Contextual Interpretation of MCMI-IV: Using a Case Study

Seth Grossman, Psy.D.

C ont e xt ual I nt e r pretati on of t he M C M I ® - I V:

U s i ng a C a s e St udy
Se t h G r os s man, Ps y. D .

Agenda

Analyze MCMI-IV report to

• Describe patient’s personality patterns;
• Describe clinical syndromes; and
• Identify therapeutic needs.

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 1
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

B r i e f O ve r vi e w of M C M I - IV

Personality Patterns – Spectrum

Spectrum Normal Style Abnormal Type Clinical Disorder
AASchd Apathetic Asocial Schizoid
SRAvoid Shy Reticent Avoidant
DFMelan Dejected Forlorn Melancholic
DADepn Deferential Attached Dependent
SPHistr Sociable Pleasuring Histrionic
EETurbu Ebullient Exuberant Turbulent
CENarc Confident Egotistic Narcissistic
ADAntis Aggrandizing Devious Antisocial
ADSadis Assertive Denigrating Sadistic
RCComp Reliable Constricted Compulsive
DRNegat Discontented Resentful Negativistic
AAMasoc Abused Aggrieved Masochistic
ESSchizoph Eccentric Schizotypal Schizophrenic
UBCycloph Unstable Borderline Cyclophrenic
MPParaph Mistrustful Paranoid Paraphrenic
Millon, T. (2011). Disorders of personality: Introducing a DSM/ICD spectrum from normal to abnormal. Hoboken, NJ: Wiley.

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 2
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Evolutionary Theory of Personality

Disorders
Existence
Pleasure Pain
(Life Enhancing) (Life Sustaining)

Adaptation
Passive Active
(Accommodating) (Modifying)

Replication
Self Other
(Independent) (Dependent)
Three basic polarities (dimensions)

The Spectra on a More Molecular Level

Pleasure Pain
Active Passive
Self Other

Functional/Structural Domains
Level Functional Domains Structural Domains
Emotional Expression
Behavioral
Interpersonal Conduct
Phenomenological Cognitive Style Self-Image
Intrapsychic Content
Intrapsychic Intrapsychic Dynamics
Intrapsychic Architecture
Biophysical Mood/Temperament

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 3
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Expression of Personality Disorders Across the Functional and Structural Domains of Personality
Functional Domains Structural Domains
Emotional Interpersonal Intrapsychic Intrapsychic Intrapsychic Mood/
Scale Disorder Expression Conduct Cognitive Style Dynamics Self-image Content Architecture Temperament
Undifferent-
1 Schizoid Impassive Unengaged Impoverished Intellectualization Complacent Meager Apathetic
iated

2A Avoidant Fretful Aversive Distracted Fantasy Alienated Vexatious Fragile Anguished

2B Melancholic Disconsolate Defenseless Fatalistic Asceticism Worthless Forsaken Depleted Woeful

3 Dependent Puerile Submissive Naive Introjection Inept Immature Inchoate Pacific

Attention-
4A Histrionic Dramatic Flighty Dissociation Gregarious Shallow Disjointed Fickle
Seeking

4B Turbulent Impetuous High-Spirited Scattered Magnification Exalted Piecemeal Unsteady Mercurial

5 Narcissistic Haughty Exploitive Expansive Rationalization Admirable Contrived Spurious Insouciant

6A Antisocial Impulsive Irresponsible Nonconforming Acting Out Autonomous Debased Unruly Callous

6B Sadistic Precipitate Abrasive Dogmatic Isolation Combative Pernicious Eruptive Hostile

Reaction Compartment-
7 Compulsive Disciplined Courteous Constricted Reliable Concealed Solemn
Formation alized

8A Negativistic Embittered Contrary Cynical Displacement Discontented Fluctuating Divergent Irritable

8B Masochistic Abstinent Acquiescent Diffident Exaggeration Undeserving Discredited Inverted Dysphoric

Distraught/
S Schizotypal Peculiar Secretive Circumstantial Undoing Estranged Chaotic Fragmented
Insentient

C Borderline Spasmodic Paradoxical Vacillating Regression Uncertain Incompatible Split Labile

P Paranoid Defensive Provocative Mistrustful Projection Inviolable Unalterable Inelastic Irascible

MCMI-IV: Severe Clinical Syndromes

SS Schizophrenic Spectrum (SCHspe) Change

(Thought Disorder on MCMI-III)

CC Major Depression (MAJdep)

PP Delusional (DELdis)

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 4
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

MCMI-IV: Clinical Syndromes

A Generalized Anxiety GENanx

H Somatic Symptom SOMsym

N Bipolar Spectrum BIPspe

D Persistent Depression PERdep

B Alcohol Use ALCuse

T Drug Use DRGuse

R Post-Traumatic Stress P-Tstr

Sc or es a nd I nt e rpretation

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 5
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Types of Normative Scores

Base Rate Percentile Rank

Scaled to reflect the differing Signifies percentage of
prevalence rates of normative population that
characteristics measured by scored at or below a given BR
MCMI-IV. score.

Because MCMI-IV scales have

BR transformation tables are
varying distribution shapes, the
available for Personality
relationship between BR scores
Pattern, Clinical Syndrome,
and percentile ranks varies
validity, and facet scales.
across scales.

Base Rate Scores . . .

• Are based on prevalence rate of disorder.
• Describe where a person is on a spectrum of personality.

Base
Interpretation/Interpretive Benchmarks
Rate
• Normal Style
60-74 • Likely presence of traits; some may be
problematic, still in “style” range
• Abnormal Type
75-84 • Abnormal trait level, more defined dysfunction
possible
• Clinical Disorder
85+
• Clinical disorder range, likely at an impairing level

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 6
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

M a k i ng t he C onne c tions f r om
As s e s s m e nt t o Ps yc hot he r a py

The Role of Personality in Mental Wellness

Clinical Presentation

(Anxiety, Depression
= Fever, Cough)

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 7
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Interpretive Stages

Millon, T., Grossman, S., & Millon, C. (2015). Millon Clinical Multiaxial Inventory, Fourth Edition: Manual.
Minneapolis, MN: Pearson.

Scale Elevations and Configurations

Personality Clinical
Scales Syndromes

Severe
Personality Severe Clinical
Pathology Syndromes

Clinical
Personality Clinical
Patterns Syndromes

Grossman
Facet Scales

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 8
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Severe Personality Pathology Scales

Examine the following scales:

• Schizotypal (Scale S)
• Borderline (Scale C)
• Paranoid (Scale P)

Benchmark BR of 75 may be indicative of the personality

types that approximate DSM-5 diagnoses.
BR of 85 may be further level of pathology indicating the
likelihood of a severely impairing personality disorder.

Personality Scales
“Severe” scales: Any elevation above BR 60 can colorize
interpretation of scales 1-8B

Pleasure Pain Pleasure Pain

Passive Active Passive Active

Self Other Self Other

S: ESSchizoph C: UBCycloph

Pleasure Pain

Passive Active

Self Other
P: MPParaph

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 9
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Clinical Personality Patterns Scales

• Examine Scales 1 through 8B.

• Identify clinically elevated scales (base rate 60 and above).
• Identify as high-point code the three scales with highest
clinical elevations.

Benchmark BR of 60 – generally adaptive personality styles

with moderate or occasional difficulties in specific areas.
Higher base rate benchmarks of 75 or 85 are indicative of less
adaptive personality types or clinical personality disorders,
respectively.

Language of the Theory > Language of Interpretation

Motivating Aims: Develop facility for translating categorical/clinical, to
dimensional/descriptive
• e.g., traditional, “This shows you are a dependent.”
• more effective to describe, via theory: “You may prefer holding back,
maybe wait for approval before you’re sure of your actions.”

Dynamic Interpretation: Develop facility in describing several scales in context

with one another, with this method.
• Use of “if this were everything about you…” but it’s not.
• Note where evolutionary polarities may align, complement, or conflict,
e.g., “at times these tendencies may balance, but other times they may
get you ‘stuck’”.
Facets: Move toward descriptions of specific “domains…”
• Developed to correspond with different personologic functions and
structures
• Aligned with modalities of treatment, e.g., cognitive, experiential,
dynamic, etc.– begins to suggest therapeutic goals

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 10
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Ex: 2A-5 (Avoidant/Narcissistic) Admixture

Scale 2A: Avoidant

Pleasure Pain Language feedback cues:

1. Intense focus on safety

2. High energy in self-protection
Passive Active 3. Little room to relax
4. Little room for enhancement/fulfillment
5. Self/other variables likely will be clarified by
other scale elevations
Self Other

Weak on Polarity Dimension

Average on Polarity Dimension

Strong on Polarity Dimension

Ex: 2A-5 (Avoidant/Narcissistic) Admixture

Scale 5: Narcissistic

Pleasure Pain
Language feedback cues:

1. Unremarkable fulfillment/safety engagement

Passive Active 2. “Environment will be there for me”
3. No perceived need to act on pursuits
4. Major focus on self
5. Others important only as extension of self
Self Other

Weak on Polarity Dimension

Average on Polarity Dimension

Strong on Polarity Dimension

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 11
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Language of the Theory > Language of Interpretation

Motivating Aims: Develop facility for translating categorical/clinical, to

dimensional/descriptive
• e.g., traditional, “This shows you are a dependent.”
• more effective to describe, via theory: “You may prefer holding back,
maybe wait for approval before you’re sure of your actions.”
Dynamic Interpretation: Develop facility in describing several scales in
context with one another, with this method.
• Use of “if this were everything about you…” but it’s not.
• Note where evolutionary polarities may align, complement, or conflict,
e.g., “at times these tendencies may balance, but other times they may
get you ‘stuck.’”
Facets: Move toward descriptions of specific “domains…”
• Developed to correspond with different personologic functions and
structures
• Aligned with modalities of treatment, e.g., cognitive, experiential,
dynamic, etc.– begins to suggest therapeutic goals

Multiple elevations: Bringing us closer to an

accurate reflection of the person . . .

Pleasure Pain Pleasure Pain

Passive Active Passive Active

Self Other Self Other

CENarc SRAvoid

Weak Conflict
Average
Reversal
Strong

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 12
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Personality Scales (2): Examine patterns

between 2-3 (sometimes more) most
elevated scales
Pleasure Pain Pleasure Pain

Passive Active Passive Active

Self Other Self Other

2A: SRAvoid 2B: DFMelan

Pleasure Pain

Passive Active
Weak
Average Self Other
Strong Wavering S: ESSchizoph

Language of the Theory > Language of Interpretation

Motivating Aims: Develop facility for translating categorical/clinical, to

dimensional/descriptive
• e.g., traditional, “This shows you are a dependent.”
• more effective to describe, via theory: “You may prefer holding back,
maybe wait for approval before you’re sure of your actions.”
Dynamic Interpretation: Develop facility in describing several scales in
context with one another, with this method.
• Use of “if this were everything about you…” but it’s not.
• Note where evolutionary polarities may align, complement, or conflict,
e.g., “at times these tendencies may balance, but other times they
may get you ‘stuck’”.
Facets: Move toward descriptions of specific “domains…”
• Developed to correspond with different personologic functions and
structures
• Aligned with modalities of treatment, e.g., cognitive, experiential,
dynamic, etc. – begins to suggest therapeutic goals

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 13
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Grossman Facet Scales

1 Schizoid 4B Turbulent 8A Negativistic
1.1 Interpersonally Unengaged 4B.1 Expressively Impetuous 8A.1 Expressively Embittered
1.2 Meager Content 4B.2 Interpersonally High-Spirited 8A.2 Discontented Self-Image
1.3 Temperamentally Apathetic 4B.3 Exalted Self-Image 8A.3 Temperamentally Irritable
2A Avoidant 5 Narcissistic 8B Masochistic
2A.1 Interpersonally Aversive 5.1 Interpersonally Exploitive 8B.1 Undeserving Self-Image
2A.2 Alienated Self-Image 5.2 Cognitively Expansive 8B.2 Inverted Architecture
2A.3 Vexatious Content 5.3 Admirable Self-Image 8B.3 Temperamentally Dysphoric
2B Melancholic 6A Antisocial S Schizotypal
2B.1 Cognitively Fatalistic 6A.1 Interpersonally Irresponsible S.1 Cognitively Circumstantial
2B.2 Worthless Self-Image 6A.2 Autonomous Self-Image S.2 Estranged Self-Image
2B.3 Temperamentally Woeful 6A.3 Acting-Out Dynamics S.3 Chaotic Content
3 Dependent 6B Sadistic C Borderline
3.1 Expressively Puerile 6B.1 Expressively Precipitate C.1 Uncertain Self-Image
3.2 Interpersonally Submissive 6B.2 Interpersonally Abrasive C.2 Split Architecture
3.3 Inept Self-Image 6B.3 Eruptive Architecture C.3 Temperamentally Labile
4A Histrionic 7 Compulsive P Paranoid
4.1 Expressively Dramatic 7.1 Expressively Disciplined P.1 Expressively Defensive
4.2 Interpersonally Attention-Seeking 7.2 Cognitively Constricted P.2 Cognitively Mistrustful
4.3 Temperamentally Fickle 7.3 Reliable Self-Image P.3 Projection Dynamics

Scale Elevations and Configurations

Personality Clinical
Scales Syndromes

Severe
Personality Severe Clinical
Pathology Syndromes

Clinical
Personality Clinical
Patterns Syndromes

Grossman Facet BR 75 to 84: Present

Scales BR >= 85: Prominent

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 14
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

M C M I - I V Ex a m ple Pr of i le
Se e Sa m pl e R e por t

Organization of Interpretive Report

The MCMI-IV Interpretive Report includes scores and in-

depth interpretive text organized as follows:

Cover Page Clinical Syndromes

Report Summary Noteworthy Responses
Profile Summary Possible DSM-5 (ICD-10)
Diagnoses
Response Tendencies
Treatment Guide
Personality Patterns
Item Responses
Grossman Facet Scales

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 15
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Demographic Information

Report Summary
MCMI-IV reports are normed on patients who were in the early phases of
assessment or psychotherapy for emotional discomfort or social difficulties.
Respondents who do not fit this normative population or who have
inappropriately taken the MCMI-IV for nonclinical purposes may have
inaccurate reports. The MCMI-IV report cannot be considered definitive. It
should be evaluated in conjunction with additional clinical data. The report
should be evaluated by a mental health clinician trained in the use of
psychological tests.
Interpretive Considerations
The patient is a 33-year-old single white male with a high school diploma or
equivalent. He is currently being seen as an outpatient, and he reports that
he has recently experienced a problem that involves his job or school.
These self-reported difficulties, which have occurred for an unspecified
period of time, may take the form of a clinical syndrome disorder.

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 16
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

MCMI-IV Validity

Raw Score Classification Categories for Scales V and W

Classification Scale V: Invalidity Scale W: Inconsistency
Acceptable 0 0-8
Questionable 1 9-19
Invalid 2-3 20-25

Noteworthy Items

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

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 17
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Some Noteworthy Responses

Personality Patterns

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 18
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

3 highest elevated personality patterns:

Pleasure Pain Pleasure Pain

Passive Active Passive Active

Self Other Self Other

6A: ADAntis 8B: AAMasoc

Pleasure Pain

Passive Active
Weak
Self Other
Average
Strong Reversal 2A: SRAvoid

Facet Scores

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 19
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Clinical Syndromes

Interpretive Considerations

The patient is a 33-year-old single white male with a

high school diploma or equivalent. He is currently being
seen as an outpatient, and he reports that he has
recently experienced a problem that involves his job or
school. These self-reported difficulties, which have
occurred for an unspecified period of time, may take the
form of a clinical syndrome disorder.

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 20
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Profile Severity

On the basis of the test data, it may be reasonable to

assume that the patient is experiencing a moderately
severe mental disorder; further professional study may
be advisable to assess the need for ongoing clinical care.
The text of the following interpretive report may need to
be modulated only slightly upward or downward given
this probable level of severity.

MCMI-IV and DSM-5 Personality Disorders

DSM-5 Cluster A

DSM-5 Cluster C

DSM-5 Cluster C
DSM-5 Cluster B

DSM-5 Cluster B
DSM-5 Cluster B

DSM-5 Cluster C

DSM-5 Cluster A
DSM-5 Cluster B

DSM-5 Cluster A

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 21
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Possible Diagnoses

He appears to fit the following personality disorder

classifications best: Antisocial Personality Disorder, with
Unspecified Personality Disorder (Masochistic) Type,
Avoidant Personality Type, and Borderline Personality
Style.
Clinical syndromes are suggested by the patient's MCMI-
IV profile in the areas of Alcohol Use Disorder and Other
(or Unknown) Substance Use Disorder.

Possible DSM5 and ICD-10 Diagnoses

Clinical Syndromes
305.00 (F10.10) Alcohol Use Disorder
305.90 (F19.10) Other (or Unknown) Substance Use
Disorder
Personality Disorders
301.7 (F60.2) Antisocial Personality Disorder with
Unspecified Personality Disorder
(Masochistic Type)
Avoidant Personality Type and
Borderline Personality Style

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 22
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Therapeutic Considerations

• Moody and unpredictable, this person may act in a self-

demeaning yet angry way in anticipation of condemnation
from others.
• Psychological difficulties may leave him feeling unduly
vulnerable and contrary. Close attention and a supportive
attitude should diminish noncompliance. Any sign of
uncooperativeness should be responded to in a firm, no-
nonsense manner that is professional rather than punitive
in character.
• A brief and focused approach to therapy should be
effective in moderating his erratic emotions and behavior.

Treatment Guide

• Treatment should be oriented toward issues and

techniques of a short-term character, focusing on
matters that might call for immediate attention,
followed by time-limited procedures designed to
reduce the likelihood of repeated relapses.
• Worthy of note is the possibility of a troublesome
alcohol and/or substance-abuse disorder. If verified,
appropriate short-term behavioral management or
group therapy programs should be rapidly
implemented.

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 23
 Contextual Interpretation of MCMI-IV: Using a Case Study
Seth Grossman, Psy.D.

Questions
Clinical Presentation

(Anxiety, Dysthymia
= Fever, Cough)

Available
Now!

PearsonClinical.com/MCMI-IV
Customer Support
800-627-7271 (USA)
866-335-8418 (Canada)

Get a Free Trial: www. pearsonclinical.com/MCMI-IVTrial

Copyright © 2015. Pearson, Inc., and/or its affiliates. All rights reserved. 24