self-conscious and tense. (True) 161. I seem to create situations with others in which I get hurt or feel rejected. (True) Emotional Dyscontrol 14. Sometimes I can be pretty rough and mean in my relations with my family. (True) 22. I'm a very erratic person, changing my mind and feelings all the time. (True) 30. Lately, I have begun to feel like smashing things. (True) 34. Lately, I have gone all to pieces. (True) 83. My moods seem to change a great deal from one day to the next. (True) 87. I often get angry with people who do things slowly. (True) 124. When I'm alone and away from home, I often begin to feel tense and panicky. (True) Self-destructive Potential Childhood Abuse Eating Disorder POSSIBLE DSM-IV MULTIAXIAL DIAGNOSES The following diagnostic assignments should be considered judgments of personality and clinical prototypes that correspond conceptually to formal diagnostic categories. The diagnostic criteria and items used in the MCMI-III™ differ somewhat from those in the DSM-IV, but there are sufficient parallels in the MCMI-III™ items to recommend consideration of the following assignments. It should be noted that several DSM-IV Axis I syndromes are not assessed in the MCMI-III™. Definitive diagnoses must draw on biographical, observational, and interview data in addition to self-report inventories such as the MCMI-III™. |
| Axis I: Clinical
Syndromes The major complaints and behaviors of the patient parallel the following Axis I diagnoses listed in order of their clinical significance and salience.
Axis II: Personality Disorders Personality configuration composed of the following:
Course: The major personality features described previously reflect long-term or chronic traits that are likely to have persisted for several years prior to the present assessment. The clinical syndromes described previously tend to be relatively transient, waxing and waning in their prominence and intensity depending on the presence of environmental stress. Axis IV: Psychosocial and Environmental Problems Loneliness Low Self-Confidence If additional clinical data are supportive of the MCMI-III™ hypotheses, it is likely that this patient's difficulties can be managed with either brief or extended therapeutic methods. The following guide to treatment planning is oriented toward issues and techniques of a short-term character, focusing on matters that might call for immediate attention, followed by time-limited procedures designed to reduce the likelihood of repeated relapses. As a first step, it would appear advisable to implement methods to ameliorate this patient's current State of clinical anxiety, depressive hopelessness, or pathological personality functioning by the rapid implementation of supportive psychotherapeutic measures. With appropriate consultation, targeted psychopharmacologic medications may also be useful at this initial stage. |
| Once this patient's more pressing
or acute difficulties are adequately stabilized, attention should be directed toward goals
that would aid in preventing a recurrence of problems, focusing on circumscribed issues
and employing delimited methods such as those discussed in the following paragraphs. As a first approach in a short-term therapeutic program, an effort should be made to assist the patient in arranging for a more rewarding environment and in discovering opportunities that will enhance her self-worth. Supportive therapy may be all she can tolerate in the very first sessions, that it, until she is comfortable dealing with her most painful feelings. Psychopharmacologic treatment may be considered, following appropriate consultation, as a means of diminishing her depressive feelings or controlling her anxiety. Behavior modification may also be employed to help her learn competent reactions to stressful situations. As trust in her therapist develops, she should be amenable to methods of cognitive reframing to alter dysfunctional attitudes and depressogenic social expectations; particularly appropriate would be the methods proposed by Beck and Meichenbaum. To decrease the potential of a recurrence, focused dynamic methods may be explored to rework deep object attachments and to construct a base for competency strivings. The interpersonal focus proposed by Benjamin and Klerman and group therapy procedures may provide a means of learning autonomous skills and the growth of social confidence. An important self-defeating belief that a cognitive approach should seek to reframe is her assumption that she must appease others and apologize for her incompetence in order to assure that she will not be abandoned. What can be shown to her is that this behavior exasperates and alienates those on whom she leans most heavily. This exasperation and alienation then serve only to increase her fear and neediness. She may come to recognize that a vicious circle is created, making her feel more desperate and more ingratiating. A vigorous but short-term approach that illustrates her dysfunctional beliefs and expectations should be used to break the circle and reorient her actions lest destructively. The combination of cognitive restructuring and the development of increasing interpersonal skills should prove an effective brief course of treatment. To restate her difficulty in different terms, not only does this patient precipitate real difficulties through her self-demeaning attitudes but she also perceives and anticipates difficulties where none in fact exist. She believes that good things do not last and that the positive feelings and attitudes of those from whom she seeks support will probably end capriciously and be followed by disappointment and rejection. This cognitive assumption should be directly confronted by appropriate therapeutic techniques. 'What mutt be undone is the fact that each time the announces her defects, the convinces herself at well as others and thereby deepens her discontent and her self-image of incompetence. Trapped by her own persuasiveness, she repeatedly reinforces her belief in the futility of standing on her own and is therefore likely to try less and less to overcome her inadequacies. This therapeutic strategy should aim at undoing this vicious circle of increased despondency and dependency. Skillful attention is also needed to alter her ambivalence about dependency and her willingness to be used, if not abused. Unless checked, this woman may have difficulty sustaining a consistent therapeutic relationship and may subsequently deteriorate or relapse. Maneuvers designed to test the dependability of the therapist will probably be evident. To prevent such setbacks, empathic warmth should be expressed to help her overcome her fear of facing her own feelings of unworthiness. Similar support levels are necessary to undo her wish to retain her image of being a self-denying person whose security lies in suffering and martyrdom. She needs to be guided into recognizing the basis of her self-contempt and her ambivalence about dependency relationships. She should be helped to tee that not all nurturant parental figures will habitually become abusive and exploitive. Efforts to undo these self-sabotaging beliefs will pay considerable dividends in short-term and possibly more substantial long-term progress. End of Report |
