Comparing the Sensitivity of the MMPI-2 Clinical Scales and the MMPI-RC Scales to Clients Rated as Psychotic, Borderline or Neurotic on the Psychodiagnostic Chart

doi:10.4236/psych.2013.49A1003

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Psychology

2013. Vol.4, No.9A1, 12-16

Published Online September 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.49A1003

Comparing the Sensitivity of the MMPI-2 Clinical Scales and the

MMPI-RC Scales to Clients Rated as Psychotic, Borderline or

Neurotic on the Psychodiagnostic Chart

Robert M. Gordon1, Ronald W. Stoffey2, Bethany L. Perkins3

1Independent Practice, Allentown, USA

2Psychology Department, Kutztown University, Kutztown, USA

3Department of Education and Human Services, Lehigh University, Bethlehem, USA

Email: [email protected]

Received July 14th, 2013; revised August 15th, 2013; accepted September 19th, 2013

mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, pro-

vided the original work is properly cited.

The purpose of this study was to assess the differences between the MMPI-2 and the MMPI-RC scales in

sensitivity to levels of psychopathology. Ninety-eight clients from forensic, disability and psychotherapy

evaluations were evaluated on the MMPI-2 and RC scales and rated for personality organization (neurotic,

borderline or psychotic) on the Psychodiagnostic Chart. The results over-all showed support that most of

the MMPI-2 scales have more clinical sensitivity than the RC scales at all levels of psychopathology and

particularly at the less pathological levels. K correction does not account for the elevation differences.

Most of the RC scales add little to no incremental validity to the MMPI-2 Clinical scales except for RC 1,

RC 2, and RC 9 and these may be used as supplemental scales.

Keywords: MMPI-2; MMPI-RC; MMPI-RF; Psychodiagnostic Chart; PDM; Psychopathology

Introduction

Tellegen, Ben-Porath, McNulty, Arbisi, Graham, and Kaem-

mer (2003) first produced the Restructured Clinical scales (RC)

to improve measurement of the core constructs of the MMPI-2

Clinical scales, but then went on to develop a separate compet-

ing form of the MMPI. Rouse, Greene, Butcher, Nichols, and

Williams (2008) looked at a sample of 78,159 respondents

across diverse clinical settings and found that each RC scale

was highly correlated with the existing MMPI-2 contents scales;

higher, in fact, than the correlation between the RC scale and its

parent scale concluding that the RC scales added nothing new

to the MMPI-2 scales.

Binford and Liljequist (2008) compared the behavioral cor-

relates of RCd, RC 2, and RC 4 with their original Clinical

scale counterparts (Scale 2, Scale 4), and conceptually related

Content scales (DEP, ASP, CYN) in an outpatient clinical sam-

ple (N = 150). The results indicated that RC 4 is a stronger

predictor of several antisocial behaviors than Clinical Scale 4 or

the Content Scales ASP and CYN. In contrast, RC 2 demon-

strated significantly lower correlations with several behaviors

conceptually related to depression than its Clinical scale coun-

terpart or DEP. Bolinskey, and Nichols (2011) concluded that

RC 4, RC 7, and RC 9 are not necessarily equivalent to those

assessed by the original scales.

The RC scales have higher internal consistency and dis-

criminant validity than the original MMPI-2 clinical scales,

which the authors believe, would lead to greater clinical utility.

However, Gordon (2008) warned that the high internal consis-

tency of the RC scales violates a basic assumption of complex

psychopathology. Whereas some unitary symptoms such as

anxiety or anger can be assessed with scales of high internal

consistency, such homogenized scales will not work well for

complex diagnostic conditions such as Hysteria, Post Traumatic

Stress Disorder and Borderline Personality.

For example, Tellegen, et al. (2003) eliminated the Hysteria

scale and replaced it with the RC 3 Cynicism scale. Dahlstrom,

Welsh, and Dahlstrom (1972) stated that the items on the Hys-

teria scale seem mutually contradictory. The Hysteria scale has

such seemingly unrelated issues such as somatic complaints,

naiveté, denial of aggressive motives, unhappy home life and

sexual conflicts. The RC researchers removed from the Hys-

teria scales the demoralization and somatic complaints items

and assigned them to their own distinct scales, leaving mainly

the items of naively trusting. Naiveté is an aspect of hysteria.

The researchers reversed the scoring of the naiveté items and

produced the RC 3 scale of Cynicism. Cynicism is neither an

aspect of nor a substitute for Hysteria. The authors found that

RC 3 poorly correlated with the MMPI-2 Hysteria scale; −.24

for females and −.18 for males. The RC 3 scale serves as an

excellent example of the failure of the behavioral assumption

that psychopathology is simply the sum of additive correlated

symptoms.

The RC scales have been criticized for having less clinical

sensitivity than the MMPI-2 Clinical Scales. Wallace (2005)

found that the majority of client MMPI-2 profiles (56%) had

fewer scale elevations on the RC scales as compared to the

MMPI-2 Clinical scales. In Nichols’ (2011) review of the issue,

he concluded “upon the presently available weight of the evi-

dence, the RC scales, like the MMPI content scales, the sub-

R. M. GORDON ET AL.

stantive MMPI-2-RF scales, and other content-based measures

lack sensitivity and therefore may underestimate the presence,

significance, and magnitude of clinical problems, a liability that

may render them less than suitable for screening purposes (e.g.,

employment screening) for which maximal sensitivity is desir-

able...” (p. 16).

Sellbom, Ben-Porath, McNulty, Arbisi, and Graham (2006)

felt that the demoralization items, subtle items, and K correc-

tion contributed substantially to elevation differences between

the MMPI-2 and RC scales. Though the item diversity of clini-

cal syndromes would contribute to greater sensitivity of the

MMPI-2 over the RC scales, it is unlikely that K is a cause of

the differences. K is often lower with greater psychopathology

and would not be adding to the elevation.

There are currently no known published studies comparing

the sensitivity of the MMPI-2 Clinical scales and the MMPI-

RC scales with a population of individuals diagnosed through

the full dimension of psychopathology (psychotic, borderline

and neurotic). Lanyon and Thomas (2013) did look at the

MMPI-RF and Psychological Screening Inventory (PSI) noting

that the 3 Higher Order (HO) scales of the MMPI-RF and the 3

core clinical scales of the PSI/PSI-2 were developed to broadly

represent the 3 traditional categories of mental disorder: major

psychiatric disorder (“psychotic”), general psychological dis-

tress (“neurotic”), and significant antisocial characteristics

(“character disorder”). Their research found support for using

these basic personality organizations, but the authors did not

compare the sensitivity of these tests to these categories.

Gordon and Bornstein (2012) developed the Psychodiagnos-

tic Chart (PDC)1,2 to operationalize the Psychodynamic Diag-

nostic Manual (2006). The first axis of the PDC measures per-

sonality organization with the Overall Personality Organization

scale (OPO), which helps categorized individuals as mainly

operating on a psychotic, borderline or neurotic to healthy level

(Bornstein & Gordon, 2012). A preliminary study of the OPO

scale and PDC indicted good reliability and validity (Gordon &

Stoffey, 2013).

Method

Participants

Thirty-eight psychologists who are MMPI-2 experts were

contacted by email and asked to rate their last ten psychother-

apy patients, disability or forensic clients on the PDC. They

were advised to share no other identifying data other than the

client’s initials, gender, ethnicity, age and years of education.

They were given a manual as to how to use the Psychodiagnos-

tic Chart (PDC) and asked to rate each client without looking at

their MMPI-2s. Of the 38 psychologists, 15 sent in 98 PDCs

with MMPI-2s. The overall sample of 104 clients consisted of

43 women, 61 men (93% Caucasian, mean age = 40.65, age

range: 18 - 74 years, mean years of education = 15.54, educa-

tion range: 6 - 22 years). The client sample included people

from forensic, disability and psychotherapy evaluations, repre-

senting a wide range from psychotic to neurotic personality

organizations.

Results

Hypothesis One

For Hypothesis 1, we predicted that the MMPI-2 scales

should show more clinical sensitivity than the RC scales at: 1)

all levels of psychopathology and 2) particularly at the less

pathological levels. To test this hypothesis, we calculated a

series of paired-samples t tests using 8 MMPI-2 scale scores

(Hs, D, Hy, Pd, Pa, Pt, Sc, Ma) and 8 corresponding MMPI-RC

scale scores (RC 1, RC 2, RC 3, RC 4, RC 6, RC 7, RC 8, RC 9)

within each of the three levels or categories of the Overall Per-

sonality Organization (OPO) scale. The categories were derived

by dividing the 10-point OPO scale into psychotic (ratings 1 - 3,

n = 13), borderline (4 - 6, n = 51), and neurotic (7 - 10, n = 33)

levels. (There were no “healthy” levels of individuals in this

sample so this category was labeled “neurotic.”).

Within the psychotic level, the first 3 paired-samples t tests

comparing MMPI-2 Hs, D, and Hy scales with the correspond-

ing MMPI RC 1, RC 2, RC 3 scales were not significant. The

paired-samples t tests comparing MMPI-2 Pd, Pa, Pt, and Sc

with the MMPI RC 4, RC 6, RC 7, and RC 8 were all signifi-

cant. Finally, the paired-samples t test comparing the MMPI-2

Ma scale with the MMPI RC 9 scale failed to reach significance.

Taken together, within the psychotic level of the OPO, 50% of

the paired-samples t tests were significant in the predicted di-

rection (see Table 1 for a summary of the scale means, standard

deviations, t values, p values and d values within the psychotic

level of the OPO).

Within the borderline level, the first paired-sample t test

comparing the MMPI-2 Hs scale with the MMPI RC 1 scale

was not significant. The paired-samples t tests comparing

Table 1.

The MMPI-2 vs. RC sensitivity at psychotic level of overall personality

organization.

Scale M SD t p d

Hs 65.69 17.12 −1.95 .075 −.54

RC 1 69.31 19.31

D 71.23 17.54 1.29 .223 .36

RC 2 67.38 18.87

Hy 72.69 18.46 1.91 .08 .53

RC 3 60 9.8

Pd 79.46 12.07 7.4 .001 2.06

RC 4 56.54 5.75

Pa 80.46 18.67 3.99 .002 1.11

RC 6 66.08 15.07

Pt 78 19.43 6.27 .001 1.74

RC 7 54.38 10.28

Sc 85.77 19.55 4.4 .001 1.22

RC 8 67.54 16.88

Ma 61.38 14.06 −.318 .756 −.09

RC 9 62.23 10.13

1Parts of these findings were presented at the American Psychoanalytic

Association National Meeting at New York Discussion on January 17, 2013,

“Research in Psychoanalysis: Creating the Psychodynamic Diagnostic Man-

ual, Version 2 (PDM-2): Conceptual and Empirical Issues.” The session was

co-organized by the American Psychoanalytic Association and the Psycho-

dynamic Psychoanalytic Research Society.

2For free copies of the PDC search online for “Psychodiagnostic Chart” or

email [email protected].

R. M. GORDON ET AL.

MMPI-2 D, Hy, Pd, Pa, Pt, and Sc with the corresponding

MMPI RC 2, RC 3, RC 4, RC 6, RC 7, and RC 8 were all sig-

nificant.

The final paired-sample t test comparing the MMPI-2 Ma

scale with the MMPI RC 9 scale failed to reach significance.

Taken together, 75% of the paired-sample t tests within the

borderline level were significant in the predicted direction (see

Table 2 for a summary of the scale means, standard deviations,

t values, p values and d values within the borderline level of the

OPO).

The last set of paired-sample t tests examined mean differ-

ences between the MMPI-2 and MMPI RC scales within the

neurotic level of the OPO. The only paired-samples t test that

failed to reach significance was between the MMPI-2 D and

MMPI RC 2 scale. Within the neurotic level, a total of 88% of

the paired-samples t tests were significant in the predicted di-

rection (see Table 3 for a summary of the scale means, scale

standard deviations, t values, p values and d values within the

neurotic level of the OPO).

Across all three levels of the Overall Personality Organiza-

tion (OPO) scale a total of 71% of the paired-samples t tests

were significant. Taken together, the above analyses lend strong

support to Hypothesis 1 (a). In support of Hypothesis 1 (b), the

neurotic level of the OPO contained the largest percentage of

significant pair-sample t tests (88%), followed by the borderline

level (75%), and lastly the psychotic level (50%).

Hypothesis Two

For Hypothesis 2, we predicted that the added K correction

does not account for the differences in elevation between the

MMPI-2 scales versus the MMPI RC scales. To test this hy-

pothesis, we calculated means and standard deviations both

within each level of the Overall Personality Organization (OPO)

scale and an overall mean and standard deviation across all

three levels of the OPO. The level means and standard devia-

tions were: psychotic (M = 40.08, SD = 7.16), borderline (M =

48.44, SD = 8.65) and neurotic (M = 55.88, SD = 9.33). The

Table 2.

The MMPI-2 vs. RC sensitivity borderline level of the overall personal-

ity organization.

Scale M SD t p d

Hs 58.86 13.36 1.34 .185 .19

RC 1 57.63 13.98

D 66.57 16.01 3.43 .001 .48

RC 2 61.94 15.91

Hy 64.31 13.98 5.23 .001 .73

RC 3 50.24 10.13

Pd 66.06 11.2 7.15 .001 1

RC 4 54.04 10.13

Pa 63.33 11.71 5.6 .001 .78

RC 6 53.94 11.9

Pt 63.67 12.98 7.69 .001 1.08

RC 7 50.86 10.98

Sc 62.08 12.39 6.02 .001 .84

RC 8 52.86 11.78

Ma 50.63 8.57 1.21 .234 .17

RC 9 49.35 8.31

Table 3.

The MMPI-2 vs. RC sensitivity neurotic level of the overall personality

organization.

Scale M SD t p d

Hs 56.67 11.24 3.21 .003 .56

RC 1 52.85 11.55

D 54.73 9.92 1.1 .279 .19

RC 2 52.85 7.44

Hy 59.85 12.15 4.49 .001 .78

RC 3 46.79 8.31

Pd 59.7 8.87 4.41 .001 .77

RC 4 52 9.68

Pa 56.97 9.85 5.9 .001 1.03

RC 6 46.48 8.02

Pt 57.27 10.07 6.15 .001 1.07

RC 7 45.97 8.04

Sc 56.18 9.28 4.91 .001 .85

RC 8 45.91 7.84

Ma 49.24 6.49 2.67 .012 .46

RC 9 45.76 6.76

overall mean and standard deviation across all levels of the

OPO was M = 49.80 and SD = 10.30 indicating that the greater

elevations in the MMPI-2 Clinical scales are not due to the K

correction.

Hypothesis Three

For hypothesis 3, we predicted that for each clinical scale,

the RC scale adds very little incremental validity to the MMPI-

2 clinical scales in predicting the level of severity in the Overall

Personality Organization (OPO) scale. In testing hypothesis 3, a

series of multiple regressions were conducted where an MMPI-

2 scale was entered first, followed by its corresponding RC

scale.

In the first regression, Hs was entered first followed by RC 1.

For the first model, Hs accounted for 3.80% of the variance in

the OPO scale (R2 = .038). When RC 1 is included (model 2),

this value increases to .149 or 14.9% of the variance in the OPO

scale (R2 = .149), an increase of 11.1%. The F change for

model 2 was significant, F(1,94) = 12.303, p = .001, indicating

that adding RC 1 significantly improved the prediction of the

OPO scale compared to using Hs as a single predictor.

In the second regression, D was entered first followed by RC

2. For model 1, D accounted for 15% of the variance in the

OPO scale (R2 = .150). When RC 2 was entered in model 2,

this value increased to .153 or 15.3% (R2 = .153), an increase of

only .30%. The F change for model 2 was not significant,

F(1,94) = .382, p = .538, indicating that adding the RC 2 scale

did not significantly improve the prediction of the OPO scale

compared to using only D.

The third regression entered Hy followed by RC 3. For

model 1, Hy accounted for 7.30% of the variance in the OPO

scale (R2 = .073). For model 2, this value increased to .247 or

24.7% (R2 = .247), an increase of 17.4%. The F change was

significant, F(1,94) = 21.68, p = .001, indicating the adding RC

3 did significantly improve the prediction of the OPO scale

above and beyond what was predicted using only Hy. However,

R. M. GORDON ET AL.

RC 3 is a measure of Cynicism and not hysterical personality

traits and therefore cannot be considered a substitute for the

MMPI-2 Hy scale.

In the next regression, model 1 contained Pd, with RC 4

added in model 2. For model 1, Pd accounted for 23.9% of the

variance in the OPO scale (R2 = .239). For model 2, this value

increased to .241 or 24.1% (R2 = .241), an increase of only .2%.

This change in R2 produced a non-significant F(1,94) = .249, p

= .619, indicating no predictive improvement with the inclusion

of RC 4.

The fifth regression entered Pa followed by RC 6. For the

first model with Pa entered alone, Pa accounted for 24.2% of

the variance in the OPO scale (R2 = .242). When RC 6 was

added in model 2, this value increased to .289 or 28.9%, pro-

ducing a significant F(1,94) = 6.228, p = .014, indicating im-

provement in predicting the OPO scale compared to using only

Pa. An examination of the beta values for these two predictors

in model 2 suggests, however, that Pa predicts more of the

variance in the OPO scale than does RC 6 (−.317 vs. −.279).

That is, while RC 6 predicts additional variance above and

beyond that predicted by Pa alone, the amount predicted is

small relative to Pa.

We next entered Pt in model 1 followed by RC 7 in model 2.

For model 1, Pt accounted for 18.2% of the variance in the

OPO scale (R2 = .182). For model 2, this value increased

to .184 or 18.4 (R2 = .184), an increase of only .2%. This

change in R2 produced a non-significant F(1,94) = .306, p

= .582, indicating no predictive improvement with the inclusion

of RC 7.

The next regression entered Sc in model 1 and RC 8 in

model 2. For model 1, Sc accounted for 28.3% of the variance

in the OPO scale (R2 = .283). For model 2, this value increased

to .320 or 32.0.1% (R2 = .320), an increase of 3.7%. This

change in R2 produced a significant F(1,94) = 5.036, p = .027,

indicating improvement in predicting in the OPO scale with the

inclusion of RC 8. However, the beta values indicate the Sc

predicts more of the variance in the OPO scale than does the

RC 8 scale (−.366 vs. −.253).

In the final regression, Ma was entered first, followed in

model 2 with RC 9. For model 1, Ma accounted for 11.3% of

the variance in the OPO scale (R2 = .113). Adding RC 9 in

model two increased this value to 24.1% (R2 = .241), producing

a significant F(1,94) = 15.809, p = .001. In this regression, the

beta values indicate that RC 9 in comparison to MA also pre-

dicts more of the variance in the OPO scale (−.476 vs. −.021).

In summary, 5 of the 8 RC scales (RC 1, RC 2, RC 6, RC 8,

and RC 9) added incremental validity to the MMPI-2 clinical

scales in predicting the level of severity in the Overall Person-

ality Organization (OPO) scale. However, an examination of

the beta values indicates that for 2 of the 5 RC scales (RC 6 and

RC 8) the amount of additional predicted variance is relatively

small in comparison to the amount predicted by their corre-

sponding MMPI-2 scales (Pa and SC). Taken together, in terms

of predictive utility, the results suggest that only 3 of the 8 or

37.5% of the RC scales contribute incrementally in predicting

the level of severity in the OPO scale, lending support to hy-

pothesis 3.

Discussion

This study looked at the clinical sensitivity of the MMPI-2

Clinical scales vs. the MMPI-RC scales with 98 clients from

forensic, disability and psychotherapy evaluations, representing

a wide range from psychotic, borderline to neurotic levels of

personality organization as measured by the Psychodiagnostic

Chart. Since the RC scales lack a diversity of items and subtly,

we hypothesized that the MMPI-2 Clinical scales would have

more clinical sensitivity than the RC scales at: 1) all levels of

psychopathology and 2) particularly at the less pathological

levels where subtlety is more of an issue in detecting psycho-

pathology.

We found that the clients at the psychotic level of personality

organization as measured by the PDC, the MMPI-2 Hs, D, Hy

and Ma scales were not significantly different than the corre-

sponding MMPI RC 1, RC 2, RC 3, RC 9 scales. The MMPI-2

Pd, Pa, Pt, and Sc were all significantly higher than the corre-

sponding RC 4, RC 6, RC 7, and RC 8. Only 4 of the RC scales

reached clinical significance (T 65 or more), while 7 of the 8

MMPI 2 Clinical scales were T 65 or more for clients at the

psychotic level.

For those clients rated on the PDC at the borderline level the

MMPI-2, Hs and Ma scales and the RC 1 and RC 9 scales were

not significantly different. The MMPI-2 D, Hy, Pd, Pa, Pt, and

Sc were all significantly higher than the corresponding RC 2,

RC 3, RC 4, RC 6, RC 7, and RC 8 scales. D and Pd were in

the clinical range, but none of the RC scales reached the clinical

range of T 65.

For those clients rated on the PDC at the neurotic level, only

the MMPI-2 D scale and the RC 2 scales were not significantly

different. The MMPI-2 Hs, Hy, Pd, Pa, Pt, Sc and Ma were all

significantly higher than the corresponding RC scales. Across

all three levels of the Overall Personality Organization (OPO),

the neurotic level of the OPO had 88% difference between the

MMPI-2 and RC, followed by the borderline level (75%) and

lastly the psychotic level (50%).

The added K correction to the MMPI-2 Clinical scales does

not seem likely to account for the differences in elevations.

Overall, K was at the normal level (M = 49.80). K was lowest

in the psychotic level and highest in the neurotic level. K func-

tions in much the same way as the subtle items function in

those scales that are not K corrected, i.e. as the defensive as-

pects of the psychopathology (Gordon, 1989). These diagnosti-

cally valid items are not artificially elevating the Clinical scales.

Both K and the subtle items add diagnostic sensitivity to the

MMPI-2 scales not found in homogenized scales.

Most of the RC scales add little to no incremental validity to

the MMPI-2 Clinical scales in predicting the level of severity in

the Overall Personality Organization (OPO) scale. However,

RC 1, RC 2, and RC 9 do have value in adding to the incre-

mental validity of the MMPI-2 and should be considered as

supplemental scales. We recommend using the MMPI-2 Clini-

cal scales for screening psychopathology and to use the RC

scales only as supplemental scales. The broader issue, however,

is the value of criteria-based scales. The MMPI-2 scales were

based on the complexity expressed in the conflicts of disturbed

individuals. The RC scales are based on behavioral reductionis-

tic assumptions of psychopathology which fail to capture the

complexity of human conflicts.

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