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MMPI to MMPI-2 to MMPI-2-RF: An examination of the psychometric properties in a sample of patients with medically unexplained physical symptoms

ProQuest Dissertations and Theses, 2009
Dissertation
Author: P. Dian Evans
Abstract:
This study used archival data to examine psychometric properties of the MMPI in a medical sample composed of patients seeking medical care from physicians for physical complaints, but where no medical problems or physiologies were recorded. Answers to the MMPI were converted to MMPI-2 and MMPI-2-RF formats, and T -scores were calculated for MMPI, MMPI-2, and MMPI-2-RF Scales. Specifically, MMPI Clinical Scales, MMPI-2 Clinical Scales, Revised Clinical Scales, PSY-5 Scales, PSY-5 Revised Scales, MMPI-2-RF Fs Scale, and MMPI-2-RF Somatic/Cognitive Specific Problems Scales were studied. The dataset was evaluated for the presence of the Neurotic Triad. Grouping scales were investigated for correlation properties and other statistical properties, specifically focusing on possible somatization characteristics, and the extent to which MMPI-2 RC Scales were comparable to their MMPI-2 Clinical Scale counterparts, by studying differences between related internal consistency coefficients. Results indicated that the Neurotic Triad was present in these patients with medically unexplained physical symptoms. The highest scales ( T ≥ 65) were the MMPI-2-RF Fs, followed by the MMPI-2 Clinical Scales 1, 2, 3, respectively, MMPI-2-RF MLS, RC Scale 1, then three more (T ≥ 62) MMPI-2-RF Specific Problems (Somatic/Cognitive) Scales, GIC, NUC, and HPC, respectively. The MMPI-2 Ss Scale was significant for almost every scale in the study, or 19 out of 23 scales. Gender was significant for seven scales and age was significant for only one scale. The new Infrequency Somatic Responses (Fs) Scale proved to have interesting additional findings with particular significance for the MMPI-2-RF Specific Problems (Somatic/Cognitive) Scales in medical samples. KEY WORDS: Minnesota Multiphasic Personality Inventory (MMPI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Minnesota Multiphasic Personality Inventory-2 Revised Form (MMPI-2-RF), Revised Clinical (RC) Scales, Psychometrics, Somatization, Medical Sample, Archival Data, Prorated norms, Renormed, Recoded, Fs Scale, Ss Scale, Psychology, Personality, Medically Unexplained Physical Symptoms, MMPI, MMPI-2, RC, and MMPI-2-RF.

TABLE OF CONTENTS PARTS A and B PART A 1 I NTRODUCTI ON 1 PSYCHOMETRICS 4 SOMATIZATION 6 THE MI NNESOTA MULTIPHASIC PERSONALITY INVENTORY 19 MMPI Development 20 MMPI-2 Development 21 MMPI-2 Convention 23 Linear Versus Uniform T-scores 23 The Restructured Clinical (RC) Scales Development 24 MMPI-2-RF Development 27 MMPI Scales 28 Clinical Scale 1 (Hypochondriasis, Hs) 28 Clinical Scale 2 (Depression, D) 29 Clinical Scale 3 (Hysteria, Hy) 29 Clinical Scale 4 (Psychopathic Deviate, Pd) 30 Clinical Scale 5 (Masculinity Feminity, Mf) 31 Clinical Scale 6 (Paranoia, Pa) 31 Clinical Scale 7 (Psychasthenia, Pt) 32 Clinical Scale 8 (Schizophrenia, Sc) 32 vi

Clinical Scale 9 (Hypomania, Ma) 33 Clinical Scale 0 (Social Introversion, Si) 34 Socioeconomic Status Scale (Ss) 34 The Neurotic Triad 35 Restructured Clinical Scale d (Demoralization, dem) 38 Restructured Clinical Scale 1 (Somatic Complaints, som) 38 Restructured Clinical Scale 2 (Low Positive Emotions, lpe) 39 Restructured Clinical Scale 3 (Cynicism, cyn) 39 Restructured Clinical Scale 4 (Antisocial Behavior, asb) 40 Restructured Clinical Scale 6 (Ideas of Persecution, per) 40 Restructured Clinical Scale 7 (Dysfunctional Negative Emotions, dne) 40 Restructured Clinical Scale 8 (Aberrant Experiences, abx) 41 Restructured Clinical Scale 9 (Hypomanic Activation, hpm) 41 Personality Psychopathology Five (PSY-5) Scales 42 Specific Problems Scales (Somatic/Cognitive) 43 Infrequency Somatic Responses (Fs) 44 Code-Types 45 REFERENCES ( PART A) 49 PARTB 62 I NTRODUCTI ON 62 Background 62 Somatization 62 vii

Psychometrics 66 HYPOTHESES 68 METHOD 69 Participants 70 Instruments 71 Procedure 72 Data Analysis 73 Hypothesis 1 78 Hypothesis 2 80 Hypothesis 3 82 Hypothesis 4 84 Hypothesis S 86 Additional Findings 89 DISCUSSION 94 Summary 94 Limitations 96 Future Research 96 CONCLUSI ON 97 REFERENCES ( PART B) 100 vm

LIST OF APPENDIXES APPENDIX A: STEPS TAKEN TO RECODE DATA AND OBTAIN T-SCORES 104 APPENDIX B: ADDITIONAL SCALE MEANS AND STANDARD DEVIATIONS 105 APPENDIX C: MMPI AND MMPI-2 CLINICAL SCALES CORRELATIONS 106 APPENDIX D: MMPI-2-RF CORRELATIONS 108 APPENDIX E: ADDITIONAL CLINICAL SCALES PROFILES 110 IX

LIST OF FIGURES Figure 1 Six Major Steps in Conversion of Data 72 Figure 2 MMPI-2 Clinical Scales Mean Profile of Study Participants 78 Figure 3 RC Scales Mean Profile of Study Participants 80 Figure 4 MMPI-2 PSY-5 Scales Mean Profile of Study Participants 82 Figure S MMPI-2-RF PSY-5 Revised Scales Mean Profile of Study Participants 84 Figure 6 MMPI-2-RF Somatic/Cognitive Scales Mean Profile of Study Participants 86 Figure 7 Fs Scale Histogram 89 Figure 9 Fs Scale Mean T-scores by Years of Education 91 Figure 10 Fs Scale Mean T-scores by Ss Scale 93 Figure E1 MMPI- 2 Validity and Clinical Scales Mean Profile of Study Participants 110 Figure E2 MMPI Clinical Scales Mean Profile of Study Participants I l l x

LIST OF TABLES Table 1 General Demographic Characteristics of Study Participants 74 Table 2 All Scales T-score Means and Standard Deviations in Descending Order 76 Table 3 Correlations bet ween Demographics and the MMPI-2 Ss Scale 88 Table 5 Analysis of Specific Problems (Somatic/Cognitive) Scales (MMPI-2-RF) 94 Table Bl Means and Standard Deviations for MMPI Clinical Scales 105 Table B2 Means and Standard Deviations for VRIN, TRIN, L, F, Fb & K Scales (MMPI-2) 105 Table CI Correlations MMPI and MMPI-2 Clinical Scales 106 Table C2 Correlations MMPI and RC Scales 107 Table Dl Correlations MMPI-2 PSY-5 and MMPI-2-RF PSY-5 Revised Scales 108 Table D2 Correlations PSY-5 Revised and Specific Problems (Somatic/Cognitive) Scales .. 109 XI

MMPI TO MMPI-2 TO MMPI-2-RF: AN EXAMINATION OF THE PSYCHOMETRIC PROPERTIES IN A SAMPLE OF PATIENTS WITH MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS PART A A REVIEW OF THE LITERATURE By P. Dian Evans Fielding Graduate University xn

Abstract MMPI TO MMPI-2 TO MMPI-2-RF: AN EXAMINATION OF THE PSYCHOMETRIC PROPERTIES IN A SAMPLE OF PATIENTS WI TH MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS Review of Literature Part A by P. Dian Evans Fielding Graduate University This study used archival data to examine psychometric properties of the MMPI in a medical sample composed of patients seeking medical care from physicians for physical complaints, but where no medical problems or physiologies were recorded. Answers t o the MMPI were converted to MMPI-2 and MMPI-2-RF formats, and 7-scores were calculated for MMPI, MMPI-2, and MMPI-2-RF Scales. Specifically, MMPI Clinical Scales, MMPI-2 Clinical Scales, Revised Clinical Scales, PSY-5 Scales, PSY-5 Revised Scales, MMPI-2-RF Fs Scale, and MMPI-2 -RF Somatic/Cognitive Specific Problems Scales were studied. The dataset was evaluated for the presence of the Neurotic Triad. Grouping scales were investigated for correlation properties and other statistical properties, specifically focusing on possible somatization characteristics, and the extent to which MMPI-2 RC Scales were comparable to their MMPI-2 Clinical Scale counterparts, by studying differences between related internal consistency coefficients. Results indicated that the Neurotic Triad was present in these patients with medically unexplained physical symptoms. The highest scales ( 7 > 65) were the MMPI-2-RF Fs, followed by the MMPI-2 Clinical Scales 1, 2, 3, respectively, MMPI-2-RF MLS, RC Scale 1, then three mor e ( 7 > 62) MMPI-2-RF Specific xiii

Problems (Somatic/Cognitive) Scales, GIC, NUC, and HPC, respectively. The MMPI-2 Ss Scale was significant for almost every scale in the study, or 19 out of 23 scales. Gender was significant for seven scales and age was significant for only one scale. The new Infrequency Somatic Responses (Fs) Scale proved to have interesting additional findings with particular significance for the MMPI-2-RF Specific Problems (Somatic/Cognitive) Scales in medical samples. KEY WORDS: Minnesota Multiphasic Personality Inventory (MMPI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Minnesota Multiphasic Personality Inventory-2 Revised Form (MMPI-2-RF), Revised Clinical (RC) Scales, Psychometrics, Somatization, Medical Sample, Archival Data, Prorated norms, Renormed, Recoded, Fs Scale, Ss Scale, Psychology, Personality, Medically Unexplained Physical Symptoms, MMPI, MMPI-2, RC, andMMPI-2-RF. xiv

1 Introduction Sometimes it seems that understanding other people's actions is an almost impossible task and as a result, people often make comparisons bet ween their own behavior and the behavior of others in their group. Accurately understanding the human personality and all aspects of that personality takes much mor e structure than mer e comparisons bet ween oneself and others. It is t rue that personality theories do not involve all the higher math and symbolic systems that astrophysics, rocket science, the human genome project, molecular physics, organic chemistry, or spectroscopy involve, but one should not mistake knowledge of a subject with the tool or tools the scientist uses to study that subject and certainly not the subject itself. The topic of personality assessment is probably one of the most difficult and complex subjects that can be studied as can be attested by the variety of theories present in the academic world today, and its subset somatization is no different. Over the last t wo decades, the study of personality has grown and expanded rapidly and we have begun t o attempt to measure a person's personality objectively. Because personality is difficult to define, it logically has developed several definitions over the years (Feist & Feist, 2002). "In everyday language the word personality refers to one's social skills charisma and popularity" (Feist & Feist, p. 1). Psychologists use the t erm personality to mean mor e than a person's character (Feist & Feist, 2002), but this terminology does little to narrow the definition. Mischel, Shoda, and Smith (2004) state that, "The t erm personality has many definitions but no single meaning is accepted universally" (p. 3). Our

charge as psychologists is to define personality mor e narrowly and find constructs that help us measure the permanent traits or characteristics that give some consistency to a person's behavior. The dictionary (Webster, 2008) defines personality as the totality of an individual's behavioral and emotional characteristics. "Personality is not an existing substantive entity to be searched for but a complex construct to be developed and defined by the observer" (Smith & Vetter, 1982, p. 5). Carver and Scheier (2000) define personality as, "A dynamic organization inside the person of psychophysical systems that create a person's characteristic patterns of behavior thoughts and feelings" and further state that personality, "conveys a sense of consistency internal causality and personal distinctiveness" (p. 5). Mont e and Sollod (2003) define it as, "A pattern of relatively permanent traits dispositions or propensities that lead consistency to a person's behavior and thought processes" (p. 17). It appears that defining personality is as difficult as measuring it. Whichever definition and whichever theory one subscribes t o, with psychometric tools, we are getting closer and closer to being able to inventory, catalogue, and measure personality and all of its facets accurately. Psychometrics, therefore, is generally thought to be a theory and technique of psychological measurement, including knowledge, abilities, attitudes, and personality traits. It encompasses the design and analysis of research and the measurement of human characteristics (Michell, 1999). The subject of the present study is the psychometric properties of the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943); its revised editions, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Friedman, Lewak,

Nichols, & Webb, 2001); the Minnesota Multiphasic Personality Inventory-2 Revised Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008b); and the Restructured Clinical Scales (Tellegen et al., 2003) in a sample where physical complaints were present, but no physical illness was found. Perhaps no test has been mor e popular or more studied (an average of about 2,300 studies per decade since the 1940s) than the MMPI and its revised editions the MMPI-2 and the MMPI-2-RF (Friedman et al., 2001; Tellegen et al., 2003). It has been written that it is "the most widely used objective personality inventory in the world" (Friedman et al., 2001, p. 1). It is currently used in mental health settings, forensic settings, and non-clinical settings (Ben-Porath & Tellegen, 2008a). Indeed, in both forensic and clinical settings it is used extensively (Lally, 2003; Piotrowski, Belter, & Keller, 1998). It is also used in psychiatric inpatient settings (Arbisi, Sellbom, & Ben-Porath, 2008), employment settings (Butcher, 1994), and medical settings (Arbisi & Butcher, 2004). In addition, psychologists are using it to help make determinations of candidacy for organ transplantation (Ruchinskas et al., 2000). In 1943, Starke Hathaway and J. Charnley McKinley published the MMPI as a self- report tool designed to measure personality and aid in the diagnosis of psychopathology. The first MMPI attempted to measure such things as depression, schizophrenia, hysteria, deviance, psychasthenia, paranoia, and hypochondrias among other things using theories of personality and psychopathology. Later the construct of social introversion was added. Hathaway and McKinley (Hathaway & McKinley, 1940; Hathaway & McKinley, 1943; McKinley & Hathaway, 1940, 1942, 1944) had developed the test in the late 1930s using an empirical keying approach.

The second edition of the test, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), is arguably the most studied psychological assessment tool in the world. Conceptual overlap and heterogeneity have often been noted as potential weaknesses of the MMPI-2's Clinical Scales (Friedman et al., 2001). In 2003, the University of Minnesota Press introduced the MMPI-2 Restructured Clinical (RC) Scales to address these concerns (Tellegen et al., 2003), and mor e than that, to measure accurately what they were meant to measure. The RC Scales specifically look at the constructs of somatic complaints and demoralization among other things. Wi t h the release of the new Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) in 2008, a new era of research has begun. Composed of 338 items with the RC Scales at its core, the MMPI-2-RF is touted to build on the strengths of the MMPI-2 test to create a new standard that is publicized as psychometrically up-to-date and linked to current models of psychopathology and personality (Ben-Porath & Tellegen, 2008b). Psychometrics It has been written that "to ask what a scale measures is to inquire into its construct validity" (Tellegen, Ben-Porath, & Sellbom, 2009). Psychometrics is generally regarded as a study of theory and technique of psychological measurement, including knowledge, abilities, attitudes, and personality traits (Michell, 1999). It is concerned with the design and analysis of research and the measurement of human characteristics (Michell). It began with an attempt to measure intelligence (Michell, 1997). Francis Galton was a pioneer in the field devising intelligence measures (Bulmer, 2003) among his anthropometric

measures. Galton was followed in 1866 by Wilhelm Wundt, in 1906 by Charles Spearman, in 1910 by Alfred Binet, and in 1924 by Louis Thurstone, all contributing to the field with applied theoretical approaches (Martin). Binet developed what we now consider the first intelligence testing for children (Wolf, 1969). Within the context that intelligence was a single quantifiable entity as opposed to a global, multifaceted, qualitative process, Thurstone (1927, 1929, 1959) criticized the lack of exactness of the statistical tools used in the assessment instrument (Martin). Subsequently, people began to look mor e closely at psychometrics to determine if what was thought to be measured was indeed being measured (Martin, 1997). As a result, the justification for measurement based on the law of comparative judgment was developed, to which Thornt on contributed immensely (Martin, 1997). Psychometrics in the field of psychology and psychometric theory has expanded from mere intelligence determination to the measurement of other unseen things such as personality, attitudes, and beliefs. Once it had been suspected that the unseen could be measured, a definition of measurement needed to be developed. The classical scientists defined measurement as the numerical estimation and expression of the magnitude of one quantity relative to another (Michell, 1997). The reasoning was that Measurement in psychology and physics are in no sense different. Physicists can measure when they can find the operations by which they may meet the necessary criteria; psychologists have but to do the same. They need not worry about the mysterious differences bet ween the meaning of measurement in the t wo sciences. (Reese, 1943, p. 49) Others did not agree, however, and a new definition of measurement was proposed by Stanley Stevens (1946), as "the assignment of numerals to objects or events according to

some rule" (Miller, 197S, p. 47). This definition was launched by Stevens when he proposed four scales of measure, also called levels of measurement, when he claimed that all social scientific measurement could be reduced to four different types of scales, which he called "nominal," "ordinal," "interval," and "ratio," and is the definition of measurement used most in psychology today (Michell, 1997). Following the advancement of the definition of measurement, psychometrics began to be applied widely in assessment to measure abilities in domains such as general knowledge, memory, matrix reasoning, reading, writing, and mathematics. For the field of psychometrics, the next step brought attempts to measure attitudes, and finally, personality constructs, including somatization. Alternatively, there is a belief that that increasing theoretical and technical sophistication has not resulted in commensurate improvements in test design overall (Blinkhorn, 1997). Blinkhorn further asserts that current test theory places importance on statistical as opposed to psychological models that do not reflect the real psychological concerns. He has called for a new conceptualization. Nevertheless, the field continues to become proficient at both technical sophistication and test design. Somatization Since its original construction, the MMPI's prospective ability to assist physicians and other healthcare providers in understanding the psychological foundation, emotional components, and consequences of medical conditions was recognized (Arbisi & Butcher, 2004). It was anticipated that the MMPI would recognize the emotional features that contributed to the development of physical complaints and certain illness (Arbisi & Butcher;

Hanvik, 1949, 1951). Leo Hanvik (1949) report ed findings in his dissertation that there were significant differences between MMPIs of patients diagnosed with "definite organic etiology" and those with "presumed psychogenic etiology." He studied patients (n = 60) from Minneapolis Veterans Administration Hospital whose primary reason for hospitalization was low-back pain (Hanvik, 1949, 1951). He divided the patients into t wo groups of 30, differentiating between cases of presumed psychogenic backache and backache cases in which there were explicit findings of herniated intervertebral discs (Hanvik, 1951). He found statistically significant differences between the two groups on the Hs (significance at the p < .001 level), D (significance at the p < .05 level), Hy (significance at the p < .001 level), Pd (significance at the p < .01 level), Pt (significance at the p < .001 level), and Sc (significance at the p < .001 level) scales. Hanvik, however, did not have access to a Bonferroni (1935) correction formula. When done on his data, a Bonferroni correction would have revealed that Scales 2 and 4 were not significant. The patients without evidence of true backache, which he labeled "functional patients" scored higher on all of the scales. After he plotted the T-scores for all the patients in the functional group, he t ermed the resulting MMPI profile "neurotic in type, showing the 'conversion-V configuration, which features elevations on Hs and Hy, with D relatively low and a mild rise on Pt" (Hanvik, 1951, p. 353). Further analysis of Hanvik's data shows that his effect size for Scales 1 and 3 were d > 1.0. The effect was huge at d = 1.78 for Scale 1 and very large at d - 1.41 for Scale 3. Scale 2, however, had a medi um effect size at d = .58. Scales 7 and 8 though, had very large and large effect sizes of d = 1.11 and d = 1.08, respectively (Cohen, 1988). The study is important in the history of the MMPI. From there, the MMPI and the MMPI-2 were used

widely in the assessment of medical patients both to judge the effect of medical illness on the psychological welfare of the individual and vice versa (Arbisi & Butcher). Efforts t o discover and classify personality factors or traits that "would predispose individuals to a prolonged recovery from illness or t o identify patients who presented medically with functionally based somatic complaints were often hard to replicate and criticized for over pathologizing a normal response to medical illness" (Arbisi & Butcher, 2004, p. 573). Indeed, careful consideration is warranted when looking at assessment results in a medical sample. For people who have a defined physiological illness, denial or minimization of psychopathology is a commonly adopted response set in medical settings, as opposed to exaggerating or feigning pathology, which can happen when a person is having a somatic response to an emotional problem (Feldman & Christensen, 2007; Ruchinskas et al.,2000). Somatization is a state marked by various medically unexplained physical, or somatic, symptoms (Feldman & Christensen, 2007). Somatic development has been a fundamental concern of psychologists since the Egyptians described hysteria over 4,000 years ago (Woolfolk & Allen, 2007). It was initially attributed to women with wanderings of the uterus (Veith, 196S). It was further attributed to a disturbance of the stomach and spleen and other upper abdominal organs (Ladee, 1996). The Egyptians were quickly followed by the Greeks who described a similar set of psychosomatic symptoms (Woolfolk & Allen). In the 17' century, the notion that men could also have "hysteria" was penned by Charles Le Pois and named hypochondria (Boss, 1979). Paul Briquet (1859) described its

symptoms in terms of psychopathology in his monograph, Traite Clinique et Therapeutique de L'hysterie marking the beginning of the modern descriptive somatization. Somatization, however, remained an ill-defined group of disorders, characterized by multiple physical as well as psychological symptoms, especially depression (Noyes, Stuart, & Watson, 2008). Then, during the 19 century, somatization disorders became less popular as a diagnosis as organic diseases were discovered (Noyes et al., 2008). Tertiary syphilis, epilepsy, and gastrointestinal diseases were diseases that could be definitively diagnosed and somatization diseases became a concern of psychoanalysis (Noyes et al., 2008). Woolfolk and Allen (2007) note that Briquet's monograph is directly responsible for psychology's current conception of somatization disorder. Modern practice of the ideas detailed in this monograph came into being when Josef Breuer and Sigmund Freud (Breuer & Freud, 2000; Freud, 1917, 19S2) first began treating patients they suspected had somatization. Under the first theoretical position, psychoanalytic theory, there exists an unconscious connection bet ween physical indicators, such as bodily pain, and past disturbing experiences, conflicts, and trauma (Breuer & Freud, 2000; Freud, 1917, 1952). Under this theory, in some individuals, if these disturbing experiences, conflicts, and trauma are not discharged appropriately, they transfer into maladaptive bodily processes or the development of physical symptoms (Breuer & Freud, 2000; Freud, 1917, 1952). Others consider hysteria to be an interruption of goal-directed behavior (McHugh & Slavney, 1998). It is viewed not as a disease, but as a behavior (McHugh & Slavney, 1998). It is a role the person plays of a compromised state or physical condition because the

10 individual believes that he or she suffers from a disease and must persuade others that he or she is unwell (Glickman, 1980). The physical symptoms in somatization may echo an appeal for assistance or a longing for comfort and care and may reflect other rationale, such as avoiding responsibilities owed to others (Goldberg & Bridges, 1988). Under this theory, however, symptoms are not intentionally produced or contrived. The aspects of personality that elicit this performance are those that may take a resolution in playing a sick role or an overtly recognized disability (Goldberg & Bridges). Noyes, Langbehn, Happel, Stout, Muller, and Longley (2001) suggested that personality disorders and traits manifest in somatization with increased symptomatology and resulting visits to healthcare professionals. To examine the nature and extent of personality dysfunction associated with somatization, they (Noyes et al., 2001) administered testing and conducted structured interviews with what they considered somatizing and nonsomatizing patients in a general medicine clinic. They did so by examining the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) classifications of personality disorders and traits in what they considered a representative sample of somatizing patients from the General Internal Medicine Clinic of the University of Iowa Hospitals and Clinics (Noyes et al., 2001). Their hypotheses were that personality disorders would be mor e prevalent in somatizing than nonsomatizing patients; that the dimensions of neuroticism, extraversion, and agreeableness would distinguish the groups; and that mor e abnormal personality traits would be found among those who acknowledged the contribution of psychological factors to their symptoms than among those who did not in the somatizing

11 patients themselves (Noyes et al., 2001). The study's authors concluded that a greater percentage of the somatizing patients had one or mor e personality disorders, especially obsessive-compulsive disorder, than did the nonsomatizing patients (Noyes et al., 2001). They also concluded that the somatizing patients diverged from the nonsomatizing patients with respect to self-defeating, depressive, and negativistic personality traits and with higher neuroticism and lower agreeableness, plus mor e personality pathology (Noyes et al., 2001). The study, however, lacked diversity and had a small control group, with the participants in the study dwindling from 1, 010, to 550, and finally to 141 somatizing patients, 110 women and 31 men with a mean age of 42.2+13.0 years and 34 control patients, 27 women and 7 men with a mean age of 45.4+12.9 years. In addition, informants were not interviewed, more than a majority (59%) of the somatizing patients were depressed, and patients may have been misidentified (Noyes et al., 2001). The researchers themselves admitted, "It was often difficult to determine when somatic symptoms were unexplained or when worry about illness was excessive" (Noyes et al., p. 324). Along the same line, Bass and Murphy (1995) concluded that most patients with somatoform disorders have personality pathology and that these disturbances are best conceptualized as disorders of personality. Their literature review (Bass & Murphy, 1995) on somatoform disorders and personality disorders discovered that approximately t wo in three patients with a somatoform disorder met criteria for a personality disorder and suggested that the most clinically important problems presented by patients with somatoform disorders mirror dysfunctions of personality and concluded that somatoform disorders are disorders of development along with personality disorders. Whet her this can

12 be said for patients who somatize, as opposed to being diagnosed with somatoform disorder, is not yet known and something in need of study. Perhaps, some of the problem lies in the fact that despite the noticeable clinical importance of somatization and how it relates to personality disorder, it does not have a single meaning (De Gucht & Fischler, 2002) and it is equally difficult to define and study. Defining somatization is multifarious. The t erm incorporates multiple concepts with as many different definitions. The word "somatization" comes from the Greek word for body, "some" (Webster, 2008). It was first conceptualized by Lipowski (1968) as "the tendency to experience, conceptualize and/or communicate psychological states or contents as bodily sensations, functional changes or somatic metaphors" (p. 395). A decade later, he changed the definition to "a tendency to experience and/or communicate somatic distress and symptoms unaccounted for by pathological findings to attribute them to physical illness and to seek medical help for them" (Lipowski, 1988, p. 1358). It is an unconscious process where psychological distress is expressed as physical symptoms (Webster, 2008). Kellner (1985) defines somatization as the "occurrence of physical symptoms that are not supported by recognizable or sufficient physical pathology" (p. 150). It is defined in this study as recurrent physical complaints not fully explained by physical factors and resulting in medical attention or significant impairment. Although the concept of somatization has been recognized and discussed for centuries now, we still do not have a solid understanding of the cause. Neither do we have psychotherapeutic or pharmacologic intervention capable of producing clinically meaningful improvement in symptoms or functioning (Allen, Woolfolk, Escobar, Gara, & Hamer,

13 2006). The history of somatization is one of shifting conceptualizations and disputes (Noyes et al., 2008). Underlying theories of somatization are multiple and include psychosomatic theory, altered somatic awareness, virulent and contagious ideas, and metaphorical disease (Piatt, 2003) among others. From the various theories in existence, it is clear that we have been thinking about somatization for a while now, but despite the modernization of somatization treatment in the last 100 years, there are two theoretically divergent conceptions of somatization that can be ferreted from the research. These t wo opposing theories relate to either "a psychological connection" or "no psychological connection." The basic concept behind "connection" somatization is that a disconnect or a misconnect in the mind exists and this disconnect or misconnect manifests as a psychical symptom or symptoms within the body. This is the modern psychoanalytic theory of somatization, which holds that there is a relationship between emotions and bodily symptoms causing emotional energy to channel into physical symptoms (Breuer & Freud, 2000; Freud, 1917, 1952). It posits a connection between the experience of psychological suffering and the appearance of somatic indicators (De Gucht & Fischler, 2002). In this theoretical view, the somatic symptoms substitute for the psychological distress (De Gucht & Fischler). Cameron (2001) argues that these connection theories are incomplete. He postulates that, "Understanding the physical basis of psychosomatic processes, including the so-called mind-body problem, will require a detailed understanding of the psychobiology of interoception" (p. 697). He maintains that the assumption of the existence of psychosomatic development is constructed on the principle that psychological functions can

Full document contains 125 pages
Abstract: This study used archival data to examine psychometric properties of the MMPI in a medical sample composed of patients seeking medical care from physicians for physical complaints, but where no medical problems or physiologies were recorded. Answers to the MMPI were converted to MMPI-2 and MMPI-2-RF formats, and T -scores were calculated for MMPI, MMPI-2, and MMPI-2-RF Scales. Specifically, MMPI Clinical Scales, MMPI-2 Clinical Scales, Revised Clinical Scales, PSY-5 Scales, PSY-5 Revised Scales, MMPI-2-RF Fs Scale, and MMPI-2-RF Somatic/Cognitive Specific Problems Scales were studied. The dataset was evaluated for the presence of the Neurotic Triad. Grouping scales were investigated for correlation properties and other statistical properties, specifically focusing on possible somatization characteristics, and the extent to which MMPI-2 RC Scales were comparable to their MMPI-2 Clinical Scale counterparts, by studying differences between related internal consistency coefficients. Results indicated that the Neurotic Triad was present in these patients with medically unexplained physical symptoms. The highest scales ( T ≥ 65) were the MMPI-2-RF Fs, followed by the MMPI-2 Clinical Scales 1, 2, 3, respectively, MMPI-2-RF MLS, RC Scale 1, then three more (T ≥ 62) MMPI-2-RF Specific Problems (Somatic/Cognitive) Scales, GIC, NUC, and HPC, respectively. The MMPI-2 Ss Scale was significant for almost every scale in the study, or 19 out of 23 scales. Gender was significant for seven scales and age was significant for only one scale. The new Infrequency Somatic Responses (Fs) Scale proved to have interesting additional findings with particular significance for the MMPI-2-RF Specific Problems (Somatic/Cognitive) Scales in medical samples. KEY WORDS: Minnesota Multiphasic Personality Inventory (MMPI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Minnesota Multiphasic Personality Inventory-2 Revised Form (MMPI-2-RF), Revised Clinical (RC) Scales, Psychometrics, Somatization, Medical Sample, Archival Data, Prorated norms, Renormed, Recoded, Fs Scale, Ss Scale, Psychology, Personality, Medically Unexplained Physical Symptoms, MMPI, MMPI-2, RC, and MMPI-2-RF.