Millon Clinical Multiaxial Inventory

In 1969, Theodore Millon wrote a book called Modern Psychopathology, after which he received many letters from students stating that his ideas were helpful in writing their dissertations. This was the event that prompted him to undertake test construction of the MCMI himself. The original version of the MCMI was published in 1977 and corresponds with the DSM-III. It contained 11 personality scales and 9 clinical syndrome scales.[6]

With the publication of the DSM-III-R, a new version of the MCMI (MCMI-II) was published in 1987 to reflect the changes made to the revised DSM. The MCMI-II contained 13 personality scales and 9 clinical syndrome scales. The antisocial-aggressive scale was separated into two separate scales, and the masochistic (self-defeating) scale was added. Additionally, 3 modifying indices added and a 3-point item-weighting system introduced.

The MCMI-III was published in 1994 and reflected revisions made in the DSM-IV. This version eliminated specific personality scales and added scales for depressive and PTSD bringing the total number of scales to 14 personality scales, 10 clinical syndrome scales, and 5 correction scales. The previous 3-point item-weighting scale was modified to a 2-point scale. Additional content was added to include child abuse, anorexia and bulimia. The Grossman Facet scales are also new to this version. The MCMI-III is composed of 175 true-false questions that reportedly take 25–30 minutes to complete.[7]

The MCMI-IV was published in 2015. This version contains 195 true-false items and takes approximately 25–30 minutes to complete.[1] The MCMI-IV consists of 5 validity scales, 15 personality scales and 10 clinical syndrome scales. Changes from the MCMI-III include a complete normative update, both new and updated test items, changes to remain aligned to the DSM-5, the inclusion of ICD-10 code types, an updated set of Grossman Facet Scales, the addition of critical responses, and the addition of the Turbulent Personality Scale.

The personality scales are associated with personality patterns identified in Millon's evolutionary theory and the DSM-5 personality disorders. There are two main categories of personality scales: Clinical Personality Pattern Scales and Severe Personality Pathology Scales. Each of the personality scales contain 3 Grossman Facet Scales for a total of 45 Grossman Facet Scales. When interpreting the personality scales, the authors recommend that qualified professionals interpret the Severe Personality Pathology scales before the Clinical Personality Pattern scales as the pattern of responding indicated by the Severe Personality Pathology scale scores may also affect the scores on the Clinical Personality Pattern scales (i.e. if an individual scores high on the Severe Personality Pathology scale P (Paranoid), this may also explain the pattern of scores on the Clinical Personality Pattern scales).[1]

The Grossman Facet Scales were added to improve the overall clinical utility and specificity of the test, and attempt to influence future iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The hope was the DSM would adopt the prototypical feature identification method used in the MCMI to differentiate between personality disorders.[8]

There are three facet scales within each of the Clinical Personality Patterns and Severe Personality Pathology scales. Each facet scale is thought to help identify the key descriptive components of each personality scale, making it easier to evaluate slight differences in symptom presentations between people with elevated scores on the same personality scale. For instance, two profiles with an elevated score on the Borderline scale may have differences in their Temperamentally Labile facet scale scores. This would mean, for clinical treatment or assessment planning, you could have a better understanding of how quickly and spontaneously a person's mood may change, compared to others with elevated Borderline scale scores.[8][9]

There are also some noteworthy limitations of the Grossman facet scales. The MCMI personality scales share some of the same test items, leading to strong intercorrelations between different personality scales. Additionally, each facet consists of less than 10 items and the items are often similar to ones in other facets of the same personality scale. Thus, it is unclear how much a facet measures a unique component of a personality scale.[10] Furthermore, statistical analysis has found some items within the facet scales may not be consistently measuring the same component as other items on that scale, with some item alpha coefficients as low as .51.[10] For these reasons it is recommended to use supplemental information, in addition to that provided by the facet scales, to inform any assessment or treatment decisions.[10]

10 Clinical Syndrome Scales correspond with clinical disorders of the DSM-5. Similar to the personality scales, the 10 clinical syndrome scales are broken down into 7 clinical syndrome scales (A-R) and 3 severe clinical syndrome scales (SS-PP). When interpreting the clinical scales, the authors recommend that qualified professionals interpret the Severe Clinical Syndrome scales before the Clinical Syndrome scales as the pattern of responding indicated by the Severe Clinical Syndrome scale scores may also affect the scores on the Clinical Syndrome scales (e.g. if an individual scores high on the Severe P scale Clinical Syndrome scale score (e.g. Thought Disorder), this may also explain the pattern of scores on the other Clinical Syndrome scales).[1]

The modifying indices consist of 3 scales: the Disclosure Scale (X), the Desirability Scale (Y) and the Debasement Scale (Z).

These scales are used to provide information about a patient's response style, including whether they presented themselves in a positive light (elevated Desirability scale) or negative light (elevated Debasement scale). The Disclosure scale measures whether the person was open in the assessment, or if they were unwilling to share details about his/her history.

These two scales assist in detecting random responding. In general, the Validity Scale (V) contains a number of improbable items which may indicate questionable results if endorsed. The Inconsistency Scale (W) detects differences in responses to pairs of items that should be endorsed similarly. The more inconsistent responding on pairs of items, the more confident the examiner can be that the person is responding randomly, as opposed to carefully considering their response to items.

The first stage was a deductive approach and involved developing a large pool of items. 245 new items were generated by the authors in accordance with relevant personality research, reference materials, and the current diagnostic criteria. These items were then administered to 449 clinical and non-clinical participants.[1] The number of items was reduced based on a rational approach according to the degree to which they fit Millon's evolutionary theory. Items were also eliminated based on simplicity, grammar, content, and scale relevance.

Once the initial item pool was reduced after piloting, the second validation stage assessed how well items interrelated, and the psychometric properties of the test were determined. 106 items were retained and administered along with the 175 MCMI-III items. The ability of the MCMI items to give reliable indications of the domains of interest were examined using internal consistency and test-retest reliability. Internal consistency is the extent to which the items on a scale generally measure the same thing. Cronbach’s alpha values (an estimate of internal consistency) median (average) values were .84 for the personality pattern scales, .83 for the clinical syndrome scales, and .80 for the Grossman Facet Scales.[1] Test-retest reliability is an estimate of the stability of the responses in the same person over a brief period of time. Examining test-retest reliability requires administering the items from the MCMI-IV at two different time periods. The median testing interval between administrations was 13 days.[1] The higher the correlation between scores at two time points, more stable the measure is. Based on 129 participants, the test-retest reliability of the MCMI-IV personality and clinical syndrome scales ranged from .73 (Delusional) to .93 (Histrionic) with a most values above .80.[1] These statistics indicate that the measure is highly stable over a short period of time; however, no long-term data are available. After examining the psychometrics of these "tryout" items, 50 items were replaced, resulting in 284 items that were administered to the standardization sample of 1,547 clinical patients. [1]

The final validation stage included examining convergent and discriminative validity of the test, which is assessed by correlating the test with similar/dissimilar instruments. Most correlations between the MCMI-IV Personality Pattern scales and the MMPI-2-RF (another widely used and validated measure of personality psychopathology) Restructured Clinical scales were low to moderate. Some, but not all, of the MCMI-IV Clinical Syndrome scales were correlated moderately to highly with the MMPI-2-RF Restructured Clinical and Specific Problem scales. The authors describe these relationships as "support for the measurement of similar constructs" across measures and that the validity correlations are consistent with the "argument that the two assessments are best used complimentarily to elucidate personality and clinical symptomatology in the therapeutic context" (pg. 77).[1]

The MIPS Revised was published in 2003 and was created for individuals 18 years of age or older. The purpose of the MIPS is to assess the personality of adults with typical functioning and is often used for counseling and employment screening. The test consists of 180 true-false questions and evaluates an individual on four sets of scales: thinking styles, behaving styles, motivating styles, and validity indices.[13]

The MAPI was published in 1986 as an update of the Millon Adolescent Inventory (MAI) and contains 150 true-false questions. It is intended to be used with both normally functioning adolescents ages 13 to 18 years, and those who are receiving clinical services. This inventory assesses personality characteristics on four groups of scales: personality styles, expressed concerns, behavioral correlates, and validity indices.[14]

The MACI was published in 1993 as a supplement to the MAPI. This inventory was created for teenagers 13–19 years of age; however, it is intended specifically for clinical populations. Four groups of scales are included: clinical syndromes, expressed concerns, personality patterns, and modifying indices. The MACI consists of 160 true-false questions.[14]

The M-PACI was published in 2005 and is intended to assess personality characteristics in clinical populations of pre-adolescent children. It is intended for individuals who are 9 to 12 years of age and contains 97 true-false questions. M-PACI scale sets include emerging personality patterns, current clinical signs, and response validity indicators.[13]

The MCCI was published in 2006 as an assessment of personality specifically geared towards college students, ages 16 to 40. This inventory is used with typically functioning students and is often administered at college counseling centers. The MCCI consists of 150 items, and unlike the other Millon inventories, responses are rated on a Likert scale. The sets of scales include personality styles, severe personality tendencies, expressed concerns, clinical signs, and response issues.[13]

The MBMD was published in 2001 as an assessment for chronically ill adults, ages 18 to 85 years. The purpose of this test is to assess various patient factors that may affect treatment for a medical condition. It consists of 165 true-false questions and evaluates patients on seven groups of scales: negative health habits, psychiatric indications, coping styles, stress moderators, treatment prognostics, management guide, and response patterns.[15]