Assessment of Psychopathology I Pertemuan 8 Matakuliah: Psikologi Diagnostik Tahun: 2010

Millon Clinical Multiaxial Inventory (MCMI) The MCMI-III is a 175 item true-false self-report measure composed of 11 Clinical Personality Patterns scales, 3 Severe Personality Pathology scales, 7 Clinical Syndromes scales, and 3 Severe Syndromes scales plus a validity scale and 3 modifying indices. Wide range of information related to a client’s personality, emotional adjustment, and attitude toward taking tests. Focus on personality disorders along with symptoms that are frequently associated with these disordersDesigned for use with adults 18 years and older who are being evaluated and/or treated in mental health settings. Bina Nusantara University 3

MCMI – Theoretical Basis One of his core principles is the use of the polarities of pleasurepain, active-passive, and self-other (R. Davis, 1999; Millon & Davis, 1996; Strack, 1999) * These three fundamental polarities form a foundation, based in the larger framework of evolutionary theory Scale elevations should always be placed into the context of the person’s life. A high score is not diagnostic of a personality disorder in and of itself. Thus, the distinction between a personality “style” and an actual personality “disorder” should be stressed. Bina Nusantara University 4

MCMI – Theoretical Basis MCMI-III is based on an integrative conception of personality and psychopathology; conceptions of the individual’s manifest symptoms in terms of the interaction between longstanding coping styles and psychosocial stressors. Clinicians must retrace the above historical progression within the individual person, in order to achieve a conception of each patient’s psychopathology that contextualizes these manifest disorders in terms of the larger context of the individual’s style of perceiving, thinking, feeling, and behaving. Bina Nusantara University 5

MCMI - Scales Clinical Personality Patterns scales are described in the following sections: Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive/Sadistic, Compulsive, Negativistic (Passive-Aggressive), Self-Defeating Severe Personality Pathology Scales are three additional pathological personality patterns the schizotypal, borderline, and paranoid * Clinical Syndromes Scales (Axis I Syndrome) –Anxiety, Somatoform, Bipolar: Manic Disorder, Dysthymia, Alcohol Dependence, Drug Dependence, Post-Traumatic Stress Disorder. Severe Syndromes Scales – Thought Disorder, Major Depression, Delusional Disorder Bina Nusantara University 6

Beck Depression Inventory The BDI-II is a 21-item self-administered inventorydesigned to measure the intensity of depressive symptoms in psychiatric and nonpsychiatric populations of both adults and adolescents (Beck et al., 1996). Items are rated on a 4-point scale (0 to 3) and total scores are obtained by tallying the ratings for all 21 items. Scores range from 0 to 63, with higher scores reflecting increased depressive severity Bina Nusantara University 7

BDI - Theoretical Basis The BDI-II items were specifically selected to evaluate the symptoms and attitudes characteristic of the phenomenology of depression rather than to adhere to any particular theory (Beck et al., 1996). Additionally, although the BDI-II’s items are congruent with the DSM-IV, the BDIII is intended to identify the severity of symptoms and not nosological depression. Thus, the BDI-II should be supplemented with other information for a comprehensive assessment and diagnosis of depression. Bina Nusantara University 8

Test Development The original BDI (Beck et al., 1961) was designed to be administered in an interviewer-assisted fashion by trained professionals The BDI items were initially drawn from clinical observations and typical descriptions of symptoms provided by depressed patients. The 1978 revision, which was published as the BDI-IA in Beck et al. (1979), permitted simpler administration and scoring (see Beck & Steer, 1984). Bina Nusantara University 9

BDI – Assets and Limitations Among the most frequently used psychological tests to date A number of different populations have been studied over the years Clinically sensitive instrument that may be used for determining a baseline level of severity, formulating clinical hypotheses, deriving a case conceptualization, monitoring session-by-session treatment change, and determining treatment outcome 10 Difficulties at the individual item level Limited ability to detect deviant response sets and styles Instability of scores over time Lack of normative information for different ethnic groups Lack of established criteria for determining the accuracy of an examinee’s response.

Assessment of Children and Adolescents Personality Inventory for Children (PIC) multidimensional true-false objective questionnaire completed by a parent or a parent surrogate that assesses both broad and narrow dimensions of behavioral, emotional, cognitive, and interpersonal adjustment of children and adolescents. –Standard form –Behavioral Summary Bina Nusantara University 11

PIC – Adjustment Scales The nine full-length adjustment scales, each followed by their factor-guided two or three component subscales, are then presented in the following order: (1)cognitive status (Cognitive Impairment) with subscales measuring limited ability (Inadequate Abilities), inadequate academic achievement (Poor Achievement), and problematic development (Developmental Delay); (2)disruptive or externalizing problem behaviors (Impulsivity and Distractibility [Disruptive Behavior, Fearlessness] and Delinquency [Antisocial Behavior, Dyscontrol, Noncompliance]); Bina Nusantara University 12

PIC – Adjustment Scales cont’d..  Family status (Family Dysfunction [Conflict Among Members, Parent Maladjustment]); (4)Overcontrolled or internalizing problem behaviors (Reality Distortion [Developmental Deviation, Hallucinations and Delusions], Somatic Concern [Psychosomatic Preoccupation, Muscular Tension and Anxiety], and Psychological Discomfort [Fear and Worry, Depression, Sleep Disturbance/Preoccupation With Death]); and (5)Social status (Social Withdrawal [Social Introversion, Isolation] and Social Skill Deficits [Limited Peer Status, Conflict With Peers]). Scale interpretation may be supplemented by endorsed responses to a critical item list of 106 statements placed into nine broad clinical categories. Bina Nusantara University 13

Eight shortened 12-item versions of the adjustment scales (Cognitive Impairment is omitted) are placed on the profile form in standard format order followed by a profile of four summary composites: Externalization, Internalization, Social Adjustment, and Total Score. Bina Nusantara University 14

Personality Inventory for Youth a self-report companion to the PIC for students in Grades 4 through 12 (Lachar & Gruber, 1993). The PIY and PIC-2 are closely related in that the majority of the 270 true-false PIY items were derived from rewriting content-appropriate PIC items into a first- person format. three response validity scales and nine substantive scales Developmental or historical items were excluded in the self-report inventory because children cannot be expected to be accurate reporters of developmental delay Bina Nusantara University 15

Theoretical Basis developed without reference to any specific theory of personality or psychopathology Dimensions assessed by these instruments were selected to reflect established empirical and important clinical phenomena, taking into account problem frequency in childhood and adolescence and problem dimension salience in diagnostic assessment. Multidimensional and multisource assessment Bina Nusantara University 16

Theoretical Basis Multidimensional instruments efficiently measure a comprehensive range of complementary problem dimensions using a consistent format and standardization process. Comorbidity of problem dimensions is more likely to be the rule than the exception The diagnostic process for youth requires the accurate assessment of both problem presence and problem absence. Assessment of only the inferred condition in such cases would result in a highly inaccurate evaluation Bina Nusantara University 17