The MMPI - summary of part of chapter 7 of Handbook of psychological assessment

Groth-Marnat, G. Handbook of Psychological Assessment, Wiley, Pagina 213-226, 240-269, 295-297, 302-304

Chapter 7. Minnesota Multiphasic Personality Inventory

Introduction

The Minnesota Multiphasic Personality Inventory (MMPI) is a standardised questionnaire that elicits a wide range of self-descriptions scored to give a quantitative measurement of an individual’s level of emotional adjustment and attitude toward test taking.

The MMPI test format consisted of affirmative statements that could be answered ‘True’ or ‘False’.

The original MMPI had 13 scales. The recent MMPI-2 and MMPI-A have maintained the original 10 clinical/personality scales as well as the original 3 validity scales. The total number of validity scales has been increased.

The clinical and personality scales are known by their scale numbers and scale abbreviations. Additional options are available to refine the meaning of the clinical scales as well as provide additional information 1) content scales, scales based on item content 2) Harris-Lingoes subscales, for the clinical and personality scales based on clusters of content-related items 3) critical scales, assessment of items and item clusters that relate to relevant dimensions 4) supplementary scales, empirically derived new scales.

The content for the majority of MMPI questions are relatively obvious and deal largely with psychiatric, psychological, neurological, or physical symptoms. Some questions are psychologically obscure because the underlying process they are assessing is not intuitively obvious.

After a test profile has been developed, the scores are frequently arranged or coded in a way that summarizes and highlights significant peaks and valleys. To accurately interpret the test, both the overall configuration of the different scales and the relevant demographic characteristics of the client must be taken into consideration. In many instances, the same scaled score on one test profile can mean something quite differently on another person’s profile when the elevations of lowerings of other scales are considered.  

The scales represent measures of personality traits rather than simply diagnostic categories. It is useful to consider that the scales indicate clusters of personality variables.

History and development

The MMPI was developed to be an aid in assessing adult patients during routine psychiatric case workshops and could accurately determine the severity of their disturbances. The developers were interested in developing an objective estimate of the change produced by psychotherapy or other variables in the patient’s life.

Empirical criterion keying refers to the development, selection, and scoring of items within the scales based on some external criterion of reference. If a clinical population was given a serious of questions to answer, the individuals developing the test would select questions for inclusions or exclusion based on whether this clinical population answered differently form a comparison group.

The original resulting 504 statements were considered to be clear, readable, not duplicated, and balanced between positive and negative wording. The items were extremely varied and purposely designed to tap as wide a number of areas in an individual’s life as possible. The questions were administered to different groups of normal and psychiatric patients so their responses could be compared. Each item that correctly differentiated between the group was included in the resulting clinical scale. This was done twice.

A scale for masculinity and introversion were also developed.

It became apparent that persons could alter the impression they made on the test. Scales that would detect the types and magnitude of different test-taking attitudes most likely to invalidate the other Clinical scales were developed: 1) cannot say, the total number of unanswered questions 2) lie, a naieve and unsophisticated effort on the part of the examinee to create an overly favourable impression. These are items that indicate a reluctance to admit to even minor personal shortcommings 3) infrequency, Items endorsed by fewer than 10% of normal. They reflect a high number of unusually deviant responses 4) correction, an examinee’s degree of psychological defensiveness. Items were selected by comparing the responses of known psychiatric patients who still produced normal MMPIs with ‘true’ normals who also produced normal MMPIs.

 Since the publication of the MMPI, numerous adjunctive approaches to interpretation have been developed.

Criticisms of the original MMPI have primarily centred on its: 1) growing obsolescence 2) difficulties with the original scale construction 3) inadequacy of its standardization sample 4) difficulties with many of the items; sexist wording, possible racial bias, archaic phrases and objectionable content. These criticisms led to an standardization.

The MMPI-2 differs from the older test in a number of ways: 1) the T scores that subjects obtain are not as deviant as those from the earlier version 2) the T scores were designed to produce the same range and distribution throughout the traditional Clinical Scales 3) The percentile distributions are uniform throughout the different Clinical scales 4) The traditional scales can be derived from the first 370 items, and the remaining 197 provide different supplementary, content and research measures 5) a number of new scales 6) an extensive research base has accumulated related to areas such as the validity of code systems, use with special populations, the ability to distinguish over- or underresponding of symptoms, and comparability between the MMPI, MMPI-2 and MMPI-A.

The original MMPI produced different scale elevations for adolescents than for adults. This resulted in the development of different sets of recommended norms for use with adolescent populations. Even then, there were difficulties: 1) it was too long 2) the reading level was too high 3) there was a need for contemporary norms 4) more of the content needed to assess problems specifically related to adolescents 5) some of the language was outmoded/inappropriate.

The MMPI-Adolescent (MMPI-A) was made. Differences were: 1) 58 items were deleted from the original standard scales 2) some of the wording of items were changed 3) new items relevant to adolescent concerns were included 4) the inclusion of four new validity scales, six supplementary scales and content scales.

Reliability and validity

The original MMPI had moderate levels of temporal stability and internal consistency.

The MMPI-2 has moderate test-retest reliabilities. These were calculated for a narrow population over short-term retesting intervals.

One difficulty with the MMPI(-2) lies in the construction of the scales themselves. The intercorrelations between many of the scales are quite high, which results from the extensive degree of item overlap. Sometimes the same items will be simultaneously used for the scoring for different scales, and most of the scales have a high proportion of items common to other scales. The factors are not highly differentiated.

The different scales correlate so high, in part, because the original selection of the items for inclusion in each scale was based on a comparison of normal with different clinical groups. The items were selected based on their differentiation of normal from various psychiatric populations, rather than on their differentiation of one psychiatric population from another. The scales are filled with many heterogenous items that measure multidimensional, often poorly defined attributes.

For complex, multidimensional variables such as pathological syndromes, important relationships would be expected with other similar constructs.

An issue related to MMPI(-2 –A) scale multidimensionality is that elevations can often occur for a variety of reasons. To enhance the likelihood of accurate interpretations, practitioners need to carefully evaluate the meanings of scale elevations.

There is an imbalance  in the number of true and false items. The danger of this imbalance is that persons having response styles of either acquiescing (yes-saying) or disagreeing (nay-saying) may answer according to their response style rather than the content of the items. It would be better if a balance between true and false items were used.

The difficulties associated with reliability and scale construction have led to changes to the MMPI’s validity.

Individual clinicians can consult research on code types to obtain specific personality descriptions and learn of potential problems to which a client may be susceptible.

The MMPI-2 has good incremental validity.

Assets and limitations

The original MMPI doesn’t provide much information n related to normal populations. Items were selected on the basis of their ability to differentiate a bimodal populations of normal from psychiatric patients. Extreme scores can be interpreted with a high degree of confidence, but moderate elevations must be interpreted with appropriate caution.

An elevation in the range of one standard deviation above the mean is more likely to represent an insignificant fluctuation of a normal population than would be the case if a normally distributed group had been used.

Issues have been raised regarding the comparability between the MMPI and the MMPI-2. There are many similarities in format, scale descriptions, and items. Studies have found that there are few differences based on individual scale comparisons The use of the restandardization norms and the use of uniform T scores have created differences in two-point codes among different population samples
Special care should be taken regarding poorly defined code types. If more than two scales are elevated, the meaning of the relatively high scales not included in the core should be given interpretive attention.

Research has found that scores on the MMPI-2 predict the same sorts of behaviours that were found in the MMPI.

Difficulties with MMPI studies include: 1) some studies have tried to be extremely inclusive in deciding which codes to evaluate, others have not  2) the mean effect size across studies was variable. These vary among different scales and code types.

In all versions of the MMPI, the scale labels can be misleading because they use traditional diagnostic categories. Clinicians should become aware of the current meanings of the scales based on research rather than the meanings implied by the often misleading titles. This can be aided by using scale numbers instead of titles.

A complicating aspect of the MMPI is that interpretations often need to take into account many demographic variables. The same elevations of profiles can have quite different meanings when corrections are made for demographic variables.

Age

Typically, elevations occur on scales 1 and 3 for older normal populations, and scales F, 4, 6, 8, and 0 are elevated for adolescent populations. These patterns have been accounted for in the MMPI-A by suing separate norms.

The left side of the profile increases with age, and the right side decreases.

Validity scales

The validity scales are able to effectively detect faking. A concern is that a wide range of cut-off scores are recommended depending on the group being assessed.

The ? scale (cannot say (Cs)

The ? scale represents the number of items left unanswered on the profile sheet.   If 30 or more items are left unanswered, the protocol is most likely invalid.

To minimize the number of ‘cannot say’ responses, the client should be encourage to answer all questions.

A high number of unanswered questions can occur for a variety of reasons.

VRIN (variable response inconsistency scale)

The VIRN scale comprises pairs of selected questions that would be expected to answered in a consistent manner if the person is approaching the testing in a valid manner. Each pair of items is either similar or opposite in content. Similar items would be answered in the same direction and the other way around.

A high number of inconsistent responses suggests indiscriminate responding.

If VRIN is high along with a high F, this suggests that the person has answered in a random manner. A low or moderate VRIN accompanied by high F suggests that the person was either severely disturbed, or intentionally attempting to exaggerate symptoms.

TRIN (True response inconsistency scale)

 The VRIN Scale comprises of pairs of items. Only pairs of opposite contents are included. Acquienscence and denying is measured.

High F accompanied by high TRIN suggests indiscriminate responses. High F and low to moderate TRIN suggest either excessive pathology or an exaggeration of symptoms.

The F scale (infrequency)

The F scale measures the extent to which a person answers in an atypical and deviant manner. The MMPI(-2) scale items were selected based in their endorsement by less than 10% of the population. They reflect non-conventional thinking. The items do not cohere around any particularly trait or syndrome.

High scores on F are typically accompanied by high scores on many of the clinical scales. High scores can often be used as a general indicator of pathology. They can also reflect unusual feelings caused by some specific life circumstance to which the person is reacting.

In general, moderate elevations represent an openness to unusual experiences and possible psychopathology. It is not until extreme elevations that an invalid profile is suspected.

High scores on F

MMPI-2 scores approximating 100 or greater suggest an invalid profile.

Different recommendations for indicating an invalid profile have been provided for each of these groups.

Low scores on F

Low scores on F indicate that clients perceive the world as most other people do. If their history suggests pathology, they might be denying difficulties. This distinction might be made by nodding the relative elevation on K and L.

Fb (F back) scale (MMPI-2); F1 and F2 (MMPI-A)

The MMPI-2 Fb was developed to identify a ‘fake bad’ mode of responding. IT was developed in the same manner as the F scale, in that items with low endorsement frequency were included.

High scores suggests the person was answering the items in an unusual mode.

The MMPI-A includes a 66-item F scale that is divided into F1 and F2 subscales. F1 relates to the standard Clinical scales. F2 relates to the supplementary and clinical scales. They can be interpreted the same way as for F and Fb.

The Fp (infrequency-psychopathology) scale

There is a set of items developed that were infrequently answered even by psychiatric inpatients. High scores on Fp can potentially identify persons who are faking bad even if they are psychiatric patients.

The L (lie) Scale

The L or lie scale consist of 15 items that indicate the extent to which a client is attempting to describe him- or herself in an unrealistically positive manner. High scorers describe themselves in an overly perfectionistic and idealized manner.

The items consist of descriptions of relatively minor flaws to which most people are willing to admit.

High scores on L

Evaluating whether an L scale is elevated requires that the person’s demographic characteristics first be considered.

An high score may indicate the person is describing him or herself in an overly favourable light.

Low scores on L

Low scores suggest that clients were frank and open regarding their responses to the items. It may also be sarcastic and cynical.

The K (correction) scale

The K scale was designed to detect clients who are describing themselves in overly positive terms. It is more subtle and effective than the L scale.

Moderate scorers often have good ego strength, effective emotional defences, good contact with reality and excellent coping skills.

High scores on K

High scores on K suggest that clients are attempting to describe themselves in an overly favourable light or deny their difficulties, or that they answered false to all items.

Moderate scores on K

Moderate scores suggest moderate levels of defensiveness, as well as a number of potential positive qualities.

Low scores on K

Low scores suggest a fake bad profile in which the person exaggerates his or her pathology. It might also suggest a protocol in which all the responses have been marked true.

The F-K index (dissimulation index)

The differences between scores on F and K have been used to provide an index of the likelihood that a person is producing an invalid profile. This index can be determined by subtracting the raw score on K from the raw score on F.

The S (superlative) scale

The S scale was developed in the hopes that it might more accurately identify those persons attempting to appear overly virtuous.

The scale was developed by noting the differences in item endorsement between persons in an employment situation who were likely to be presenting themselves in an extremely favourable light and the responses of the normative sample.

For the moment is should be considered an experimental scale.

Clinical scales

Scale 1. Hypochondriasis (Hs)

Scale 1 was developed to distinguish hypochondriacs from other types of psychiatric patients. It is most useful as a scale to indicate a variety of personality characteristics that are often consistent with, but not necessarily diagnostic of, hypochondriasis.

High scorers show: 1) a high concern with illness and disease 2) likely to be egocentric, immature, pessimistic, sour, whiny, passive-aggressive 3) rarely act out directly 4) complaints are usually related to a wide variety of physical difficulties. A purpose is to manipulate and control others. 

Individuals with elevations on Scale 1 would be likely to reset any suggestion that their difficulties are even partly psychologically based. Their level of insight is poor. They typically don’t make good candidates for psychotherapy. They need to be assured that they have been well understood and that their symptoms will not be ignored. Framing interventions with biomedical terminology may make interventions more acceptable.

Scale 2. Depression (D)

Scale 2 is organized around the areas of brooding, physical slowness, subjective feelings of depression, mental apathy, and physical malfunctioning. High scores may indicate difficulties in one or more of these areas.

Elevations on 2 typically decrease after successful psychotherapy.

The relative elevation on scale 2 is the best predictor of a person’s level of satisfaction, sense of security, and degree of comfort.

Any interpretation of scores on 2 needs to take into account the person’s age and the implications of possible elevations on other scales.

The neurotic triad occurs when 1, 2, and 3 are elevated. This suggest that the person has a wide variety of complaints. An additional elevation on scale 7 suggests that the self-criticalness and intropuitiveness also includes tension and nervousness. If scale 2 and 8 are elevated, it suggests that the depression is characterized by unusual thoughts, disaffiliation, isolation, and a sense of alienation.

Moderate elevations on 2 might suggest a reactive depression.

An important consideration is whether external or internal factors are responsible for the depression. The client should be further assessed to determine the relative contribution of cognitions, social support, and the prevalence of vegetative symptoms. An elevation on 2 raises the possibility of suicide.

Low scores don’t indicate an absence of depression, but that the person is likely to be cheerful, optimistic, alert, active, and spontaneous.

Scale 3. Hysteria (Hy)

Scale 3 was originally designed to identify patients who had developed a psychogenically based sensory or motor disorder. The items primarily involve specific physical complaints and a defensive denial of emotional or interpersonal difficulties. They are quite specific.

The important feature of persons who score high on this scale is that they simultaneously report specific physical complaints but also use a style of denial In which they may even express an exaggerated degree of optimism. One of the important and primary ways in which they deal with anxiety and conflict is to channel or convert these difficulties onto the body. Their traits might be consistent with a histrionic personality in that they will demand affection and social support in an indirect and manipulative manner.

Analysis has divided scale 3 into: 1) denial of social anxiety 2)need for affection 3)  lassitude-mailaise 4) somatic complaints 5) inhibition of aggression

If scale K is also elevated, the person is likely to be inhibited, affiliative, overconventional, and to have an exaggerated need to be liked and approved by others.

High scores are likely to have specific functionally related somatic complaints. Their insight about their behaviour will be low as they both deny difficulties and have a strong need to see themselves in a favourable light.

The initial response to therapy is likely to be enthusiastic and optimistic, at least in part because the clients have strong needs to be liked. They will be slow to gain insight into the underlying motives for their behaviour because they use extensive denial and repression, typically denying the presence of any psychological problems.

Low scores on scale 3 might be consistent with persons who are narrow-minded, cynical, socially isolated, conventional, constricted, and controlled. They might have a difficult time trusting others and be difficult to get to know.

Scale 4. Psychopathic deviate (Pd)

The purpose of scale 4 is to assess the person’s general level of social adjustment. The questions deal with areas such as 1) degree of alienation from family 2) social imperviousness 3) difficulties with school and authority figures 4) alienation form self and society.

High scorers might not be engaged in acting out at the time of testing. Under stress or when confronted with a situation that demands consistent, responsible behaviour, they would be expected to act out in antisocial ways. These persons have a difficult time learning form their mistakes.

If scales 4 and 9 are elevated, it indicates that the persons not only have an underlying sense of danger and impulsiveness, but also have the energy to act on these feelings. A high 3 and 4 suggests that antisocial behaviour might be expressed in covert or disguised methods or that the person might even manipulate another person into acting out for him. Elevations on 2 and 4 suggest that the person has been caught performing antisocial behaviour and is feeling temporary guilt and remorse.

The difficulty in profiting from experience extends to difficulties in benefiting from psychotherapy.

Because persons scoring high on 4 are usually verbally fluent, energetic, and intelligent, they might initially be perceived as good candidates for psychotherapy. However, their underlying hostility, impulsiveness, and feelings of alienation eventually surface. They are likely to blame others for problems they have. They will eventually resist therapy and terminate as soon as possible. Long-term prognosis in therapy is poor. Short-term goals would be indicated.

Low scores reflect persons who are overcontrolled, self-critical, rigid, conventional, and over identified with social status. They might be balanced, cheerful, persistent, and modest, but somewhat passive.

Scale 5. Masculinity-femininity (Mf)

This scale was originally designed to identify males who were having difficulty with homosexual feelings and gender-identity confusion. It has been largely unsuccessful. A high score seems to relate to the degree to which a person endorses items related to traditional masculine or feminine roles of interest. A high score for males is positively correlated with intelligence and education. The item content seems to be organized around: 1) personal and emotional stability 2) sexual identification 3) altruism 4) feminine occupational identification 5) denial of masculine occupations.

The items are scored in the opposite direction for females.

Since the original development, considerable change has occurred in society regarding the roles and behaviours of males and females. This has caused challenges in to the validity. Clinicians must make scale 5 interpretations quite cautiously, particularly for females.

Scale 5 is not an actual clinical scale. It doesn’t actually assess any pathological syndromes and thus doesn’t provide clinical information. It can be useful in providing colour or tone to the others scales. Interpretations should first be made of the other scales and then the meaning of the relative score on scale 5 should be taken into consideration.

A high scale 5 for males should never be used to diagnose homosexuality. High-scoring males are more likely to 1) has aesthetic interest 2) sensitivity to others 3) a wide range of interests 4) tolerance 5) passivity 6) capable of expressing warmth.

Females who lack much education and score low on 5 are usually passive, submissive, modest, sensitive, and yielding. Highly educated females who score the same are likely to be intelligent, forceful, considerate, insightful, conscientious, and capable.

High scores for males have traditionally been interpreted as suggesting that they are likely to be undemanding, shy, emotional, curious, and creative, with a wide range of intellectual interests.

Extremely high scores might suggest males who are effeminate, passive, experience homoerotic feelings, and have difficulty asserting themselves.

Moderate scores in males suggest that the individual is insightful, sensitive and introspective, all of which are qualities conductive to psychotherapy. A high 5 reduces the likelihood that any existing pathology will be acting out. With increasing elevations, there are likely issues related to passivity, dependency, impracticality, dealing with anger and heterosexual adjustment. Low-scoring men may have difficulties with psychotherapy because of low verbal skills, narrow interests and lack of originality . They will prefer action over contemplation.

High scores for females means the opposite as it would for males. High-scoring females would be endorsing traditionally masculine interests and activities. As scale elevation increases, they correspondingly might be more aggressive, tough-minded, and domineering.

High-scoring females might be difficult to engage in psychotherapy because they usually do not value introspection and insight Low-scoring females who are well educated are good candidates for therapy. Low-scoring low-educated females might be more difficult to work with.

Scale 6. Paranoia (Pa)

Scale 6 was designed to identify persons with paranoid conditions or paranoid states. It measures a person’s degree of interpersonal sensitivity, self-righteousness, and suspiciousness. Many of the items centre on areas such as ideas of reference, delusional beliefs, feelings of persecution, grandiose self-beliefs and interpersonal rigidity.

Scale 6 is divided into: 1) ideas of external influence 2) poignancy (feelings of being high-strung, sensitive, having stronger feelings than others, and a sense of interpersonal distance) 3) naivete (overly optimistic, high morality, denial of hostility, overly trusting, and vulnerability to being hurt).

Mild elevations on scale 6 suggest that the person is emotional, soft-hearted, and experiences interpersonal sensitivity. As the elevation increases, a person’s suspicion and sensitivity become progressively more extreme and consistent with psychotic processes. Low-scoring persons are seen as being quite balanced. Persons scoring extremely low might actually be paranoid but are attempting to hide their processes.

The content of most of the items in this scale are fairly obvious.

A pronounced elevation on scales 6 and 8 is highly suggestive of paranoid schizophrenia, regardless of the elations on the other scales.

Extremely high scores on scale 6 indicate persons who are highly suspicious, vengeful, brooding, resentful, and angry. They will feel mistreated and typically misinterpret the motives of others, feeling that they have not received a fair deal in life. They are likely have a thought disorder with accompanying symptoms like delusional thinking.

The scale provides an index of the degree to which clients can develop a trusting relationship, their attitudes toward authority figures, and their degree of flexibility.  Very high scores suggest psychotic processes possibly requiring medication. Psychotherapy would be extremely difficult with high scoring individuals, because of the rigidity, poor level of insight, and suspiciousness. They don’t like to discuss emotional issues, overvalue rationality, and are likely to blame others for their difficulties.

Scale 7. Psychasthenia (Pt)

The items of scale 7 were designed to measure psychasthenia. This is no longer used as a diagnosis. It consistend of compulsions, obsessions, unreasonable fears, and excessive doubts. Scale 7 measures overt fears and anxieties than the person might be experiencing.

Scale 7 most clearly measures anxiety and ruminative self-doubts. It is a good general indicator of the degree of distress the person is undergoing. High scorers are likely to be tense, indecisive, obsessionally worried, and have difficulty concentrating.

If both scales 2 and 7 are moderately elevated, it suggests a good prognosis for therapy because these individuals are sufficiently uncomfortable to be motivated to change.

If 7 is significantly higher than 8, it indicates the person is still anxious about and struggling with an underlying psychotic process. If 7 is quite low in comparison to 8, the person is likely to have given up an attempt to fight.

Elevations on scale 7 suggest persons who are apprehensive, worrying, perfectionistic, and tense, who may have a wide variety of superstitious fears. Mild elevations suggest that, in addition to a certain level of anxiety, these persons will be orderly, conscientious, reliable, persistent and organized, although they will lack originality. Even minor problems might become a source of considerable concern.

Because persons scoring high on scale 7 experience clear, overt levels of discomfort, tension, and cognitive inefficiency, they are highly motivated to change. They will usually stay in therapy. Progress tend to be slow and steady.

Low scorers are likely to be relaxed, warm, cheerful, friendly, alert, and self-confident. They approach their world in a balanced manner.

Scale 8. Schizophrenia (Sc)

Scale 8 was designed to identify persons who were experiencing schizophrenic or schizophrenic-like conditions. Elevations of this scale occur for a variety of reasons. It consists of six content areas: 1) social alienation 2) emotional alienation 3) lack of ego mastery-cognitive (strange though processes, fear of losing his or her mind, difficulty concentrating, feeling of unreality) 4) lack of ego mastery-cognative (difficulty coping with everyday life, low interest in life, hopelessness, depression) 5) lack of ego mastery-defective inhibition (impulsive, hyperactive, sense of being out of control, impulsive, laughing or crying spells) 6) bizarre sensory experiences.

An elevated score on scale 8 suggests the person feels alienated, distant from social situations and misunderstood. (S)he might have a highly varied fantasy life and, when under stress, withdraw further into fantasy. They will often have a difficult time maintaining a clear and coherent line of thought.

Age and race are important in deciding what would be considered a high versus a low score on scale 8.

Simultaneously elevations on 4 and 8 indicate persons who feel extremely distrustful and alienated from their world. They perceive their environment as dangerous and are likely to react to others in a hostile and aggressive fashion. If there is an elevation on 8 and 9, the person is likely to constantly deflect the direction of conversation, frequently diverting it to unusual tangents. They are likely to have not only a distorted view of their world, but also the energy to act on these distorted perceptions.

A high score suggests persons who have unusual beliefs, are unconventional, and may experience difficulties concentrating and focusing their attention.

Because high-scoring persons have difficulty trusting others and developing relationships, therapy might be difficult, especially during its initial stages. Such individuals tend to stay in therapy longer and may eventually develop a relatively close and trusting client/therapist relationship. Because of the often-chronic nature of their difficulties, their prognosis is frequently poor. If thought processes are extremely disorganized, referred for medication might be indicated.

Persons scoring low in scale 8 are likely to be cheerful, good-natured, friendly, trustful, and adaptable. They are also likely to be overly accepting of authority, restrained, submissive, unimaginative, and avoid deep relationships.

Scale 9. Hypomania (Ma)

Scale 9 was developed to identify persons experiencing hypomanic symptoms. These might include cyclical periods of euphoria, increased irritability , and excessive unproductive activity that might be used as a distraction to stave off an impending depression.

The subscales are: 1) amorality 2) psychomotor acceleration 3) imperturbability 4) ego inflation.

Hypomania occurs in cycles.

The scale is effective in identifying persons with moderate manic conditions (extreme manic patients are untestable). 10 to 15% of normals have elevations on this scale.

Age and race are important when evaluating what would be considered a high or low score.

Usually 9 and 2 are negatively correlated. Sometimes they can both be elevated, reflecting an agitated state in which the person is attempting to defend or distract him or herself from underlying hostile and aggressive impulses.

Extremely high scores are suggestive of a moderate manic episode.

Persons with more moderate elevations are often more able to focus and direct their energy in productive directions.

Because elevation on scale 9 indicates distractibility and over-activity, these clients may be difficult to work with.  They have a low tolerance for frustration and become easily irritated.

Persons with low scores on scale 9 are likely to have low levels of energy and activity.

Scale 0. Social introversion (Si)

This scale was developed from the responses of college students on questions relating to an introversion-extraversion continuum. It was validated based on the degree to which the students participated in social activities. High scores suggest that the respondent is shy, has limited social skills, feels uncomfortable ins social interactions, and withdraws from many interpersonal situations.

One cluster deals with self-depreciation and neurotic maladjustment. The other group deals with the degree to which the person participates in interpersonal interactions.

The different item contents have been organised around areas of 1) shyness/self-consciousness 2) social avoidance 3) the extent that a person feels alienated form self and others.

Scale 0 is used to colour or provide a different emphasis to the other clinical scales.

A low 0 suggests that, even if persons have a certain level of pathology, they are able to find socially acceptable outlets for these difficulties. A high 0 suggests an exaggeration of difficulties indicated by the other scales.

Persons scoring high on scale 0 will feel uncomfortable in group interactions and may have poorly developed social skills.

The relative elevation on 0 is potentially quite useful in treatment planning because it provides an index of the individual’s degree of social comfort, inhibition, and control in relationships. Group treatment and social skills training are often appropriate in high scoring individuals.

Low scorers on scale 0 are described as warm, outgoing, assertive, self-confident, verbally fluent and gregarious. They have strong needs to be around other people. Extremely low scores indicate that individuals have developed techniques like hiding behind their external image.