MCMI-IV

Million Clinical Multiaxial

Inventory IVCHARLES J VELLA PHD

2016

Normality and pathology of personality exist on a continuum.

Quick facts

Scales

MCMI-IV

Languages: English, Spanish

Completion Time: 25 to 30 minutes

The record forms (which is a 2-in-1 form with both the questions and answer column) are in the

file cabinets. Similar to the MCMI-III, it is scored using the Q-local computer scoring program.

Scores/Interpretation: Adult inpatient and outpatient clinical sample; nor for normals

Scoring Options: Q-global® web-based, Q Local™ software, or Mail-in

Report Options: Interpretive and Profile Reports

MCMI-IV

The MCMI-IV offers:

updated norms that are based on a clinical adult population,

a new scale,

DSM-5® and ICD-10-CM alignment, updated narrative content

a new and deeper therapeutic focus.

The brevity of the MCMI-IV allows clinicians to maintain an efficient and productive clinical

practice.

New

•Full normative update, more closely representing the current clinical adult

population

•New Turbulent scale, providing deeper understanding of those patients presenting

with this unbridled personality type

•New and updated test items characterizing the evolution of Dr. Millon's personality

theory, refreshed to increase clarity and clinical relevance

•New and improved narrative content that better integrates results with therapeutic

practice and links to personalized treatment

New features

• Aligns with DSM-5; includes ICD-10 code sets

• New option to present scale scores using scale abbreviations

• Brevity, allowing clinicians to maintain an efficient and productive clinical practice

• 5th Grade reading level

• Seven new Noteworthy Response categories

• New digital manual in Q-global Resource Library

Psychometrics

The extensive normative sample for the MCMI-IV consists of a nationally representative

sample of 1,547 males and females with a wide variety of diagnoses.

This combined-gender sample includes adult patients seen in a wide array of settings, such

as clinics, independent practices, mental health centers, residential facilities, and hospitals.

Use of BR scores: actuarial base data

Does not assume normal curve; most tests standardize all scales to same mean and sd

BR (Base Rate): pts according to percentages that reflect underlying clinical prevalence; BR

score scaled to reflect differing prevalence rates of the disorder

Percentiles also used for Personality Pattern, clinical syndromes, and facet scales; % signify

rarity & percentage of population that scored at or below a given BR score

MCMI: Scoring and Interpreting

Base Rate Anchors

115 Maximum raw score

85 Prevalence PD disorder (1-8) or Prev of “prominent” disorder (A-PP)

75 Prev of PD traits or Prev of present disorder (A-PP)

60 Median for patients

0 Minimum raw score

Gender differences:

Females score higher: internalizing – Melancholic, Dependent, Somatic, Persistent Depression, Post-Traumatic Stress, & Major Depression

Males: externalizing – Antisocial, Alcohol Use, Drug Use, Narcissistic

Base Rate Adjustments

Raw score converted to BRs

2 adjustments may be necessary

X (Disclosure) – degree of rankness and self-revelation vs reticence & guardedness

1 point for each true on 121 items from scales 1 to 8B

Low score = underreporting symptoms; high scores = exaggeration of clinical picture

If X is less than 21 or greater than 60, BRs increased or decreased

X scores less than 7 or greater than 114 are invalid

Anxiety/Depression (A/CC): if too anxious or depressed

Add together the number of BR points that exceed 75 (minimum for clinical syndrome) for Anxiety & Major Depression Scales

Applied to 2A (Avoidant), 2B (Melancholic), 8B (Masochistic), S (Schizotypal), & C (Borderline); decreased scores

Administration

Administration Scorability Rules

The administration of the assessment cannot be scored if any of the following conditions are

true:

• Examinee’s identification number is missing or invalid and examinee’s first or last name is

missing or invalid

• Birth date is missing or invalid

• Test date is missing or invalid

• Examinee’s age at testing is less than 18

• Gender is missing or invalid

• Number of omits or invalid test responses is greater than 13

If an administration is unscorable, you must fill in the appropriate responses or raw scores

before you can score the instrument.

Administration: Invalidity

Report invalidity rules describe circumstances in which a valid interpretation cannot be made. Common examples are too many missing responses, a client’s age that is outside the appropriate range, an abnormal score on an assessment’s validity index, and an uninterpretable profile configuration.

This report is invalid if any of the following conditions are true:

• Raw V (Invalidity) is greater than 1

• Raw X (Disclosure) is less than 7 or greater than 114

• All Clinical Personality Patterns BR scores (1 - 8B) are less than 60

• Raw W (Inconsistency) is greater than 19

Unless you have modified your default system settings, you will always be asked whether or not you want to print an invalid report. An on-screen message will briefly describe the invalidity condition and the data you will receive if you print the report. For example, an invalid report might include a printout of raw and transformed scores, but the scores would not be plotted and no interpretation would be attempted.

Scale Invalidity Rules

If 5 or more items are missing from a scale then the scale is considered invalid.

New Turbulent scale

Scale 4B: Ebullient–Exuberant–Turbulent Spectrum

The Turbulent scale on the MCMI-IV provides clinicians with a deeper understanding of adult

patients experiencing abnormal personality traits, such as a lost sense of reality or

unwavering optimism. "Turbulent" refers to the more severe (disorder) end of the personality

functioning spectrum.

The Ebullient–Exuberant–Turbulent personality pattern as typically energetic and buoyant in

manner and prone to vigorous pursuits of happiness.

The high energy and generally positive attitude of moderated variants of this pattern can

show considerable characterological strengths.

Patients with less integrated variations of this pattern may be prone to scatteredness,

overstimulation, overanimation, and an inability to maintain balance within their environment

which can adversely affect their relationships with others.

Scales: 3 Levels of functioning

The MCMI®-IV overtly conceptualizes personality patterns on a new continuum, or spectrum,

ranging from adaptive to maladaptive levels of functioning.

The MCMI-IV personality patterns, or scale spectrums, capture the patient's broad range of

personality by way of three levels of personality functioning:

Normal Style: Generally adaptive personality patterns

Abnormal Traits/Type: Moderately maladaptive personality attributes

Clinical Disorder: Likelihood of greater personality dysfunction

For example: The CENarc spectrum

Normal Style: Confident

Abnormal Traits/Style: Egotistic

Clinical Disorder: Narcissistic

12 Clinical Personality Patterns

3 Severe Personality Pathology

7 Clinical Syndrome Scales

Formerly Somatoform

Formerly Bipolar: Manic

Formerly Dysthymia

Formerly Dependence

Severe Clinical Syndromes

Grossman Facet Scales

Stage 1 Interpretation

Need clinical history

Review of personality scales:

Which exceed relatively functional BR 60 level

BR 60 to 74 = personality style

Less functional BR 75 to 85 = clinically significant personality type (can be debilitating); i.e.

BR of 79 on Narcissistic implies pattern of entitlement or grandiosity

At or above BR 85 = personality disorder

Clinical Syndrome scales:

BR 75 to 84 = syndrome present

At BR 85 = syndrome prominent; can review prototypical items (appendix C) for dx

Scores below 75 should be noticed, as well as combinations (Narciss-Depend vs Narciss-ASP)

Evaluating Noteworthy Responses

Special attention items grouped into 13 categories:

Adult ADHD

Autism spectrum

Childhood abuse

Eating disorder

Emotional dyscontrol

Explosively angry

Health preoccupied

Interpersonally alienated

Prescription drug abuse

Self-destructive potential

Self-injurious behavior/tendency

Traumatic brain injury

Vengefully prone

5 Validity Scales

Evaluating validity and modifying Indices

Random Response Indicators (Scales V & W)

V (Invalidity) = 3 items for which a True response is highly implausible (Have not seen a car in 10 years)

W (Inconsistency)= 25 similar item response pairs; look for discrepancy

Index combing V and W identifies questionable or invalid protocols because of random responding

Disclosure Index (Scale X)

Frank and open (high) or reticent and secretive (low)

Both low and high scores are clinically interpretable; below 7 or above 114 = invalid

Desirability Index (Scale Y)

Inclination to appear socially attractive, morally virtuous, or emotionally composed;

BR of 75 and higher = tendency to place oneself in favorable and appealing light; higher = more concealment

Debasement Index (Scale Z)

Opposite of Scale Y; but both can be high in unusually self-disclosing

BR of 75 + = inclination to depreciate or devalue oneself; extremely high may = cry for help

Response Style considerations

Configural patterns of Scales X, Y, and Z:

Low Disclosure and Desirability and high debasement: moderate exaggeration of current

emotional problems, but does not affect validity

Low X and Y and Z high: endorses antithetical sxs and characteristics; raises validity ?; ? Of

agitated depression

Best possible light pts: low X and high Y; can have high Depend, Narciss, Compulsive

scales

Cry for help: more impaired than they are; X & Z elevated, as well as many severe scales

Stage 2 Interpretation: Exam Single Scale and Multiscale elevations and

configurations

Very rare for individual to present clinically as a pure prototype; even rarer for single personality

scale will elevate with a single clinical syndrome scale.

Single scale elevations: recommend focusing on top 3-4 highest scales & severe pathology

Greater the number of scales elevated above BR 75, the greater the extent of personality

pathology.

Severe Personality Pathology Scales:

Scales S (Schizotypal), C (Borderline) & P (Paranoid)

Start with highest elevation and work down

BR of 75 indicative of personality types that approximate DSM-5 diagnoses

BR of 85 = personality disorder

If any of these elevations are present, and are highest elevations in profile, probable DSM-5

diagnosis

Elevations of BR 60 or higher when not highest in profile – consider as “colorization” for

other scales (S – diffusion of motivating aims; C – conflict; P – immobilize and constrict

Stage 2: Clinical Personality patterns

Scales 1 thru 8B should be considered next

3 highest constitute high-point code

BR of 60 = similar to standardization sample evidencing traits of given prototype, reflecting

generally adaptive personality style with moderate or occasional difficulty

BR of 75 or 85 = less adaptive personality types or clinical personality disorders respectively

If none are elevated to BR60, protocol invalid; not for dx purposes

Multiscale Elevations and Configurations

Except where highest scale is elevated above any other to a significant degree, 2ndary scales

are always meaningful

Configural analysis: i.e. 2 high Dependent – 1 with 2nd Avoidant; 2 with 2nd Histrionic

Examine Severe Personality Pathology Elevations

These are extreme dysfunctional variants of Clinical Personality Patterns

More dysfunctional variants of schizoid and avoidant blend into schizotypal

Masochistic and sadistic blend into either borderline or paranoid

Dependent and histrionic blend into borderline

Narcissistic and antisocial blend into paranoid

Compulsive and negativistic blend into borderline or paranoid

Any elevation of Scales S, C and P may serve to colorize interpretations of other scales

Grossman Facet Scales

45 facet scales for Analysis of 15 scales: 12 Clinical and 3 Severe

Each has 3 facet scales: discriminating, salient features of larger scale aimed at therapeutic

interpretations

Must be BR of 60 +

Graph of facets of 3 highest personality scales; interpret only those with BR of 75+

Represent areas of more difficulty

Hypothesis-building tools

Interpretation:

Which of 2 primary personality scales has higher elevation and how significant

Are facets related in some meaningful way?

What are relative elevations of overlapping facets? If 2 primaries are high, look at facets.

Psychopathology Scales

BR elevations for Clinical Syndrome and Severe Clinical Syndrome scales:

BR scores 60 to 74 = suggestive but not sufficient of pathology unless they are highest scale

BR of 75 to 84 = suggest that clinical syndrome is present

BR of 85 = syndrome is prominent

Double depression = Major Depression and Persistent Depressive Disorder

Always begin with Severe Clinical Syndrome scales; meaningfully colorize the interpretation of

Clinical Syndrome scales

Stage 3 Interpretation

MCMI-IV is only 1 facet of total patient evaluation

Need psychosocial history

Special consideration for 3 scales

Research indicates that elevation on Histrionic, Narcissistic, and Compulsive Scales (4A, 5, 7) may reflect personality strengths rather than pathology

Measurement of these is psychometrically problematic, esp. because they excel at minimizing problems, denying difficulties, and presenting a favorable self picture.

Tend, at modest levels of elevation, to include traits that or normal or adaptive: sociability, self esteem, and prudence are beneficial

Shape of these 3 constructs is curvilinear: high and low levels of each are maladaptive, but modest levels are healthy.

Interpretation:

Higher the BR, more likely it is pathology

Presence of significant clinical syndrome pathology supports presence of PD

Presence of personality pathology can be judged by level of 3 Severe scales

Number of falsely keyed items from these 3 scales has been reduced from 50% on MCMI-III to 22% on MCMI-IV; makes it less likely for absence of personality pathology to elevate them.

Profile Report

The Profile Report provides base rate scores for all 28 scales in an easy-to-read graph. This

report can help clinicians to quickly identify clients who may require more intensive evaluation.

Do DSM-5 diagnosis given

Interpretive Report

This report provides an in-depth analysis of personality and symptom dynamics. Written with a

therapeutic focus, the interpretive report provides the clinician with a foundation upon which

treatment plans can readily be made and includes action-oriented suggestions for therapeutic

management.

This report also provides:

Patient's demographic information

Graphic presentation of base rate scores for all scales

Listing of possible DSM-5 diagnoses and the associated ICD-10 code sets

Treatment Guide - provides short-term treatment options based on individual results

Brief Report Summary of results - helping clinicians to begin a course of treatment right

away

Administration, Scoring, Reporting

Administration, Scoring and Reporting for the MCMI-IV is available on:

Q-global® web-based scoring and reporting platform

Q Local™ software system

Q-global offers:

24/7 secure, web-based access

Portability: Q-global can be used on mobile devices such as a laptop or tablet

On-demand, reliable scoring and comprehensive reporting solutions

Pricing on a per-report basis

Mail-in Scoring is also available for the MCMI-IV.

Survival

Nurturance

State of Being

Motivating Aims of Personality: 3 basic Polarities

See page 43 of manual of Table 4.1: Polarity Structure of Personality Prototypes

MCMI: Strengths

Relatively brief, easy to administer

Easy computer-scoring

Good reliability

Tied to Millon’s theory

Tied to DSM-V dx (including PD)

Use of base rates

Some research support (manual lists 500 studies; but none presented)

MCMI: Limitations

Difficult to score by hand

Descriptions and predictions are more theoretically than empirically based

Tied to Millon’s personality theory

Interpretation, especially of Axis I disorders, is not as easy as it looks

Sample Report

Sample Report