Overview of the MCMI-IV

Seth Grossman, Psy.D.

O v e r v i ew o f t h e MCMI®-IV
Seth Grossman, Psy.D.

Agenda

Describe updates to the MCMI-IV.

Describe scales of MCMI-IV.

Describe Millon’s evolutionary theory.

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

“The MCMI-IV was specifically designed,

as are all of the Millon Inventories, to facilitate
the therapeutic plans of the clinician.”

Dr. Theodore Millon, PhD, DSc

Develo pm ent of MCMI-I V and

Comparison w ith MCMI-I II

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Development of the MCMI-IV

• Norming
– Pilot: Earlier data, included clinical and nonclinical groups
– General: Fall 2014 – early 2015
• Designed for ages: 18-65+
• 5 validity indices; 15 personality scales; 10 clinical syndrome scales
• Designed to assess syndrome in context with personality style/disorder
• Base Rate scores rather than T-scores; anchored to prevalence data for a
particular disorder; no assumption of normal curve.
• Scales designed to be closely coordinated to DSM constructs
• Final test form consists of 195 items

The New MCMI-IV . . .

Offers numerous enhancements.

Is anchored in Dr. Millon’s time-honored

personality theory.

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Summary of Changes

Updated norms and test items.

Aligned with DSM-5 and ICD-10.

Changed names of several scales.

Added new “Turbulent” scale.

Integrated test results with therapeutic practice.

Report includes option to print abbreviated scale names.

MCMI-IV: Rationale for Changes

Field Trends

APA Standards Clinical Population Gender Standards

MCMI historically tied

What does that mean? Separate norms
to DSM diagnoses

Easy to use but not Difficulty translating to

Combined norms
without problems different populations

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Rationale for Changes

Current Standards

Diagnostic System
Constructs Empirical
Changes
Redefined Robustness
(DSM-5)

Personality on the Continuum:

Adaptive to Maladaptive
An oft misunderstood aspect of prior MCMIs . . .
• NOT designed solely to diagnose personality disorders
• Have ALWAYS sought to illuminate dimensions rather than
hard cutoffs
• Have always intended to complete picture of:
– First, who the person is
– Second, what syndrome/complaints the person experiences
“Clinical Population” – larger bandwidth than significantly
compromised personality dysfunction

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Major Theoretical Change:

Introducing a “Spectrum”

• Dr. Theodore Millon’s Disorders of Personality-3rd Edition more fully

explicated a range of personality dysfunction AND function
• Each prototype now described with 3 levels, broadening the range:
– Normal Style: Generally adaptive personality patterns
– Abnormal Traits/Type: Moderately maladaptive personality attributes
– Clinical Disorder: Likelihood of greater personality dysfunction
– Example: CENarc spectrum: Confident—Egotistic—Narcissistic
• Major goal of MCMI-IV is to more adequately capture this broader
range

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.

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Scale-Level Changes

New Clinical Personality Scale

4B: Turbulent

New Distinctions on Scale Names

Depressive Melancholic
Thought Disorder Schizophrenic Spectrum

New Noteworthy Response Categories

Adult ADHD Prescription Drug Abuse
Autism Spectrum Self-Injurious Behavior/Tendency
Explosively Angry Traumatic Brain Injury
Vengefully Prone

MCMI-IV: Interpretive Reports

• Clarified/updated language in interpretive material

• Improvement in Therapeutic Guide
‒ Will retain current case conceptualization components
‒ Expand on process orientation
‒ Geared to integrate with theory
‒ Involves personality domains (cognitive, affective,
self-image, etc.)
‒ Designed to follow treatment process chronologically

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

M C M I® - I V: An c h o r e d i n M i l l o n’s T h e o r y
o f P e r s o n a l i t y a n d P s yc h o p a t h o l o g y

MCMI-IV: Theoretical Anchoring

Enduring
Acute Clinical
Personality
Disorders
Characteristics

Each scale is an operational

Not explicitly derived
measure of a personality
from theory
prototype

Refined in terms of theory’s Derived from Millon’s theory

generative framework of personality

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 Overview of the MCMI-IV
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 Polarities and Personality Disorders

The polarities were combined to derive . . . personality

disorder scales that correspond to many of the
personality disorders recognized by the Diagnostic
and Statistical Manual.

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Evolutionary Model and Personality Disorders

Existential Aim Replication Strategy
Reproductive Reproductive
Life Enhancement Life Preservation
Propagation Nurturance
Pleasure-Pain Self-Other
Deficiency,
Imbalance, Conflict Pleasure (low) Pleasure-Pain Self (low) Self (high) Self-Other
Pain (low or high) Reversal Other (high) Other (low) Discordance

Adaptation Mode Personality Disorders

Schizoid (low
Passive: pleasure, low pain)
Masochistic Dependent Narcissistic Compulsive
Accommodation Melancholic (high
pain, low pleasure)

Active: Modification Avoidant (high pain,

low pleasure)
Sadistic Histrionic Antisocial Negativistic
Turbulent (high
pleasure, low pain)
Structural Pathology Borderline, Borderline,
Schizotypal Borderline Paranoid
Paranoid Paranoid

MCMI-IV: Validity Scales

Modifying Indices Random Response Indicators

X Disclosure V Invalidity
Y Desirability W Inconsistency
Z Debasement

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Severe Personality Pathology

S Schizotypal (ESSchizoph)

C Borderline (UBCycloph)

P Paranoid (MPParaph)

MCMI-IV: Clinical Personality Patterns

1 Schizoid (AASchd)
2A Avoidant (SRAvoid)
2B Melancholic (DFMelan) (Depressive on MCMI-III) Change

3 Dependent (DADepn)
4A Histrionic (SPHistr)
4B Turbulent* (EETurbu)
5 Narcissistic (CENarc)
6A Antisocial (ADAntis)
6B Sadistic (ADSadis)
7 Compulsive (RCComp)
8A Negativistic (DRNegat)
8B Masochistic (AAMasoc)
*Typically energetic and buoyant in manner, this personality type
may become overly animated, scattered, and manic.

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Severe Clinical Syndromes

SS Schizophrenic Spectrum (SCHspe) Change

(Thought Disorder on MCMI-III)

CC Major Depression (MAJdep)

PP Delusional (DELdis)

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)

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV: Eight Domains

Functional Structural

Emotional Expression Self-Image

Interpersonal Intrapsychic
Conduct Content

Intrapsychic
Cognitive Style
Architecture

Intrapsychic Mood/
Dynamics Temperament

MCMI-IV: Domain by Disorder Matrix

Functional Domains Structural Domains

Spectrum Emotional Interpersonal Cognitive Intrapsychic Intrapsychic Intrapsychic Mood/

Self-image
Disorder Expression Conduct Style Dynamics Content Architecture Temperament

AASchd Impassive Unengaged Impoverished Intellectualization Complacent Meager Undifferentiated Apathetic

SRAvoid Fretful Aversive Distracted Fantasy Alienated Vexatious Fragile Anguished

DFMelan Disconsolate Defenseless Fatalistic Asceticism Worthless Forsaken Depleted Woeful

DADepn Puerile Submissive Naive Introjection Inept Immature Inchoate Pacific

SPHistr Dramatic Attention-Seeking Flighty Dissociation Gregarious Shallow Disjointed Fickle

EETurbu Impetuous High-Spirited Scattered Magnification Exalted Piecemeal Unsteady Mercurial

CENarc Haughty Exploitive Expansive Rationalization Admirable Contrived Spurious Insouciant

ADAntis Impulsive Irresponsible Nonconforming Acting Out Autonomous Debased Unruly Callous

ADSadis Precipitate Abrasive Dogmatic Isolation Combative Pernicious Eruptive Hostile

Compartment-
RCComp Disciplined Courteous Constricted Reaction Formation Reliable Concealed Solemn
alized

DRNegat Embittered Contrary Cynical Displacement Discontented Fluctuating Divergent Irritable

AAMasoc Abstinent Acquiescent Diffident Exaggeration Undeserving Discredited Inverted Dysphoric

Distraught/
ESSchizoph Peculiar Secretive Circumstantial Undoing Estranged Chaotic Fragmented
Insentient

UBCycloph Spasmodic Paradoxical Vacillating Regression Uncertain Incompatible Split Labile

MPParaph Defensive Provocative Mistrustful Projection Inviolable Unalterable Inelastic Irascible

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Scale, Polarities, and Domains

DFMelan (Melancholic) Spectrum

Millon Evolutionary Model

MCMI-IV: Scale 2B

Enhancement Pain
Preservation
(Pleasure) (Pain)

Accommodation Modification Weak on Polarity Dimension

(Passive) (Active)
Average on Polarity Dimension

Strong on Polarity Dimension

Individuation Nurturance
(Self) (Other)

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Personologic Domains: DFMelan Spectrum

Forsaken
Intrapsychic Content Depleted
Intrapsychic Architecture

Pessimistic Woeful
Cognitive Style Mood/Temperament

Worthless Disconsolate
Self-Image
Emotional Expression

Asceticism Defenseless
Intrapsychic Dynamics
Interpersonal Conduct

EETurbu (Turbulent) Spectrum

Millon Evolutionary Model

MCMI-IV: Scale 4B

Enhancement Pain
Preservation
(Pleasure) (Pain)

Accommodation Weak on Polarity Dimension

Modification
(Passive) (Active) Average on Polarity Dimension

Strong on Polarity Dimension

Individuation Nurturance
(Self) (Other)

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Personologic Domains: EETurbu Spectrum

High-Spirited
Impetuous Interpersonal Conduct Unsteady
Emotional Expression Intrapsychic Architecture

Mercurial
Mood/Temperament Scattered
Cognitive Style

Piecemeal
Exalted Intrapsychic Content Magnification
Self-Image
Intrapsychic Dynamics

Scores and Interpret at ion

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Base Rate Scores

• Based on prevalence rate of disorder.

• Describe where a person is on a spectrum of
personality.

Base Rate Interpretation/Interpretive Benchmarks

• 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

Interpretive Procedure

Validity Scales

Noteworthy items

Personality scales

Grossman Facet Scales

Clinical Syndromes scales

Clinical Integration

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

MCMI-IV Grossman Facet Scales:

Development Considerations
Similar to MCMI-III Facets Considerations for Formation
Follows similar logic as the
Three domain-level constructs primary MCMI-IV personality
reflective of each personality scales, generated via theoretical
pattern. principles, then validated
empirically.
Designed to enhance meaning
inherent in theory and augments
clinical usefulness to therapists
working outside of Millon theory.

Domain/Facet Level of Personality

Evolutionary Polarities
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 Dynamics Intrapsychic Content
Intrapsychic
Intrapsychic Architecture
Biophysical Mood/Temperament

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Functional Domain Structural Domain

Emotional Expression
Self-Image
• Behavioral
• Phenomenologic
• Formerly Expressive Acts
• Self-beliefs, established self-narratives
• Observable behaviors inferring affect
Intrapsychic Content
Interpersonal Conduct
• Intrapsychic
• Behavioral
• Formerly Object Representations
• Observable actions in social exchanges
• Imprinted early experience with others
Intrapsychic Architecture
Cognitive Style
• Intrapsychic
• Phenomenologic
• Formerly Morphologic Organization
• Person’s mindset, decision-base, focus
• Framework for inner cohesion, pressure,
of attention, cognitive process
conflict
Intrapsychic Dynamics
Mood/Temperament
• Intrapsychic
• Biophysical
• Formerly Regulatory Mechanisms
• Level of activity, speech quality, physical
• Defenses, repeatable mechanisms,
appearance, mind/body
usually preconscious

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

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Contextual Assessment with the MCMI-IV:

Integrating the Data

Clinical Presentation

(Anxiety, Depression
= Fever, Cough)

Other Millon Inventories

Adult Counseling Inventory
MIPS® Revised (Millon® Index of Personality Styles Revised)

Adolescent & Pre-Adolescent Inventories

M-PACI® (Millon® Pre-Adolescent Clinical Inventory)
MACI® (Millon® Adolescent Clinical Inventory)
MAPI® (Millon® Adolescent Personality Inventory)

Inventory for Medical Patients

MBMD® (Millon® Behavioral Medicine Diagnostic)

College Counseling Inventory

MCCI® (Millon® College Counseling Inventory)

Visit www.Pearsonclinical.com/MillonInventories

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 Overview of the MCMI-IV
Seth Grossman, Psy.D.

Questions
Clinical Presentation

(Anxiety, Dysthymia
= Fever, Cough)

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