The Millon Clinical
Multiaxial Inventory-III, Third Edition (MCMI-III)(2006)
by Theodore Millon, Ph.D.,
D.Sc., Roger Davis, Ph.D., Carrie Millon, Ph.D., & Seth Grossman, Psy.D.
This recent Third Edition development of
the MCMI-III adds the Grossman Facet Scales, a series of therapy-guiding facet subscales, to the basic personality scales of
the instrument. These fact scales identify the most salient clinical domains
(e.g., interpersonal, cognitive) that characterize the patient taking the
inventory. This information helps "personalize" and further "individualize" the
MCMI test results by specifying those features that call for the therapist'
attention in what is called "personalized therapy". But first, a few words about
the basic MCMI-III and what distinguishes it as a clinical instrument.
The MCMI™ (Millon™ Clinical Multiaxial Inventory) is distinguished from other
inventories primarily by its brevity, its theoretical anchoring, multiaxial format,
tripartite construction and validation schema, use of base rate scores, and interpretive
depth. Each generation of the MCMI inventory has attempted to keep the total number of items
small enough to encourage its use in all types of diagnostic and treatment settings, yet
large enough to permit the assessment of a wide range of clinically relevant multiaxial
behaviors. At 175 items, the MCMI inventory is much shorter than comparable instruments. Terminology is geared to an eighth-grade reading level. The inventory is almost
self-administering. The great majority of patients can complete the MCMI-III™ in 20
to 30 minutes, facilitating relatively simple and rapid administrations while minimizing
patient resistance and fatigue.
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THEORETICAL ANCHORING
Diagnostic instruments are more useful when they are linked systematically to a
comprehensive clinical theory. Unfortunately, assessment techniques and personality theory
have developed almost independently. As a result, few diagnostic measures have either been
based on or have evolved from clinical theory. The MCMI™ is different. Each of
its Axis II scales is an operational measure of a syndrome derived from a theory of
personality (Millon, 1969, 1981, 1986a, 1986b, 1990; Millon & Davis, 1996). The scales
and profiles of the MCMI™ thus measure these theory-derived and theory-refined
variables directly and quantifiably. With a firm foundation in measurement, scale
elevations and configurations can be used to suggest specific patient diagnoses and
clinical dynamics, as well as testable hypotheses about social history and current
behavior.
COORDINATION TO DSM-IV
No less important than its link to theory is the coordination between a
clinically-oriented instrument and official diagnostic constructs. Few diagnostic
instruments currently available have been constructed to be as consonant with the official
nosology at the MCMI™. With the advent of DSM-III, DSM-III-R, and DSM-IV, diagnostic categories were precisely
specified and operationally defined. The structure of the MCMI inventory parallels that of
the DSM at a number of levels. First, the scales of the MCMI inventory are grouped into
the categories of personality and psychopathology, to reflect the DSM distinction between
Axis II and Axis I. Thus, separate scales distinguish the more enduring personality
characteristics of patients (Axis II) from the more acute clinical disorders they display
(Axis I). Profiles based on all clinical scales may be interpreted to illuminate the
interplay between long-standing characterological patterns and the distinctive clinical
symptoms currently manifest.
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TEST DEVELOPMENT
Item selection and scale development progressed through a sequence of three validation
steps: (1) theoretical-substantive; (2) internal-structural; and (3) external-criterion.
In the theoretical-substantive stage, items for each syndrome were generated to conform
both to theoretical requirements and to the substance of DSM criteria. In the
internal-structural stage, these "rational" items were subjected to internal
consistency analyses. Items having higher correlations with scales for which they were not
intended were either dropped entirely or re-examined against theoretical criteria and
reassigned or reweighted. Only items surviving each successive validation stage were
included in subsequent analyses. In the external-criterion phase, items were examined in
terms of their ability to discriminate between clinical groups, rather than between
clinical groups and normal subjects. This tripartite model of test construction attempts to synthesize the strengths of each
construction phase by rejecting items that are found to be deficient in particular
respects, thus ensuring that the final scales do not consist of items which optimize one
particular parameter of test construction, but instead conjointly satisfy multiple
requirements, increasing the generalizability of the end product.
BASE RATE SCORES
An important feature which distinguishes the MCMI inventory from other inventories is
its use of actuarial base rate data, rather than normalized standard score
transformations. T-scores implicitly assume the prevalence rates of all disorders to
be equal, that is, there are equal numbers of depressives and schizophrenics, for example. In contrast, the MCMI inventory seeks to diagnose the percentages of patients that are
actually found to be disordered across diagnostic settings. These data not only provide a
basis for selecting optimal differential diagnostic cutting lines, but also ensure that
the frequency of MCMI™ generated diagnoses and profile patterns will be
comparable to representative clinical prevalence rates.
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COMPUTER SCORING AND
INTERPRETATION
Computer programs are available for rapid and convenient machine scoring in all major
computing environments. Interpretive reports are available at two levels of detail. The PROFILE REPORT
presents the patient's MCMI™ scores and profile, and is useful as a screening
device to identify patients that may require more intensive evaluation or professional attention.The NARRATIVE REPORT integrates both personological and
symptomatic features of the patient, and are arranged in a style similar to those prepared
by clinical psychologists. Results are based on actuarial research, the MCMI's theoretical
schema, and relevant DSM diagnoses within a multiaxial framework. Therapeutic implications
are included.
CLINICAL USES
The primary intent of the MCMI inventory is to provide information to clinicians, that
is, psychologists, psychiatrists, counselors, social workers, physicians, and nurses, who
must make assessments and treatment decisions about persons with emotional and
interpersonal difficulties.
Because of its simplicity of administration and the availability of rapid computer
scoring and interpretation, the MCMI inventory can be used on a routine basis in
outpatient clinics, community agencies, mental health centers, college counseling
programs, general and mental hospitals, as well as independent and group practice offices,
and in the courts.
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RESEARCH
Over 600 research studies have used the MCMI™ inventory in a significant manner.
Objective, quantified, and theory-grounded individual scale scores and profile patterns
can be used to generate and test a variety of clinical, experimental, and demographic
hypotheses. Research support is also available through Pearson Assessments.
SCALES
The MCMI, Third
Edition consists of a total of twenty-four scales: Fourteen Clinical
Personality Patterns scales: Schizoid, Avoidant, Depressive (Melancholic),
Dependent, Histrionic, Narcissistic, Antisocial, Sadistic, Compulsive,
Negativistic, and Masochistic; three Severe Personality Pathology scales:
Schizotypal, Borderline, and Paranoid; seven Clinical Syndrome Scales:
Anxiety, Somatoform, Bipolar (Manic), Dysthymia, Alcohol Dependence, Drug
Dependence, and Posttraumatic Stress Disorder; three Severe Clinical Syndrome scales:
Thought Disorder, Major Depression, and Delusional Disorder; three Modifying Indices and a Validity scale. The personality scales parallel the
personality disorders of the DSM-III-R and DSM-IV, as refined by theory. They are grouped
into two levels of severity, the Clinical Personality Patterns scales and Severe
Personality Scales. The Axis I scales represent clinical conditions frequently seen in
clinical settings. They are also grouped into two levels of severity, the Clinical
Syndromes scales and the Severe Syndrome Scales. The three Modifying Indices - Disclosure,
Desirability, and Debasement - assess response tendencies which are connected with
particular personality patterns or Axis I conditions.
The MCMI-III, Third Edition
is a recent development in that it adds value to the basic inventory. Present
for the first time are a series of facet subscales for refining and maximizing
the utility of each of the major personality scales. Known as the Grossman Facet
Scales, they provide information specifying the patient's scores on several of
the personologic/clinical domains described in previous sections of this
Website, such as problematic interpersonal conduct, cognitive styles,
expressive behaviors, and the like. They thereby contribute useful diagnostic
information that should help clinicians better understand the particular realms
of functioning on which the patient's difficulties manifest themselves. They
should also provide the clinical practitioner with guidance for selecting
specific therapeutic modalities that are likely to maximize the achievement of
positive treatment goals.
Scale descriptions
and detailed data on test development and validation may be obtained by reading
the latest (2006) MCMI-III, Third Edition test manual.
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ORDERING THE MCMI-III™
The MCMI-III™ and all
Millon instruments are available through
Pearson Assessments
at
1-800-627-7271 (voice) or 1-800-632-9011 (fax).
(see a sample narrative report)
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