Genetic Inheritance and Gene Expression Part 1

The MMPI-2 I. MMPI-2 A. Administration 1) give the booklet to the client and read the instructions to him/her 2) if the protocol is to be computer scored, be sure the client completely fills in the dots a. not so much of a consideration if you are hand-scoring (which we are because we are not rich enough to computer score the protocols) 3) client doesn’t have to complete the MMPI in 1 setting; they can take their time to complete it 4) it can be given in a group or individual format 5) items can be read or delivered via tape recorder 6) if the client cannot decide whether an item is true or false, tell him/her to choose what it is MOST OF THE TIME a. if they persist, I usually tell them to decide what it is 51% of the time B. Scoring 1) make sure the client has answered all the questions a. when you get the protocol back, just scan it to make sure nothing was omitted. If you find some, have them re-do the questions 2) then, put the scoring templates over the answer protocol and count the dots that appear in the windows a. be sure to double check your counting b. also double check the placement of the scoring template to be sure that it is in the correct position IV. Interpretation of the MMPI-2 A. Scales give results in T-Scores 1) M of 50; SD of 10 B. Check the validity of the test administration 1) Cannot Say Scale (?) a. items left unanswered or double answered b. 1-2 are normal c. Interpret with caution any protocol with 10 or more Cannot Say items d. Do not interpret any protocols with more than 30 Cannot Say items 1. you can go back and encourage your client to complete the items e. Hypotheses for elevated scores 1. Defensiveness 2. Indecisiveness 3. Fatigue, low mood 4. Carelessness 5. Low reading skill 6. Perceived irrelevance of items f. If the Cannot Say items fall primarily after item 370, you can interpret the Validity and Basic Scales, but not the Supplementary and Harris-Lingoes 2) L Scale a. this scale attempts to detect a deliberate and unsophisticated attempt of the client to present himself/herself in a favorable light MMPI-2 Interpretation Grieve b. 15 rationally-derived items deal with minor flaws and weaknesses most people are willing to admit 1. Examples: 29. At times I feel like swearing. (F) 51. I do not read every editorial in the newspaper every day. (F) c. scores are negatively related to educational level, socioeconomic level, and psychological sophistication T-Score > 65 = an overly virtuous presentation T-Score 60-64 = an attempt to impress d. T-Scores < 65 are indicative of individuals who: 1. trying to create favorable impression of themselves by not being totally honest 2. may be defensive, denying, and repressing 3. may be confused 4. may be self-controlled and manifests little or no insight into their motivations 5. show little awareness of consequences to other people resulting from their behavior 6. tend to overvalue their own worth 7. tend to be conventional and socially conforming 8. are unoriginal in thinking and inflexible in problem solving 9. are rigid and moralistic 10. have poor tolerance for stress and pressure 11. may be unsophisticated and are trying to make a favorable impression 12. profiles with T-Scores > 65 should not be interpreted as they are invalid e. T-Scores between 56-64 are indicative of individuals who: 1. are more conforming than usual 2. have a tendency to resort to denial mechanisms f. Normal Range: T45-55 g. T-Scores < 45 are indicative of individuals who: 1. probably responded frankly to the items 2. are confident enough about themselves to be able to admit minor faults 3. in some cases, may be exaggerating negative characteristics 4. are perceptive and socially reliant 5. are seen as strong and relaxed 6. are self-reliant and independent 7. can function effectively in leadership roles 8. communicate ideas effectively 9. may be described by others as cynical and sarcastic h. caveat: ministers sometimes will have elevated L Scales because they truly do not do the behaviors 3) Infrequency Scale (F) a. 60 items reflecting infrequently endorsed items 1. Examples: 36. I have a cough most of the time. (T) 78. I am liked by most people who know me. (F) b. a measure of symptom exaggeration 1. faking bad c. T-Scores > 100 are indicative of individuals who: 1. may have responded randomly to MMPI-2 items 2. may have responded either all True or all False 3. may have been faking bad responses 4. if hospitalized psychiatric patients, may manifest: a) delusions MMPI-2 Interpretation Grieve b) visual and/or auditory hallucinations c) reduced speech d) withdrawal e) poor judgment f) short attention span g) lack of knowledge of reasons for hospitalization h) psychotic diagnosis i) some other signs of organicity d. T-Scores 80-99 are indicative of individuals who: 1. may be malingering 2. may be exaggerating symptoms and problems as a plea for help 3. may be quite resistant to the testing procedure 4. may be clearly psychotic by the usual criteria e. T-Scores 65-79 are indicative of individuals who: 1. may have very deviant social, political, or religious convictions 2. may manifest clinically severe neurotic or psychotic disorders 3. if relatively free of psychopathology, are usually described as: a) moody b) restless c) dissatisfied d) changeable, unstable e) curious, complex f) opinionated g) opportunistic 4. have endorsed items relevant to some particular problem area 5. typically function adequately in most aspects of their life situations f. Low scores on the F Scale (T < 50) are indicative of individuals who: 1. answered items as most normal people do 2. are likely to be free of disabling psychopathology 3. are socially conforming 4. may have faked good g. T-Scores > 100 are generally invalid, but some profiles of psychiatric patients and recently admitted felons can be interpreted if VRIN is in the valid range 4) Infrequency Back (Fb) a. assesses the endorsement of low frequency items on the latter part of the MMPI-2 b. measures the same constructs as the F Scale c. T-Scores > 110 1. indicate an invalid protocol, especially if F Scale is > 110 d. T-Scores < 89 1. if F Scale T-Score is < 89, indicate a valid approach to the test 2. if F Scale T-Score is > 89, do not interpret Content or Harris-Lingoes Scales e. Use the hypotheses for the F Scale when considering reasons for elevated scores, but also consider: 1. a recording error 2. client is responding randomly to items 3. client is exaggerating existing symptoms 4. client is faking a psychological problem 5. client is malingering 6. client has severe psychopathology 7. client was tired of the test MMPI-2 Interpretation Grieve 5) K Scale a. measures of test defensiveness b. assesses the willingness of the client to disclose personal information and to discuss his/her problems 1. Examples: 83. I have very few quarrels with members of my family. (T) 110. Most people will use somewhat unfair means to gain profit or an advantage rather than to lose it. (F) c. K score is used to adjust Hs, Pd, Pt, Sc, and Ma Scales d. T-Scores > 65 are indicative of individuals who: 1. may have responded false to most of the items 2. may have tried to fake good 3. may be trying to give an appearance of adequacy, control, and effectiveness 4. are shy and inhibited 5. are hesitant about becoming emotionally involved with people 6. are intolerant and unaccepting of unconventional attitudes and beliefs in others 7. lack insight and self-understanding 8. are not likely to display overt delinquent behavior 9. if clinical scales are also elevated, may be seriously disturbed psychologically but have no awareness of it 10. if not seriously disturbed psychologically, may have above-average ego strength and other positive characteristics e. T-Scores 56-64 are indicative of individuals who: 1. are being defensive and unwilling to acknowledge psychological distress 2. may exhibit denial and hysteroid defenses (especially in lower SES) f. T-Scores 41-55 are indicative of individuals who: 1. maintain a healthy balance between positive self-evaluation and self-criticism 2. are psychologically well-adjusted 3. show few overt signs of emotional disturbance 4. are independent and self-reliant 5. are capable of dealing with problems in day-to-day life 6. exhibit wide interests 7. are ingenious, enterprising, versatile, and resourceful 8. are clear thinking and approach problems in reasonable and systematic ways 9. are good mixers socially 10. are enthusiastic and verbally fluent 11. take ascendant roles in relationships g. T-Scores 35-40 are indicative of individuals who: 1. are experiencing severe distress that is being openly acknowledged 2. have poor self-concepts and are strongly self-dissatisfied, but lack either interpersonal skills or techniques necessary to alter the situation 3. may tend to be excessively open and revealing 4. in lower SES, may indicate a moderate disturbance 5. in higher SES, indicates more serious distress f. T-Scores < 35 are indicative of persons who: 1. may have responded true to most of the items 2. may have faked bad 3. may be exaggerating problems as a cry for help 4. may exhibit acute psychotic or organic confusion 5. are critical of self and others and are dissatisfied with the self MMPI-2 Interpretation Grieve 6. are ineffective in dealing with problems of daily life 7. show little insight into their own motives and behaviors 8. are socially conforming 9. are overly compliant with authority 10. have a slow personal tempo 11. are inhibited, retiring, and shallow 12. are socially awkward 13. are blunt and harsh in social situations 14. are cynical, skeptical, caustic, and disbelieving 15. are suspicious about the motivations of others 6) F-K Index a. F-K index is usually used to detect malingering, but the data do not necessarily support its use 1. consistently is the weakest predictor of malingering 2. continues to be used probably due to clinical folklore b. F-K > 9 suggests an invalid protocol due to symptom exaggeration (faking bad) c. F-K < -9 suggests an invalid protocol due to symptom minimization/ defensive responding (faking good) d. some folks argue that you need to use a higher cutoff for a forensic population (e.g., 15 & -15 rather than 9 & -9) e. others split the difference and go with 12 1. I argue that a conservative approach would be to use 12 as the cutoff e. F-K Index may not be valid with the MMPI-2 (and some authors argue that you should not use it with the MMPI-2) 1. because the F scale was decreased by 4 points and the K scale remained the same 7) Item Response Inconsistency Scales: TRIN and VRIN a. each of these scales suggests that the client is not consistent in his/her answers or approach to the test b. TRIN 1. is sensitive to people who have a tendency to answer either true or false without careful consideration of how the question was asked 2. T-Score > 80 a) indicates an inconsistent responding to the items b) client has a tendency to respond either true or false when pressed c) the scale allows you to check the direction of the responses 3. T-Score 70-79 a) is suspect and suggests a response set 4. a high K Scale T-Score with a high Basic Scale T-Score and a low Raw TRIN score can be an indication that: a) client was mostly answering false on the test b) may not be psychopathology; just answering false c. VRIN 1. reflects a general tendency to disregard item content in the answers 2. T-Scores > 80 indicate: a) inconsistent random responding; invalid protocol 3. T-Scores 70-79 indicate: a) possible invalid protocol due to inconsistent responding 8) The S Scale (Superlative Self-Presentation) a. developed by Butcher and Han to assess defensiveness MMPI-2 Interpretation Grieve b. 5 subscales based on item content that point to possible reasons for defensive attitudes: 1. S1: Beliefs in Human Goodness 2. S2: Serenity 3. S3: Contentment with Life 4. S4: Patience/Denial of Irritability 5. S5: Denial of Moral Flaws C. Scale 1: Hypochondriasis (Hs) 1) 32 items which focus on bodily concerns with a physiological basis or individuals who exaggerate bodily concerns a. Examples: 53. Parts of my body often have feelings like burning, tingling, crawling, or like “going to sleep.” (T) 255. I do not often notice my ears ringing or buzzing. (F) 2) developed on a group of neurotic patients who showed an excessive concern about their health, presented a variety of somatic complaints with little or no organic basis, and rejected repeated assurances that there was nothing physically wrong with them 3) has no associated Harris-Lingoes Scales 4) T-Scores > 65 (marked elevation) are indicative of individuals who: a. have excessive bodily concerns b. may have conversion disorder or somatic delusions 1. especially if T > 80 c. describe somatic complaints that generally are vague 1. if the somatic complaints are specific, they tend to be epigastric in nature d. complain of chronic weakness, lack of energy, and sleep disturbance e. if medical patients, they may have a strong psychological component to their illness f. are likely to be diagnosed as having somatoform, somatoform pain, depressive, or anxiety disorders g. are not likely to act out in psychopathic ways h. seem selfish, self-centered, and narcissistic i. Have a pessimistic, defeatist, and cynical outlook toward life j. are unhappy and dissatisfied k. make others miserable l. complain m. communicate in a whiny manner n. are demanding and critical of others o. express hostility indirectly p. are described as dull, unenthusiastic, and unambitious q. lack ease in oral expression r. generally do not exhibit much manifest anxiety s. seem to have functioned at a reduced level of efficiency for long periods of time t. see themselves as medically ill and seek medical treatment u. lack insight and resist psychological interpretations v. are not very good candidates for psychotherapy or counseling w. become critical of their therapist x. terminate therapy prematurely when the therapist suggests psychological reasons for symptoms or when the therapists are perceived as not giving enough attention and support 5) T-Scores 58-64 (moderate elevation) are indicative of individuals who: a. have some concern about bodily functioning b. are likely to be seen as immature, stubborn, and lacking drive MMPI-2 Interpretation Grieve c. scores in the lower end of this range are typical for individuals with physical handicaps and individuals with actual physical disease 6) Normal range T-Scores 40-57 7) T-Scores < 40 (low scores) are indicative of individuals who: a. are free of somatic preoccupation b. are alert, sensitive, and insightful c. are generally effective in their daily lives d. scores in this range are typical of individuals in helping professions D. Scale 2: Depression (D) 1) 57 items reflecting the feelings of discouragement, pessimism, and hopelessness, as well as the personality features of hyper-responsibility, high personal standards, and intrapunitiveness a. Examples: 127. Criticism or scolding hurts me terribly. (T) 117. I have never vomited blood or coughed up blood. (T) 142. I have never had a fit or convulsion. (F) 2) scale developed on psychiatric patients with various forms of symptomatic depression 3) Harris-Lingoes Scales: a. subjective depression b. psychomotor retardation c. physical malfunctioning d. mental dullness e. brooding 4) T-Scores > 65 (marked elevation) are indicative of individuals who: a. display depressive symptoms 1. especially if T-Score > 70 b. feel blue, unhappy, and dysphoric c. are quite pessimistic about the future d. have self-deprecatory and guilt feelings e. may cry, refuse to speak, and show psychomotor retardation f. often are given depressive diagnoses g. report bad dreams, physical complaints, fatigue, weakness, and loss of energy h. are agitated and tense i. Are described as irritable, high-strung, and prone to worry and fretting j. lack self-confidence k. feel useless and unable to function l. give up easily m. feel like failures in school and work n. have lifestyles characterized by withdrawal and lack of involvement with other people o. are introverted, shy, retiring, timid, seclusive, and secretive p. are aloof and maintain psychological distance from others q. have a restricted range of interests r. withdraw from activities in which they previously participated s. are very cautious and conventional t. have difficulty making decisions u. feel overwhelmed when faced with major life decisions v. are overcontrolled and deny their own impulses MMPI-2 Interpretation Grieve w. avoid unpleasantness and make concessions to avoid confrontations x. because of high personal distress, are likely to be good candidates for psychotherapy and counseling y. may terminate therapy when the immediate crisis is over 5) T-Scores 58-64 (moderate elevation) are indicative of individuals who: a. are dissatisfied with something or with themselves but may not recognize this state as depression i. mild degree of depression may not appropriately represent the situation b. may not be overly concerned about what is happening to them c. may have learned to adjust to a chronically depressed existence 6) Normal range: T-Score 40-57 7) T-Scores < 40 (low scores) are indicative of individuals who: a. do not experience much tension, anxiety, guilt, or depression b. feel relaxed and at ease c. are self-confident d. are emotionally stable and capable of effective functioning in most situations e. feel cheerful and optimistic f. have little difficulty in verbal expression g. are alert, active, and energetic h. are competitive and seek out additional responsibilities i. Are at ease in social situations j. seek out leadership roles k. create favorable first impressions l. are seen as clever, witty, and colorful m. may be impulsive and undercontrolled n. are show-offish and exhibitionistic o. may arouse hostility and resentment in other people E. Scale 3: Hysteria (Hy) 1) 60 items some of which reflect physical complaints and troubling disorders and others which reflect denial of problems and a lack of social anxiety a. Examples: 44. Once a week or oftener I suddenly feel hot all over, for no reason. (T) 176. I have very few headaches. (F) 2) scale constructed on patients who exhibited some form of sensory or organic motor disorder for which no organic basis could be established. 3) Harris-Lingoes Scales: a. denial of social anxiety b. need for affection c. lassitude-malaise d. somatic complaints e. inhibition of aggression 4) T-Scores > 65 (marked elevation) are indicative of individuals who: a. react to stress and avoid responsibility through the development of physical symptoms b. may report headaches, stomach discomfort, chest pains, weakness, and tachycardia c. have symptoms that may appear and disappear suddenly MMPI-2 Interpretation Grieve d. do not report severe emotional turmoil e. rarely report hallucinations, delusions, or suspiciousness f. lack insight concerning causes of symptoms g. lack insight about their own motives and feelings h. are psychologically immature, childish, and infantile i. if psychiatric patients, receive diagnoses of conversion disorder or psychogenic pain disorder j. are self-centered, narcissistic, and egocentric k. expect a great deal of attention and affection from others l. use indirect and devious means to get attention and affection m. do not express resentment and hostility openly n. tend to be emotionally involved, friendly, talkative, and alert o. have superficial and immature interpersonal relationships p. are interested in what other people can do for them q. occasionally act out in a sexual or aggressive manner with little apparent insight into their actions r. initially are enthusiastic about treatment s. view themselves as having medical problems and want medical treatment t. are resistant to psychological interpretations u. are likely to terminate treatment if their therapists insist on examining psychological causes of symptoms v. may be willing to talk about psychological problems as long as they are not conceptualized as causing their symptoms w. often respond well to direct advice and suggestion x. when involved in therapy, often discuss worry about failure at work and school, marital unhappiness, lack of acceptance, and problems with authority figures y. have histories of rejecting fathers 5) T-Scores 58-64 (moderate elevation) are indicative of individuals who: a. are likely to be exhibitionistic, extroverted, and superficial b. are naive, self-centered, and deny any problems c. they prefer to look on the optimistic side of life and avoid any unpleasant issues 6) Normal range: T-Scores 40-57 7) T-Scores < 40 (low scores) are indicative of individuals who: a. do not worry excessively about their health b. do not present somatic symptoms c. are constricted, conventional, and conforming d. are described as unadventurous, lacking industrialness, and having a narrow range of interests e. are cold and aloof f. may display blunted affects g. have limited social interests and participation h. avoid leadership responsibilities i. are seen as unfriendly, tough-minded, and hard to get to know j. are suspicious and have difficulties trusting others k. are realistic, logical, and level-headed in approach to problems l. are not likely to make impulsive decisions m. seem to be content with dull, uneventful life-styles MMPI-2 Interpretation Grieve F. Scale 4: Psychopathic Deviate (Pd) 1) 50 items which assess a lack of concern about most social and moral standards of conduct a. Examples 54. My family does not like the work I have chosen (or the work I intend to choose for my life work). (T) 79. I do not mind being made fun of. (F) 2) scale developed on individuals who were referred to a psychiatric service for a clarification of why they had recurring troubles with the law even though they suffered no cultural deprivation and despite their possessing normal intelligence and freedom from other psychological disorders a. tried to get at the Conduct Disorder/Antisocial Personality Disorder folks b. not too sure they made it 1. standardization with gangs? 3) Harris-Lingoes Subscales a. familial discord b. authority problems c. social impurturbability d. social alienation e. self-alienation 4) T-Scores > 65 are indicative of persons who: a. have difficulty incorporating values and standards of society into their lives b. may engage in social and antisocial acts, including lying, cheating, stealing, sexual acting out, excessive use of alcohol and/or drugs 1. especially if T-Score > 75 c. are rebellious toward authority figures d. have stormy relationships with their families e. blame family members for their difficulties f. have histories of underachievement g. tend to experience marital problems h. are impulsive and strive for immediate gratification of impulses i. do not plan their behavior well j. tend to act without considering the consequences of their actions k. are impatient; have limited frustration tolerance l. show poor judgment; take risks m. tend not to learn from experience n. are seen by others as immature and childish o. are narcissistic, self-centered, selfish, and egocentric p. are ostentatious and exhibitionistic q. are insensitive to the needs and feelings of others r. are interested in others only in terms of how they can be used s. are likable and create good first impressions t. have shallow and superficial relationships u. seem unable to form warm attachments with others v. are extroverted and outgoing w. are talkative, active, adventurous, energetic, and spontaneous x. are judged by others to be intelligent and self-confident y. have a wide range of interests but lack a clear direction z. tend to be hostile, aggressive, resentful, rebellious, antagonistic, and refractory