The Millon Clinical Multiaxial Inventory

A Clinical Research Information Synthesis

Robert J. Craig

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780805811452
• eBook ISBN:
  9781134770779
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This book presents state-of-the-art information on both the scientific and clinical aspects of the Millon Clinical Multiaxial Inventory, a test that uniquely assesses both personality pathology and psychopathology. The book presents original contributions from major researchers/clinicians who have published seminal papers on the MCMI and who are recognized authorities in their specific areas. Clinical examples of the MCMI with a variety of clinical populations are provided, and many chapters summarize the research in that area as well as present clinical illustrations of the MCMI with actual cases.

The book provides the reader with the most accurate information on the MCMI -- a test that has made exciting advances in the assessment of personality and psychopathology. The scientific and clinical status of this instrument is presented with a variety of clinical populations, including major psychiatric disorders, depression, substance abuse, anxiety disorders, eating and stress disorders, etc. Recent applications and advances in special areas, such as the instrument's use with medical populations and non-clinical populations, are also presented.

I

Introduction

1

The Millon Clinical Multiaxial Inventory: An Introduction to Theory, Development, and Interpretation

Robert C. McMahon, Ph.D.

The Millon Clinical Multiaxial Inventory (MCMI) is increasingly recognized as a major differential diagnostic instrument. It is now widely used in clinical practice and increasingly used in research settings. The popularity of the MCMI apparently derives from a number of factors including its anchorage to Millon’s (1969, 1981) comprehensive theory of personality and psychopathology and its coordination with DSM-III and DSM-HI-R personality disorder and clinical symptom syndrome categories. Approximately 200 papers have been published which deal with the various aspects of the reliability, validity, and clinical utility of the MCMI. These studies have been exceedingly useful in clarifying the strengths and limitations of this popular inventory and, together with the careful development and validation effort documented in the MCMI manual, provided the foundation upon which its clinical usefulness should be judged.

The following chapter: (a) presents an overview of Millon’s (1969, 1981) model which served as the theoretical framework upon which the MCMI was constructed, (b) summarizes development and standardization efforts connected with the original and revised versions of the MCMI, (c) describes clinical characteristics associated with MCMI-II scale elevations and the use of validity scales, and (d) provides a brief overview of recommended clinical interpretive procedures. Much of what is presented was drawn from several of Millon’s major published works including Modern Psychopathology (Millon, 1969), Disorders of Personality (Millon, 1981), -4 Theoretical Derivation of Pathological Personalities (Millon, 1986a), Personality Prototypes and Their Diagnostic Criteria (Millon, 1986b), Toward a New Personology: An Evolutionary Model (Millon, 1990), and the Manual for the MCMI-II (Millon, 1987). The interested reader should consult these sources which provide in-depth presentations of Millon’s theoretical model, and in the case of the Manual, a carefully detailed presentation of MCMI I and MCMI-II development and standardization procedures.

Normal and Pathological Personalities

Millon (1981) conceives of personality as an organized pattern of deeply embedded, largely unconscious, psychological characteristics that are revealed in most significant aspects of life functioning. These characteristics develop as a result of interacting biological dispositions and social learning experiences and ultimately form a well organized psychic system of stable structures and coordinated functions (Millon, 1981, 1986a). This system of interconnected perceptions, regulatory mechanisms, feelings, thoughts, and behaviors provides a framework for structuring how the individual interacts with his environment and relates to himself (Millon, 1986a; Millon & Everly, 1985).

Millon (1981, 1986a) argues that normal and pathological personality styles derive from the same developmental influences. It is assumed to be “differences in the character, timing, and intensity of these influences which lead some individuals to acquire pathological traits and others to acquire adaptive traits” (Millon, 1981, p.9). Although no clear discontinuity exists between normal and pathological personality styles, several features are argued to be useful as differentiating criteria (Millon, 1969, 1981, 1986a). First, normal personalities are capable of meeting social responsibilities, achieving goals, and coping with inevitable stressors in a manner that is flexible and which leads to personal satisfaction and goal attainment. Pathological personalties, in contrast, tend to have few developed capacities for coping with the demands of life. What skills they do have tend to be applied inflexibly and in situations in which they are inappropriate. Second, normal personalities are relatively free from dysfunctional cognitions, defense mechanisms, and behaviors that foster vicious circles and intensify preexisting difficulties. In contrast, pathological personalities have habitually distorted cognitions and maladaptive behaviors that provoke punishing reactions from others, reactivate earlier conflicts, perpetuate and intensify ongoing difficulties, and severely limit opportunities for new learning. Finally, normal personalities demonstrate reasonable stability and resilience when subject to stressful life experiences. Pathological personalities demonstrate pronounced fragility and lack of resilience associated with the ease with which conflicts connected with troublesome past events are activated and with the meager mechanisms available to cope with both unresolved conflicts and with the impact of new difficulties (Millon, 1969, 1981, 1986a).

Personality Prototypes

Millon (1986b) identifies the construct “prototype” as potentially useful for incorporating the diverse features that comprise personality as well as the elements that differentiate personality pathology from other forms of psycho-pathology. A prototype refers to the most typically found characteristics of members of a category and represents a theoretical ideal against which potential members of that category can be evaluated. Horowitz, Post, French, Wallis, and Siegelman (1981) point out that all the elements that make up the prototype are assumed to represent at least some members of the category. However, no single element is either necessary or sufficient for membership. One consequence of this conceptual flexibility is that individuals may vary widely in the degree to which they may be considered to approximate the prototype. Individuals who possess more of the correlated features that represent the concept are considered more typical instances and are thus more readily classified. This approach to matching people with personality prototypes contrasts with the classical approach to diagnosis which involves the specification of one or more necessary or sufficient features (Millon, 1986b; Cantor, Smith, French, & Mezzich, 1980).

Millon (1986b) suggests that the prototype model is particularly appropriate to represent the “typical, pervasive, durable, and holistic features that distinguish personality categories from the more symptomatic, less widespread, frequently transient, and narrowly circumscribed clinical syndromes” (p.674). Although it is true that the prototype model allows for categorical diversity and overlap, Millon argues that it is highly desirable to clarify distinctions around the boundaries so as to reduce the number of unclassifiable and borderline cases. In an effort to accomplish this goal of enhancing diagnostic discrimination, Millon (1986b) has developed distinctive criteria for all diagnostically pertinent clinical attributes associated with each prototypical category.

Theoretical Classifications Based on Three Polar Dimensions

Millon (1969, 1981) using a biosocial learning model, drew upon three classic polar dimensions (pain-pleasure, self-other, active-passive) in constructing a classification system that yields recognized pathological personality categories and articulates their relationships with other mental disorders. In Millon’s (1986a) view, personality reflects of an organized pattern of structures and functions that operate to enhance pleasure and reduce pain, reveal whether the individual pursues these objectives primarily in self or others, and illuminate whether the individual utilizes an active or passive approach to goal attainment. Various interacting constitutional vulnerabilities and maladaptive social learning experiences result in deficiencies or imbalances in an individual’s orientation to one or more of these polarities. In Millon’s (1986a) model, these diverse dysfunctional developmental processes result in any of a number of basic maladaptive or more severely pathological personality patterns.

Millon (1981) uses reinforcement as the central construct around which his classification system is built. It incorporates the pleasure-pain dimension and reflects that drives, motivations, and emotions are ultimately aimed toward events which are attractive, pleasurable, or positively reinforcing, and away from those that are unattractive, aversive, or negatively reinforcing. Millon (1986a) argues that there are three primary ways in which pathology may exist in the nature of pain-pleasure systems. First, it is hypothesized that certain individuals experience significantly diminished capacity to experience pain or pleasure in association with life experiences. That is, both reward and punishment systems are deficient. Second, one motivational system may be abnormally prominent. That is, some individuals may show abnormal pain-responsivity while others may reveal unusual pleasure reactivity. Obviously, the more clinically relevant are those who experience many life events as aversive and few as pleasurable (Millon, 1986a). Finally, there are some individuals in whom there is a significant reversal of the pain-pleasure polarity. These individuals seek out what might be objectively negative or aversive events and experience them as rewarding.

Also central to the framework upon which the classification scheme is built is the assumption that major dimensions of personality pathology may result from disruptions or imbalances in the degree to which, or the manner in which, reinforcement is sought from self and others. Millon (1986a) emphasizes the fundamental importance of this dimension and systematically describes personality styles that involve seeking pleasure or avoiding pain by focusing excessively on self or on others. Other pathological personality patterns involve lack of ability to experience pain and/or pleasure from self or others. Finally, several personalities experience a fundamental conflict about whether to turn to self or others in efforts to seek pleasure and avoid pain.

Millon (1986a) also utilizes the active-passive dimension to define pathological aspects of personality styles. A distinction is drawn between those who are active, engaged, persistent, and initiating in their efforts to seek the rewards and avoid the punishments of life and those who are passive, detached, and acquiescent in such endeavors.

From the three polar dimensions just described, Millon (1986a) has extended his classification to 10 basic pathological personality styles defined in accordance with a 5-by-2 matrix. The classification scheme also includes three more severely dysfunctional personality variants which reflect significantly lower levels of structural cohesion and functional integrity. Each of these 13 maladaptive personality styles is represented in Table 1.1 and basic clinical features are outlined later in this chapter in association with MCMI-II scale descriptions.

Table 1.1

Theory-Based Framework for Personality Pathology

From Millon (1987) Manual for the MCMI-II. Reproduced by permission of National Computer Systems, Inc.

The Millon Clinical Multiaxial Inventory: An Overview

The original and revised versions of the MCMI were developed as measures of the basic constructs outlined in Millon’s (1969, 1981, 1986a, 1986b) theory of personality and psychopathology. Ongoing efforts have been made to refine the instrument to enhance its correspondence both with the author’s evolving theory and with various Axis I and Axis II syndromes in the DSM-HI and the DSM-III-R (American Psychiatric Association, 1980, 1987; Millon, 1987). This self-report instrument has 175 items structured in a true or false response format. Thirteen of the 22 clinical scales in the current version are designed as measures of the basic and pathological personality styles outlined in Millon’s (1981, 1986a, 1986b) theory and are designed to be coordinated with DSM-III-R Axis II personality disorder categories. The remaining 9 clinical scales are designed to measure a number of the more common Axis I clinical symptom syndromes.

This separation of pathological personality from symptom scales reflects a central feature of Millon’s theory emphasizing the distinction between features of psychopathology that are pervasive and enduring from those that are circumscribed and transient (Millon, 1987). Indeed, interpretation of the 22 clinical scales that make up the MCMI-II profile is designed to “illuminate the interplay between long-standing characterological patterns and the distinctive clinical symptomatology a patient manifests under psychic stress” (Millon, 1987, p.4).

The first 10 scales (Scales 1–8B) are used to gauge basic maladaptive personality styles, while the next three assess personality disorders reflecting greater pathology in structure and function (Scales SS, CC, and PP). Similarly, the next 6 scales (Scales A, H, N, D, B, and T) are designed to tap the less severe clinical symptom syndromes; the final 3 (Scales SS, CC, and PP) are constructed to measure more severe symptom disorders (Millon, 1987). These scales are arranged to reflect categories which are assumed to be interrelated in such a way that each may serve as a precursor, extension, or modification of another. Severe personality disorders are assumed to be extensions of basic maladaptive personality styles. Clinical symptom syndromes are conceived as disturbances in the patient’s basic personality style that emerge under conditions of perceived stress (Millon, 1987).

Development of the MCMI-I

The MCMI was developed in accordance with a sequential 3-step validation process. The first step has been labeled “theoretical-substantive” and focuses on the selection of items that reflect the content of formal theory-derived personality disorder and clinical symptom prototypes. Careful efforts were made to include items that reflect the most salient or essential characteristics relevant to each clinical prototype in the classification system. In addition, items were examined to ...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• Contributors
• Dedication
• Part I: Introduction
• Part II: Application to Special Populations
• Part III: Correspondence to DSM-III-R Disorders
• Part IV: New Developments
• Author Index
• Subject Index