Millon Clinical Multiaxial Inventory – IV (MCMI-IV or “Millon”)

MCMI-IV, Millon, Millon Clinical Multiaxial Inventory – IV, personality assessment, psychological screening

The MCMI-IV

The Millon Clinical Multiaxial Inventory – IV (MCMI-IV or “Millon”) is a clinical and personality assessment test designed to:

Measure 10 clinical syndromes, which include anxiety, somatoform, bipolar, dysthymia, alcohol use, other drug use, PTSD, schizophrenia, major depression, and delusional thought disorder.
Screen for 15 personality disorders, including schizoid, avoidant, melancholic, dependent, histrionic, turbulent, narcissistic, antisocial, aggressive/sadistic, compulsive, negativistic, masochistic, schizotypal, borderline, and paranoid.
Validity Indexes that are sensitive to response styles that include issues with disclosure, desirability, debasement, invalid response patterns and inconsistency.

The MCMI-IV provides helpful clinical insights into a patient’s personality that allow clinicians to make more reliable diagnostic and treatment decisions. It is used in multiple settings, including clinical, counseling, medical, government, and forensic applications. The results are expressed in a narrative fashion. Portions of the computer-generated narrative are as follows, with minor edits for readability.

Excerpts from the Mental Measurements Yearbook review of the MCMI-IV

Review of the Millon Clinical Multiaxial Inventory–III [Manual Second Edition] by JAMES P. CHOCA, Director of Doctoral Studies, School of Psychology, Roosevelt University, Chicago, IL:

During a discussion at the convention of the American Psychological Association (APA), Raymond Fowler, APA Executive Director, lamented that the most commonly used psychological tests today are the same as those that were most popular 50 years ago (Fowler, 1999). It would appear that the field has not been able to duplicate, during the second half of the 20th century, the creativity of the first 50 years. The Stanford-Binet, the Rorschach, the Thematic Apperception Test (TAT), the Minnesota Multiphasic Personality Inventory (MMPI), the Wechsler batteries, and the Halstead-Reitan Neuropsychological Test Battery all originated during that time. Of course, there have been new editions, scoring systems, and refinements for many of the important tools of our trade. There has been an explosion of literature and several new journals dedicated exclusively to testing. There have even been a myriad of minor instruments added to our repertoire. These accomplishments, however, seem modest in comparison to the accomplishments of the first half of the century.

Perhaps the most notable exception to this trend has been the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1977, 1982, 1994). In spite of its relatively brief history, this instrument has become a commonly used clinical tool (Piotrowski & Keller, 1989; Piotrowski & Lubin, 1990; Watkins, Campbell, Nieberding, & Hallmark, 1995). Three books have been entirely dedicated to the MCMI (Choca & Van Denburg, 1997; Craig, 1993a, 1993b), and the test has been repeatedly included in textbooks dealing with psychological assessment (e.g., Beutler & Berren, 1995; Craig, 1999a; Groth-Marnat, 1997; Koocher, Norcross, & Hill, 1998; Maruish, 1994; McCann & Dyer, 1996; Millon, 1997a; Newmark, 1996; Strack, 1999). More than 500 published studies have used the MCMI to collect data (Craig, 1999b); in fact, only two personality tests (the MMPI and the Rorschach) have been the subject of more published studies than the MCMI in the recent past (Butcher & Rouse, 1996; Ritzler, 1996). Numerous reviews and critiques are available (Dana & Cantrell, 1988; Greer, 1984; Haladyna, 1992; Hess, 1985; Lanyon, 1984; McCabe, 1984; Reynolds, 1992; Wetzler, 1990; Wetzler & Marlowe, 1992; Widiger, 1985). The test is being used in other countries and has been translated into several other languages (Jackson, Rudd, Gazis, & Edwards, 1991; Luteijn, 1990; Montag & Comrey, 1987; Mortensen & Simonsen, 1990; Simonsen & Mortensen, 1990).

The MCMI has many advantages over its main competitor, the MMPI-2. For one thing, the instrument was especially designed to measure personality traits; although an assessment of the personality make-up can also be obtained from the MMPI-2, this reviewer believes that the MCMI offers a clearer and more comprehensive evaluation of the personality dimensions. In spite of being much shorter, the MCMI is just as valid and reliable as the MMPI-2. The instrument was normed with psychiatric patients and uses a new weighted score, the Base Rate Score (BRS), that takes into account the prevalence of the specific disorder in the psychiatric population. Finally, Millon has been eager to adjust the inventory in order to incorporate theoretical developments, as well as changes in the classification system for mental disorders. In contrast, the basic clinical scales of the MMPI were not changed appreciably during the recent revision, and are still tied to a diagnostic system that is now archaic. Recent developments linking the theory into systems of treatment planning and psychotherapy (Choca & Van Denburg, 1997; Hyer, 1994; Retzlaff, 1995; Millon, 1999) make the test useful in situations where the interest is more therapeutic than diagnostic.

Compared with other instruments designed to measure personality traits (e.g., the NEO Personality Inventory, Costa & McCrae, 1985), the MCMI is a clinical inventory. It conceptualizes personality in the way clinicians think, using prototypes that have been part of the clinical literature for years. Because it also offers scales measuring clinical syndromes (Axis I of the DSM-IV), the diagnostician does not have to resort to a different instrument in order to assess those areas of functioning.

The MCMI is routinely used by itself as a screening instrument or as part of a test battery. When used as part of a battery, the referral question and history are typically considered in order to determine what other tests should be included. A typical battery to evaluate emotional problems may include more specialized self-report questionnaires (e.g., the Eating Disorders Inventory) and projective tests such as the Rorschach and the TAT. The MCMI has also been used as part of a neuropsychological battery to evaluate brain dysfunction.

As is often the case, some of the disadvantages of the MCMI are the direct result of advantages listed above. The fact that it is based on Millon’s theory has limited, in the past, the degree of compatibility equivalent scales have had with the DSM disorders (Widiger & Sanderson, 1987; Widiger, Williams, Spitzer, & Frances, 1985). The current version (MCMI-III) has three personality scales that do not have a DSM-IV equivalent. Moreover, the efforts to make the test more DSM compatible may be limiting its compatibility with Millon’s theory (Widiger, 1999). In his eagerness to move the MCMI along, Millon has already produced three editions of this test. The end result is that, in spite of the wealth of literature available on the original MCMI and the MCMI-II, clinicians using the current version will not have access to much empirical data for a few years to come. Given the drastic changes that were made (95 of the 175 items of the MCMI-II were replaced to create the MCMI-III), one can not assume that anything that was true of an earlier version remains true with the current version.

The scoring used for the MCMI-III has been criticized for being unduly complex in ways that do not improve the performance of the test (Retzlaff, 1991; Retzlaff, Sheehand, & Lorr, 1990; Streiner, Goldberg, & Miller, 1993; Streiner & Miller, 1989). The test derives 24 scales from 175 items or the equivalent of about 7 items per scale. It accomplishes this feat by having items load on more than one scale, but that causes psychometric problems and leads to some scales that are excessively intercorrelated.

In pushing the psychological testing envelope, Millon accepted the notion of publishing operating characteristics, or the number of examinees that the test correctly diagnoses. This idea was originally proposed by Gibertini, Brandenburg, and Retzlaff (1986) for the MCMI, and the operating characteristics of the first two editions spoke well for those instruments. In contrast, the operating characteristics for the MCMI-III left something to be desired (Millon, 1994; Retzlaff, 1996). A second study was done by Roger Davis in an attempt to correct the problem, but the research design allowed clinicians who had seen the MCMI-III results to assign the diagnoses, obviously contaminating the data (study described in Millon, 1997b). It should be noted that having reasonable operating characteristics represents a very high standard for our current level of development. Even the most valid tests in our repertoire, such as the Wechsler Adult Intelligence Scale (WAIS-III), would probably fare poorly if we were to demand that–in the absence of any other information–the test results lead to an accurate DSM-IV diagnosis.

SUMMARY. In closing, it should be noted that some of the most arduous critics of the MCMI have continued to use this instrument in preference of anything else. As implied above, this reviewer sees this test as one of the greatest contributions made to the field during his professional life.

REVIEWER’S REFERENCES

Millon, T. (1977). Millon Clinical Multiaxial Inventory. Minneapolis, MN: National Computer Systems.
Millon, T. (1982). Manual for the MCMI-II. Minneapolis, MN: National Computer Systems.
Greer, S. (1984). Testing the test: A review of the Millon Clinical Multiaxial Inventory. Journal of Counseling and Development, 63, 262-263.
Lanyon, R. I. (1984). Personality assessment. Annual Review of Psychology, 35, 667-701.
McCabe, S. (1984). [Review of the Millon Clinical Multiaxial Inventory.] In D. Keyser & R. Sweetland (Eds.), Test critiques (Vol. 1, pp. 455-465). Kansas City, MO: Test Corporation of America.
Costa, P. T., & McCrae, R. R. (1985). The NEO Personality Inventory manual, Form S and Form R. Odessa, FL: Psychological Assessment Resources.
Hess, A. K. (1985). [Review of the Millon Clinical Multiaxial Inventory.] In J. V. Mitchell, Jr. (Ed.), The ninth mental measurements yearbook (pp. 984-986). Lincoln, NE: Buros Institute of Mental Measurements.
Widiger, T. A. (1985). [Review of the Millon Clinical Multiaxial Inventory.] In J. V. Mitchell, Jr. (Ed.), The ninth mental measurements yearbook (pp. 986-988). Lincoln, NE: Buros Institute of Mental Measurements.
Widiger, T. A., Williams, J. B. W., Spitzer, R. L., & Frances, A. (1985). The MCMI as a measure of DSM-III. Journal of Personality Assessment, 49, 366-378.
Gibertini, M., Brandenburg, N. A., & Retzlaff, P. D. (1986). The operating characteristics of the Millon Clinical Multiaxial Inventory. Journal of Personality Assessment, 50, 554-567.
Montag, I., & Comrey, A. L. (1987). Millon MCMI scales factor analyzed and correlated with MMPI and CPS scales. Multivariate Behavioral Research, 22, 401-413.
Widiger, T. A., & Sanderson, C. (1987). The convergent and discriminant validity of the MCMI as a measure of the DSM-III personality disorders. Journal of Personality Assessment, 51, 228-242.
Dana, R., & Cantrell, J. (1988). An update on the Millon Clinical Multiaxial Inventory (MCMI). Journal of Clinical Psychology, 44, 760-763.
Piotrowski, C., & Keller, J. W. (1989). Psychological testing in outpatient mental health facilities: A national study. Professional Psychology, Research and Practice, 20, 423-425.
Streiner, D. L., & Miller, H. R. (1989). The MCMI-II: How much better than the MCMI? Journal of Personality Assessment, 53, 81-84.
Luteijn, F. (1990). The MCMI in the Netherlands: First findings. Journal of Personality Disorders, 4, 297-302.
Mortensen, E. L., & Simonsen, E. (1990). Psychometric properties of the Danish MCMI-I translation. Scandinavian Journal of Psychology, 31, 149-153.
Piotrowski, C., & Lubin, B. (1990). Assessment practices of health psychologists: Survey of APA Division 38 clinicians. Professional Psychology: Research and Practice, 21, 99-106.
Retzlaff, P. D., Sheehan, E. P., & Lorr, M. (1990). MCMI-II scoring: Weighted and unweighted algorithms. Journal of Personality Assessment, 55, 219-223.
Simonsen, E., & Mortensen, E. L. (1990). Difficulties in translation of personality scales. Journal of Personality Disorders, 4, 290-296.
Wetzler, S. (1990). The Millon Clinical Multiaxial Inventory (MCMI): A review. Journal of Personality Assessment, 55, 445-464.
Jackson, H. J., Rudd, R., Gazis, J., & Edwards, J. (1991). Using the MCMI-I to diagnose personality disorders in inpatients: Axis I/Axis II associations and sex differences. Australian Psychologist, 26, 37-41.
Retzlaff, P. D. (1991, August). MCMI-II scoring challenges: Multi-weight items and site specific algorithms. Paper presented at the 99th Annual Convention of the American Psychological Association, San Francisco, CA.
Haladyna, T. M. (1992). [Review of the Millon Clinical Multiaxial Inventory-II.] In J. J. Kramer & J. C. Conoley (Eds.), The eleventh mental measurements yearbook (pp. 532-533). Lincoln, NE: Buros Institute of Mental Measurements.
Reynolds, C. R. (1992). [Review of the Millon Clinical Multiaxial Inventory-II.] In J. J. Kramer & J. C. Conoley (Eds.), The eleventh mental measurements yearbook (pp. 533-535). Lincoln, NE: Buros Institute of Mental Measurements.
Wetzler, S., & Marlowe, D. (1992). What they don’t tell you in the test manual: A response to Millon. Journal of Counseling and Development, 70, 427-428.
Craig, R. J. (Ed.). (1993a). The Millon Clinical Multiaxial Inventory: A clinical research information synthesis. Hillsdale, NJ: Lawrence Erlbaum.
Craig, R. J. (1993b). Psychological assessment with the Millon Clinical Multiaxial Inventory (II): An interpretative guide. Odessa, FL: Psychological Assessment Resources.
Streiner, D. L., Goldberg, J. O., & Miller, H. R. (1993). MCMI-II item weights: Their lack of effectiveness. Journal of Personality Assessment, 60, 471-476.
Hyer, L. (Ed.). (1994). Trauma victim: Theoretical issues and practical suggestions. Muncie, IN: Accelerated Development Incorporated.
Maruish, M. E. (Ed.). (1994). The use of psychological testing for treatment planning and outcome. Hillsdale, NJ: Erlbaum.
Millon, T. (1994). Millon Clinical Multiaxial Inventory–III manual. (1st ed.). Minneapolis, MN: National Computer Systems.
Beutler, L. E., & Berren, M. R. (Eds.). (1995). Integrative assessment of adult personality. New York: Guilford.
Retzlaff, P. D. (Ed.). (1995). Tactical psychotherapy of the personality disorders: An MCMI-III based approach. Boston: Allyn & Bacon.
Watkins, C. E., Jr., Campbell, V. L., Nieberding, R., & Hallmark, R. (1995). Contemporary practices of psychological assessment by clinical psychologists. Professional Psychology: Research and Practice, 26, 54-60.
Butcher, J. N., & Rouse, S. V. (1996). Personality: Individual differences and clinical assessment. Annual Review of Psychology, 47, 87-111.
McCann, J. T., & Dyer, F. J. (1996). Forensic assessment with the Millon inventories. New York: Guilford Press.
Newmark, C. S. (Ed.). (1996). Major psychological assessment instruments (Vol. II). Boston: Allyn & Bacon.
Retzlaff, P. (1996). MCMI-III diagnostic validity: Bad test or bad validity study? Journal of Personality Assessment, 66, 431-437.
Ritzler, B. (1996, Spring/Summer). Personality assessment and research: The state of the union. SPA Exchange, 6, 15.
Choca, J. P., & Van Denburg, E. (1997). Interpretative guide to the Millon Clinical Multiaxial Inventory (2nd ed.). Washington, DC: American Psychological Association.
Groth-Marnat, G. (1997). Handbook of psychological assessment (3rd ed.). New York: Wiley.
Millon, T. (1997a). The Millon inventories: Clinical and personality assessment. New York: Guilford.
Millon, T. (1997b). Millon Clinical Multiaxial Inventory–III manual (2nd ed.). Minneapolis, MN: National Computer Systems.
Koocher, G. P., Norcross, J. C., & Hill, S. S., III. (Eds.). (1998). Psychologists’ desk reference. New York: Oxford University Press.
Craig, R. J. (1999a). Interpreting personality tests: A clinical manual for the MMPI-2, MCMI-III, CPI-R, and 16PF. New York: Wiley.
Craig, R. J. (1999b). Overview and current status of the Millon Clinical Multiaxial Inventory. Journal of Personality Assessment, 72, 390-406.
Fowler, R. D. (1999, August). Discussion. In S. Urbina (Chair), Challenges and innovations in psychological testing and assessment. Symposium conducted at the 107th annual convention of the American Psychological Association, Boston.
Millon, T. (1999). Personality-guided therapy. New York: Wiley.
Strack, S. N. (Ed.). (1999). Essentials of Millon inventory assessments. New York: Wiley.
Widiger, T. A. (1999). Millon’s dimensional polarities. Journal of Personality Assessment, 72, 365-389.

Research on the Millon (MCMI-III)

Millon’s dimensional model of personality disorders: A comparative study.
Mullins-Sweatt, Stephanie N., Widiger, Thomas A.
Journal of Personality Disorders, Vol 21(1), Feb, 2007. pp. 42-57.
Abstract:
Millon has proposed six fundamental dimensions of general personality functioning as providing the underlying structure of personality disorders. However, this widely-cited theoretical model has been the subject of few empirical studies. The purpose of the current study was to directly compare the validity of this model to the five-factor model with respect to their hypothesized relationships with personality disorder symptomatology. Participants were administered the predominant measures of general personality functioning for each theoretical model, along with an assessment of personality disorder symptomatology. The results found only weak support for the theoretical model of Millon. Limitations and suggestions for future research are discussed.

The logic and methodology of the Millon Inventories.
Millon, Theodore
The SAGE handbook of personality theory and assessment, Vol 2: Personality measurement and testing. Boyle, Gregory J. (Ed.); Matthews, Gerald (Ed.); Saklofske, Donald H. (Ed.); pp. 663-683. Thousand Oaks, CA, US: Sage Publications, Inc, 2008. xxiv, 717 pp.
Abstract:
Although undoubtedly biased in my appraisal, I believe that no other group of assessment inventories offers as complete a synthesis of personality styles and classical psychiatric disorders as the Millon Inventories. Moreover, perhaps no other group of instruments is as coordinated with the official DSM and ICD taxonomies of personality disorders as the MillonInventories, or as conceptually consonant with the multiaxial logic that underlies the DSM. This chapter discusses integrative logic and the process of assessment; the importance of theory to a taxonomy of personality disorders; the polarity model of personality disorders; applying the polarity model to the personality disorders; development of the Millon Inventories; the MCMI; administration and scoring; interpretation; generating clinical domain hypotheses; the Grossman facet scales; the M-PACI and MACI (child-oriented inventories); the MBMD (psychosocial medical inventory); the MCCI (assessing college-level difficulties); and the MIPS-R (assessing normal personality styles).

On the dimensional theory, empirical support, and structural character of the MCMI-III.
Strack, Stephen, Millon, Theodore
The Millon inventories: A practitioner’s guide to personalized clinical assessment (2nd ed.). Millon, Theodore (Ed.); Bloom, Caryl (Ed.); pp. 405-429. New York, NY, US: Guilford Press, 2008. xv, 732 pp.
Abstract:
(from the chapter) The Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1997b, 2006) was created to assist clinicians in understanding the psychiatric problems of greatest concern to their patients and to contextualize the patients’ presentation features within a personality framework. A guiding assumption of the inventory is that everyone has a personality that influences the kind and severity of problems experienced, the expression of symptoms, and the types of treatments that are most likely to be effective. The test measures 14 personality disorders (PDs) and 10 clinical syndromes (CSs) via ordinal scales that quantify how much and how well respondents match or fit the constructs being assessed. As noted in earlier chapters of this text, the model represents an attempt to create a mature clinical science of personology by embodying five key elements: 1. Universal scientific principles: Science grounded in the ubiquitous laws of nature. 2. Subject-oriented theories: Explanatory and heuristic conceptual schemas of nature’s expression in what we call “personology” and “psychopathology.” 3. A taxonomy of personality patterns and clinical syndromes: A classification and nosology derived logically from a coordinated personality-psychopathology theory. 4. Integrated clinical and personality assessment instruments: Tools that are empirically grounded and quantitatively sensitive. 5. Synergistic therapeutic interventions: Coordinated strategies and modalities of treatment. Just as each person is an intrinsic unity, each component of a clinical science should not remain a separate element of unconnected parts. Rather, each facet of our clinical work—its principles, theories, taxonomy, instrumentation, and therapy—should be integrated into a gestalt, a coupled and synergistic unity in which the whole will be coordinated, and will become more informative and useful than its individual parts.

Using the Millon Inventories in forensic psychology.
Dyer, Frank J.
The Millon inventories: A practitioner’s guide to personalized clinical assessment (2nd ed.). Millon, Theodore (Ed.); Bloom, Caryl (Ed.); pp. 177-195. New York, NY, US: Guilford Press, 2008. xv, 732 pp.
Abstract:
(from the chapter) Experts are not going to be believed by judges and juries simply on the basis of their having completed extensive training in their field and having had a certain number of years of experience. One can guarantee with just about 100% certainty that if an expert comes to court and testifies based only on his or her experience and training, then the other side will put forward a similarly qualified expert who will testify on the basis of that expert’s experience and training, but will reach an entirely opposite conclusion in line with the interests of the client represented by the attorney who engaged the expert. The basis on which psychological experts testify in regard to their evaluations is enhanced in this regard by the use of assessment instruments and techniques that supplement the clinical interview. Rogers et al. (1999) criticize the content validity of the Millon Clinical Multiaxial Inventory-III (MCMI-III), citing an absence of any controlled interrater studies of the similarity of personality disorder scale items to the corresponding DSM-IV(-TR) criteria. It is therefore not unlikely that at some point forensic experts who use the MCMI-III will be forced to respond to a cross-examination attack on the instrument’s content validity based on this criticism. The question might be phrased thus: “Isn’t it true, Doctor, that there is no statistical evidence for the content validity of the MCMI-III?” The extensive validity support for the MCMI-III in the form of content validity evidence coupled with empirical research against criteria of clinical diagnosis—in conjunction with the clear connections between diagnosed disorders and specific cognitive, behavioral, and structural characteristics of the test subject provided by Millon’s theory of personality—make this a uniquely useful instrument in forensic work.

Studies relating the MCMI and the MMPI.
Antoni, Michael H.
The Millon inventories: A practitioner’s guide to personalized clinical assessment (2nd ed.). Millon, Theodore (Ed.); Bloom, Caryl (Ed.); pp. 157-176. New York, NY, US: Guilford Press, 2008. xv, 732 pp.
Abstract:
(from the chapter) Until the mid-1980s, little research had tested the utility of relating two or more “objective” inventories. One reasonable approach to addressing this issue is to examine the ways in which the best available instruments for measuring Axis I and Axis II phenomena covary. The Millon Clinical Multiaxial Inventory (MCMI) was designed to assess personality patterns and disorders (Axis II) specifically as established in the DSM-III. The MCMI is one of the few objective self-report inventories explicitly created to elucidate this realm of psychopathology. The MCMIalso assesses levels of personality disorder severity or “organization” (e.g., borderline). The Minnesota Multiphasic Personality Inventory (MMPI) is the best-documented instrument designed to assess the presence of specific clinical syndromes (Axis I). Together, the MMPI and MCMI may provide data on different domains of psychological functioning, both of which are essential to forming a complete clinical picture. Although many of the studies reported in this chapter refer to earlier versions of the MCMI and the MMPI than the present versions (the MCMI-III and MMPI-2), there is good reason to assume that the patterns of covariation found between these two early forms will hold true for later forms of these instruments. The studies reported in this chapter are the only comprehensive investigations based on large patient populations from an extensive national sample; no comparable set of studies exists in the literature.

Guidelines for the contemporary interpretation of the MCMI-III.
Rossini, Edward D., Choca, James P.
The Millon inventories: A practitioner’s guide to personalized clinical assessment (2nd ed.). Millon, Theodore (Ed.); Bloom, Caryl (Ed.); pp. 83-95. New York, NY, US: Guilford Press, 2008. xv, 732 pp.
Abstract:
(from the chapter) Over 30 years after the publication of the initial version, the Millon Clinical Multiaxial Inventory-III(MCMI-III; Millon, 1994) has met the millennium and is firmly established as the briefest and yet most distinctive of the “Big Three” comprehensive psychometric inventories measuring adult personality traits and adult psychopathology. The others are obviously the substantially longer Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and, to a lesser extent, the Personality Assessment Inventory (Morey, 1991). The latter two have considerable practical and conceptual limitations, despite their widespread use. However, surveys of psychological test usage consistently rate the MCMI-III and its companion inventories as quite popular across evaluation and treatment settings, with increasing popularity noted over the 1990s (Belter &c Piotrowski, 2001). The clinical utility of the MCMI-III is evident from the growing library of supplemental books now available. This chapter presents our method of interpreting MCMI-III profiles. This approach is presented in depth in Chapter 10 of the textbook published by the American Psychological Association (Choca, 2004). Although other MCMI-III interpretive strategies and guidelines are available and potentially useful in assessment situations, we have found the logical seven-step, sequential process we describe in this chapter to be especially helpful for understanding patients as people. This means developing a more dynamic understanding of the patients’ basic or premorbid personality style, their level of personality organization, and the likelihood of their being diagnosed with a personality disorder, in addition to the standard psychometric task of measuring their subtle or obvious psychiatric symptoms.

Scientific grounding and validation of the MCMI.
Millon, Theodore, Millon, Carrie M.,
The Millon inventories: A practitioner’s guide to personalized clinical assessment (2nd ed.). Millon, Theodore (Ed.); Bloom, Caryl (Ed.); pp. 49-82. New York, NY, US: Guilford Press, 2008. xv, 732 pp.
Abstract:
(from the chapter) This chapter is intended for readers who wish to explore the scientific grounding and validation of the Millon Clinical Multiaxial Inventory (MCMI) throughout its history (Millon, 1977, 1987, 1994). While the logic and rationale presented here may be more abstract than in other sections of this text, the discussion furnishes our perspective on how the constructs were derived and why we believe them to be consonant with recent developments in the field of personology.

Millon Clinical Multiaxial Inventory-III.
Craig, Robert J.
Personality assessment. Archer, Robert P. (Ed.); Smith, Steven R. (Ed.); pp. 133-165. New York, NY, US: Routledge/Taylor & Francis Group, 2008. xii, 463 pp.
Abstract:
(from the chapter) Discusses the Millon Clinical Multiaxial Inventory (MCMI-III) (Millon, 1983,1987,1994, 1997), which is now frequently used in clinical settings. It is stated that although test practices have changed very little over the past few decades with clinical psychologists using test instruments that were used 20 to 40 years ago, the one exception is the MCMI-III. In a survey of tests used by forensic psychologists for child custody evaluations, the MCMI was used by 34% of forensic psychologists (Ackerman & Ackerman, 1997); in a similar survey 10 years before the test was not used at all for this purpose (Keilen & Bloom, 1986). The MCMI is now the second most frequently used personality test in civil (Boccaccini & Brodsky, 1999) and criminal cases (Borum & Grisso, 1995), and it continues to be used in child custody evaluations (Quinnell & Bow, 2001). Nine books have been published on this test (Choca, 2004; Craig, 1993a,b, 1999a, 2005a,b; Jankowski, 2002; McCann & Dyer, 1996; and Retzlaff, 1995), and 12 reviews have been written, in mostly peer-reviewed journals (Choca, 2001; Craig, 1999b; Dana & Cantrell, 1988; Fleishaur, 1987; Greer, 1984; Haladyna, 1992; Hess, 1985,1990; Lanyon, 1984; McCabe, 1984; Reynolds, 1992; and Wetzler, 1990). The test is now routinely covered in edited books on major psychological tests (Bohlian, Meagher, & Millon, 2005; Craig 1997, 2001, 2006a; Davis, Meagher, Conclaves, Woodward, & Millon, 1999; Davis & Millon, 1993,1997; Conclaves, Woodward & Millon, 1994; Groth-Marnatt, 1997; Hall & Phung, 2001; Lehne, 1994,2002; Mlllon, 1984; Millon & Davis, 1996,1998; Millon & Meagher, 2003), and, of course, in texts which deal with the various Mlllon inventories (Craig, 1997, 2002 ). What accounts for this growth? The MCMI-III is a 175-questionnaire-based self-report inventory designed to diagnose personality disorders and major psychiatric syndromes in adult patients who are being evaluated for or receiving mental health services. There are many other personality tests, and many tests of personality disorders. So why has the MCMI become so popular? This chapter attempts to address three major questions: (1) Does the MCMI meet psychometric standards for reliability and validity? (2) Do the strengths of this test justify its use, given its limitations? and (3) Does it have a compendia of research base that justifies its use in the clinical context? The chapter looks at how theory was used to develop this test, how this test was standardized, and how it is under continuous revision.

Gold Medal Award for Life Achievement in the Application of Psychology.
American Psychologist, Vol 63(5), Jul-Aug, 2008. pp. 345-347
Abstract:
The 2008 recipient of the American Psychological Foundation (APF) Gold Medal Award for Life Achievement in the Application of Psychology is Theodore Millon. A citation, biography, and selected bibliography for Theodore Millon are provided in this article.

An exploration of the base rate scores of the Millon Clinical Multiaxial Inventory–III.
Grove, William M., Vrieze, Scott I.
Psychological Assessment, Vol 21(1), Mar, 2009. pp. 57-67.
Abstract:
The Millon Clinical Multiaxial Inventory (3rd ed.; MCMI–III) is a widely used psychological assessment of clinical and personality disorders. Unlike typical tests, the MCMI–III uses a base-rate score transformation to incorporate prior probabilities of disorder (i.e., base rates) in test output and diagnostic thresholds. The authors describe the base rate transformation and contend that its supporting documentation in the MCMI–III manual is incomplete and fails to meet interdisciplinary test documentation standards. They show that the MCMI–III’s base rate transformation is not optimal, and they derive an optimal alternative transformation using Bayes’ theorem. Bayes transformation formulae for 7 exponential family distributions are given. The authors discuss the effect of the base rate transformation and further argue that the MCMI–III’s use of a single base rate per diagnostic category is ill-advised. They argue that base rates differ among clinical settings and that tests like the MCMI–III should flexibly incorporate a base rate of disorder pertinent to the examinee’s characteristics, such as demographics, chief complaint, clinical history, or other variables. They explain how this can readily be accomplished.

A review and comparison of the reliabilities of the MMPI-2, MCMI-III- and PAI presented in their respective test manuals.
Wise, Edward A., Streiner, David L., Walfish, Steven
Measurement and Evaluation in Counseling and Development, Vol 42(4), Jan, 2010. pp. 246-254.
Abstract:
This article provides a review of the literature to determine the most frequently used personality tests. Based on this review, internal consistency and test—retest reliability coefficients from the test manuals for the Minnesota Multiphasic Personality Inventory—2 (MMPI-2), Millon Clinical Multiaxial Inventory—III (MCMI-III), and Personality Assessment Inventory (PAI) are reported. A summary of the strengths and weaknesses of the reliability estimates for each of the testsis provided.

Classification considerations in psychopathology and personology.
Millon, Theodore
Contemporary directions in psychopathology: Scientific foundations of the DSM-V and ICD-11. Millon, Theodore (Ed.); Krueger, Robert F. (Ed.); Simonsen, Erik (Ed.); pp. 149-173. New York, NY, US: Guilford Press, 2010. xvii, 622 pp.
Abstract:
In this chapter, the author hopes to illustrate at least one point—namely, that philosophical issues and scientific modes of analysis must be considered in formulating a psychopathological taxonomy. The author discusses conceptual issues, clinical attributes, structural models, construction methods, and evaluative standards.

Empirical evidence for a four factor framework of personality disorder organization: Multigroup confirmatory factor analysis of the Millon Clinical Multiaxial Inventory-III personality disorder scales across Belgian and Danish data samples.
Rossi, Gina, Elklit, Ask, Simonsen, Erik
Journal of Personality Disorders, Vol 24(1), Feb, 2010. pp. 128-150.
Abstract:
The factor structure of the Millon Clinical Multiaxial Inventory-Ill (Mil- Ion, Millon, Davis, & Grossman, 2006) personality disorder scales was analyzed using multigroup confirmatory factor analysis on data obtained from a Danish (N = 2030) and a Belgian (N = 1210) sample. Two-, three-, and four factor models, a priori specified using structures found by Dyce, O’Connor, Parkins, and Janzen (1997), were fitted to the data. The best fitting model was a four factor structure (RMSEA = .066, GFI = .98, CFI = .93) with partially invariant factor loadings. The robustness of this four-factor model clearly supports the efforts to organize future personality disorder description in a four-factor framework by corroborating four domains that were predominant in dimensional models (Widiger & Simonsen, 2005): Factor 1, 2, 3, and 4 respectively corresponded to emotional dysregulation versus stability, antagonism versus compliance, extraversion versus introversion, and constraint versus impulsivity.

Study of the reliability and validity of Millon Clinical Multiaxial Inventory III (MCMI-III).
Li, Ya-wen, Yang, Yun-ping, Jiang, Chang-qing
Chinese Journal of Clinical Psychology, Vol 18(1), Feb, 2010. pp. 11-13.
Abstract:
Objective: To translate Millon Clinical Multiaxial Inventory III (MCMI-III) into Chinese, and then test its reliability and validity. Methods: MCMI-III was administered to patients with mental disorders and normal people. Some subjects completed SAS, SDS, HAMA and HAMD simultaneously. 7-14 days later, some subjects completed the Chinese version of MCMI-III again. Results: Cronbach’s alpha and the split-half reliability of MCMI-III was 0.957 and 0.919, respectively. The mean Cronbach’s alpha, split-half and test-retest reliability of the subscales were 0.72, 0.70, 0.71 respectively. Most of the items correlated significantly (P < 0.05, P < 0.01) with corresponding subscales. Most of the subscales correlated significantly (P < 0.05, P < 0.01) with each other; SAS, SDS, HAMA and HAMD correlated significantly (P < 0.05, P < 0.01) with corresponding subscales. Most of the subscales’ scores of the patient group were significantly different (P < 0.05, P < 0.01) from the control group (n =45). Conclusion: The Chinese version of MCMI-IIImeets psychometric criterions, and it has good reliability and validity.

The Millon Clinical Multiaxial Inventory II: Stability over time? A seven-year follow-up study of substance abusers in treatment.
Ravndal, Edle, Vaglum, Per
European Addiction Research, Vol 16(3), Jun, 2010. pp. 146-151.
Abstract:
Measuring personality disorders among substance abusers may entail special problems related to the reliability and validity of the instruments. The Millon Clinical Multiaxial Inventory II (MCMI-II), a well-known self-reporting instrument, was used in a prospective study of drug abusers from 21 treatment programs in Norway (n = 481) to investigate the influence of substance abuse on the reliability and stability of the MCMI personality traits at intake to treatment and after 7 years (n = 342). As regards the drug-abusing and drug-free subgroups, the MCMI-II dimensional scores were equally reliable and stable in both groups, and were not influenced by the abusing state. Using the MCMI-II in a categorical diagnostic way did not show sufficient predictive validity. The MCMI-II dimensional scores should therefore be used to measure personality disorder traits among help-seeking and former drug abusers.

Disorders of personality: Introducing a DSM/ICD spectrum from normal to abnormal (3rd ed.).
Millon, Theodore
Hoboken, NJ, US: John Wiley & Sons Inc, 2011. xv, 1105 pp.
Abstract:
(from the preface) This book may be seen as an introduction and companion volume to the forthcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5), scheduled for publication by the American Psychiatric Association in 2013. Although the DSM will be more comprehensive descriptively than its predecessors, it will not be sufficient in scope to provide fully detailed clinical or theoretical presentations of the personality styles and disorders it encompasses. The lack of such materials will continue to be especially troublesome to those seeking substantial information on the many historical, modern, and contemporary conceptions of these clinical impairments. These mental syndromes have “come of age,” having been transformed from a class of pathology possessing only incidental relevance to the diagnostic enterprise into one that is central to the DSM’s multiaxial format and to professional’s everyday work. Although clinicians and researchers will find considerable literature on other psychopathologic syndromes in standard texts and journals, such information has only recently begun to accumulate for a small number of the personality styles and disorders.

A scholarly tour de force.
Widiger, Thomas A.
PsycCRITIQUES, Vol 56(39), 2011.
Abstract:
Reviews the book, “Disorders of personality: Introducing a DSM/ICD spectrum from normal to abnormal (3rd ed.)” by Theodore Millon (see record 2011-02661-000). This current text fully display’s Millon’s greatest skill, his scholarly acumen. If clinicians, scholars, or researchers wish to know anything about the history of personality disorder classification, the first place to look would be this book. It is likely that all questions will be answered. Millon also provides rich and intriguing insights and suggestions with respect to the treatment of personality disorders that are wonderfully integrated with a wide variety of alternative approaches. His impressive scholarship is again on display in his breadth of coverage of cognitive, interpersonal, and psychodynamic theories and therapies for each respective personality disorder. Clinicians and students will learn a great deal from this text. However, the empirical research concerning personality disorder treatment is not covered in detail. Instead, theory and clinical experience are emphasized.

Depression, anxiety, and the MCMI-III: Construct validity and diagnostic efficiency.
Saulsman, Lisa M.
Journal of Personality Assessment, Vol 93(1), Jan, 2011. pp. 76-83.
Abstract:
This study aimed to enhance knowledge of the construct validity and diagnostic efficiency of the depression- and anxiety-related scales of the MCMI–III (Millon, 1994). The MCMI–III, various concurrent depression and anxiety measures, and an Axis I structured diagnostic interview were administered in a total sample of 696 outpatients with depressive disorders, anxiety disorders, or both. Sound construct validity was found for the Dysthymia and Major Depression clinical syndrome scales and the Avoidant and Depressive personality disorder scales. The validity of the Anxiety scale was poor, showing moderate convergence with panic and worry-related anxiety measures, but problems discriminating from depression. Operating characteristics for discriminating depressed patients from anxious patients were fair for the Major Depression scale, but poor for the Anxiety and Dysthymia scales.

Classification accuracy of the Millon Clinical Multiaxial Inventory–III modifier indices in the detection of malingering in traumatic brain injury.
Aguerrevere, Luis E., Greve, Kevin W., Bianchini, Kevin J., Ord, Jonathan S.
Journal of Clinical and Experimental Neuropsychology, Vol 33(5), Jun, 2011. pp. 497-504.
Abstract:
The present study used criterion groups validation to determine the ability of the Millon Clinical Multiaxial Inventory–III (MCMI–III) modifier indices to detect malingering in traumatic brain injury (TBI). Patients with TBI who met criteria for malingered neurocognitive dysfunction (MND) were compared to those who showed no indications of malingering. Data were collected from 108 TBI patients referred for neuropsychological evaluation. Base rate (BR) scores were used for MCMI–III modifier indices: Disclosure, Desirability, and Debasement. Malingering classification was based on the Slick, Sherman, and Iverson (1999) criteria for MND. TBI patients were placed in one of three groups: MND (n=55), not-MND (n=26), or Indeterminate (n=26).The not-MND group had lower modifier index scores than the MND group. At scores associated with a 4% false-positive (FP) error rate, sensitivity was 47% for Disclosure, 51% for Desirability, and 55% for Debasement. Examination of joint classification analysis demonstrated 54% sensitivity at cutoffs associated with 0% FP error rate. Results suggested that scores from all MCMI–III modifier indices are useful for identifying intentional symptom exaggeration in TBI. Debasement was the most sensitive of the three indices. Clinical implications are discussed.

Classifying personality disorders: An evolution-based alternative to an evidence-based approach.
Millon, Theodore
Journal of Personality Disorders, Vol 25(3), Jun, 2011. Special issue: Special feature: The current state of personality disorder classification. pp. 279-304.
Abstract:
The study of personality disorders, no less psychology as a whole, remains divorced from broader spheres of scientific knowledge. Development of a conceptual schema for classifying personality disorders should include the examination of research limitations and inductive inconsistences that undermine the likely achievements of the evidential approach. An alternative course of action is outlined here, one that looks to evolutionary theory rather than evidence-based methods for classification guidance.

On the history and future study of personality and its disorders.
Millon, Theodore
Annual Review of Clinical Psychology, Vol 8, 2012. pp. 1-19.
Abstract:
The study of personality differences can be traced back to the early speculations of ancient societies, such as India, China, Babylonia, Greece, and Rome. Though a few clinicians, notably Hippocrates, stressed the importance of careful and systematic observation, hoping thereby to shift the focus of attention to natural rather than animistic events, it was not until centuries later that semiscientific approaches began to take hold, e.g., phrenology. In the past century, descriptive psychiatrists of note began to pose “typologies,” e.g., Kraepelin and Schneider, and several insightful psychoanalysts, e.g., Freud, Abraham, and Reich, articulated the developmental roots of “character” variations. Official classification systems, e.g., the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, have become the guiding arbiter of late-twentieth-century proposals. No less significant currently is thework of empirically oriented inductivists, e.g., Livesley and Widiger, and theoretically oriented deductivists, e.g., Kernberg and Millon.

Convergent validity of MCMI‐III clinical syndrome scales.
Hesse, Morten, Guldager, Steen, Linneberg, Inger Holm
British Journal of Clinical Psychology, Vol 51(2), Jun, 2012. pp. 172-184.
Abstract:
Objectives: This study tested the convergent validity of the Millon Clinical Multiaxial Inventory-III (MCMI-III) clinical syndrome scales. Design: Cross-sectional survey. Methods: Using a sample of 186 substance abusers from one single town referred for assessment, convergent and discriminant validity of the MCMI-III and Mini International Neuropsychiatric Interview (MINI) diagnoses was conducted. Additional measures included the Montgomery-Åsberg Depression Rating Scale and the Beck Anxiety Inventory. Results: A single Axis I factor based on the raw scores correlated adequately with the factor based on the other scales (r = .85), whereas the correlation between the factor based on the MCMI-III baserate scores was somewhat lower (r = .74), but still indicated substantial convergent validity. For individual disorders, area under the curve (AUC) analyses suggested that the convergent validity of the MCMI-III and the MINI was adequate. The raw score scales were superior to the baserate adjusted scores in all but one case. Discriminant validity was good for alcohol and drug dependence, moderate for major depression and delusion, and poor for thought disorder and anxiety. Conclusions: The MCMI-III clinical syndrome scales generally measure the constructs they were intended for. The data did not support that the adjustments used in calculating the baserate scores improved validity.