Assignment: Clinical Personality Assessments

Chapter 8

MILLON CLINICAL MULTIAXIAL INVENTORY-III

The Millon Clinical Multiaxial Inventory-III (MCMI-III: Millon, Davis, & Millon, 1994, 1997) is a broadband measure of the major dimensions of psychopathology found in Axis II disorders and some Axis I disorders of the DSM-IV-TR (American Psychiatric Association, 2000). The MCMI-III consists of 4 validity (modifier) scales, 11 personality style scales, 3 severe personality style scales, 7 clinical syndrome scales, and 3 severe clinical syndrome scales (see Table 8.1). Table 8.2 provides the general information on the MCMI-111. In contrast to the MMPl-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) that has 120+ additional scales, the MCMI-III does not have any subscales for these basic sets of scales or separate content scales so there are only 28 total scales on the MCMI-111. Consequently, learning to interpret the MCMI-III is more straightforward than the MMPI-2. Recently Grossman and del Rio (2005) described the development of 35 facet scales for the 14 personality style scales that represent the first such attempt to create subscales for any of the versions of the MCMI. These facet scales are very new so there is little research on them or clinical information on their use. They are described briefly later in this chapter. Assignment: Clinical Personality Assessments

HISTORY

Millon (1983; Millon & Davis, 1996) conceptualized an evolutionary framework for per­ sonality in which the interface of three polarities (pleasure-pain; active-passive; self-other) determines an individual’s specific personality style as an adaptation to the environment. The pleasure-pain polarity involves either seeking pleasure as a way of enhancing life or avoiding pain as a way of constricting life. The active-passive polarity involves either working to change unfavorable aspects of the environment or accepting unfavorable aspects that cannot be changed. Assignment: Clinical Personality Assessments

Table 8.3 presents the functional processes and structural domains for each of the 14 personality disorder styles in the MCMI-111. Millon et al. (1997) believe that each cell of this matrix contains the diagnostic attribute or criterion that best captures the personality style within that specific functional process or structural domain. Reading down each column provides an overview of how each personality style differs on each functional process or structural domain. Reading across each row provides an overview of how each personality style can be described.

Millon’s conceptual system for personality disorders does not map directly onto the DSM-IV-TR (American Psychiatric Association, 2000) Axis II personality disorders. The latter is an atheoretical categorical system that describes the behaviors and symptoms needed

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Table 8.1 Millon Clinical Multiaxial Inventory-III (MCMI-III)

Modifying Indices (Validity Scales) V Validity Index X y

z Personality Styles 1 2A

2B

3 4 5

6A 6B

7 BA BB

Severe Personality Styles s C p

Clinical Syndromes A

H N

D

B

T

R

Severe Clinical Syndromes ss cc pp

Disclosure Index Desirability Index Debasement Index

Schizoid Avoidant Depressive Dependent Histrionic Narcissistic Antisocial Sadistic (Aggressive) Compulsive N egativistic (Passive-Aggressive) Masochistic

Schizotypal Borderline Paranoid

Anxiety Disorder Somatoform Disorder Bipolar Disorder: Manic Dysthymic Disorder Alcohol Dependence Drug Dependence Posttraumatic Stress Disorder

Thought Disorder Major Depression Delusional Disorder

to make a specific personality disorder diagnosis. Millon also includes personality disorders

such as Sadistic (Aggressive) and Depressive on the MCMl-111 that are not included in the DSM-IV-TR.

MCMI (First Edition)

The original MCMI (Millon, 1977) had five major distinguishing features when compared

with the MMPI (Hathaway & McKinley, 1951 ), which was the primary self-report inventory in use at the time. First, the MCMI was developed following Millon’s comprehensive

 

 

Millon Clinical Multiaxial Inventory-III 253

Table 8.2 Millon Multiaxial Clinical Inventory-III (MCMI-111)

Authors: Published: Edition: Publisher: Website: Age range: Reading level: Administration formats: Languages: Number of items: Response format: Administration time: Primary scales:

Additional scales: Hand scoring: General texts:

Computer interpretation:

Millon, Davis, Millon 1994 3rd Pearson Assessments www.PearsonAssessments.com/tests/MCML3 18+ 8th grade Paper/pencil, computer, CD, cassette Spanish 175 True/False 25-30 minutes 4 Validity, 11 Personality Styles, 3 Severe Personality Styles,

7 Clinical Syndromes, 3 Severe Clinical Syndromes 35 (42) Facet Templates Choca (2004), Craig (2005), Jankowski (2002), Millon et al. (1997),

Retzlaff (1995), Strack (2002) Pearson Assessments (Millon); Psychological Assessment Resources

(Craig)

clinical theory described earlier, in contrast to the atheoretical or empirical development of the original MMPI (see Chapter 6). Second, the MCMI contained specific scales to assess personality disorders, the more enduring personality characteristics of patients, which would be incorporated into Axis II of the forthcoming diagnostic system at the time, that is, DSM-III (American Psychiatric Association, 1980). Third, the comparison group consisted of a representative sample of psychiatric patients instead of normal individuals, which would facilitate differential diagnosis among patients. Fourth, scores on the scales were transformed into actuarial base rates. These base rates reflected the actual frequency with which various forms of psychopathology occurred rather than traditional standard scores, which measure how far the person deviates from the mean of normal individuals. Assignment: Clinical Personality Assessments

Finally, the MCMI was designed to use as few items as possible to achieve these goals. At 175 items, the MCMI was and remains the shortest self-report inventory that is a broadband measure of the major dimensions of psychopathology.

The original MCMI had four items that evaluated whether the person had read the items. These four items will become the Validity (V) scale on the ensuing editions of the MCMI that assess the consistency of item endorsement.

The original MCMI did not have explicit validity scales to assess the accuracy of item endorsement. Instead a weight factor was developed based on the variation of the person’s score from the midpoint of the total raw score for the eight basic personality scales. When this total raw score was below 110, the person was thought to be too cautious in reporting problematic behaviors and symptoms of psychopathology so their scores would need to be adjusted upward. Conversely, when the total raw score was above 130, the person was thought to be too open or self-revealing so their scores would need to be adjusted downward.

 

 

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Table 8.3 Expression of personality disorders across the functional and structural domains of personality

Functional Processes

Expressive Interpersonal Regulatory Disorder Arts Conduct Cognitive Style Mechanisms

1 Schizoid Impassive Unengaged Impoverished Intellectualization 2A Avoidant Fretful Aversive Distracted Fantasy 2B Depressive Disconsolate Defenseless Pessimistic Asceticism 3 Dependent Incompetent Submissive Nai”ve Introjection 4 Histrionic Dramatic Attention- Flighty Dissociation

Seeking

5 Narcissistic Haughty Exploitive Expansive Rationalization 6A Antisocial Impulsive Irresponsible Deviant Acting Out 6B Sadistic Precipitate Abrasive Dogmatic Isolation 7 Compulsive Disciplined Respectful Constricted Reaction

Formation

SA Negativistic Resentful Contrary Skeptical Displacement SB Masochistic Abstinent Deferential Diffident Exaggeration s Schizotypal Eccentric Secretive Autistic Undoing C Borderline Spasmodic Paradoxical Capricious Regression p Paranoid Defensive Provocative Suspicious Projection. Assignment: Clinical Personality Assessments

Structural Attributes

Object Morphologic Mood/ Disorder Self-Image Representation Organization Temperament

1 Schizoid Complacent Meager Undifferentiated Apathetic 2A Avoidant Alienated Vexations Fragile Anguished 2B Depressive Worthless Forsaken Depleted Melancholic 3 Dependent Inept Immature Inchoate Pacific 4 Histrionic Gregarious Shallow Disjointed Fickle 5 Narcissistic Admirable Contrived Spurious Insouciant 6A Antisocial Autonomous Debased Unruly Callous 6B Sadistic Combative Pernicious Eruptive Hostile 7 Compulsive Conscientious Concealed Compartmentalized Solemn SA Negativistic Discontented Vacillating Divergent Irritable SB Masochistic Undeserving Discredited Inverted Dysphoric s Schizotypal Estranged Chaotic Fragmented Distraught or

Insensitive

C Borderline Uncertain Incompatible Split Labile p Paranoid Inviolable Unalterable Inelastic Irascible

Note: Self-Other are reversed in Compulsive and Negativistic. Source: MCM/-1// Manual, second edition (p. 27), by T. Millon, R. Davis, and C. Millon, 1997, Minneapolis, MN: National Computer Systems. Reprinted with permission from table 2.2.

 

 

Millon Clinical Multiaxial Inventory-III 255

This weight factor will become an explicit validity (modifier) scale (Disclosure [X]) on the ensuing forms of the MCMI.

MCMI-11 (Second Edition)

The second edition of the MCMI (MCMI-11: Millon, 1987) appeared in 1987 to enhance several features of the original MCMI. Two new personality disorder scales (Aggres­ sive/Sadistic and Self-Defeating [Masochistic]) and three validity (modifier) scales (Dis­ closure [X], Desirability [Y], and Debasement [Z]) scales were added to the profile form. Forty-five new items (45/175 = 25.7%) were added to replace 45 extant items that did not add sufficient discriminating power to their scales. Modifications also were made in the MCMI-11 items to bring the scales into closer coordination with DSM-III-R (American Psychiatric Association, 1987). An item-weighting procedure was added wherein items with greater prototypicality for a given scale were given higher weights of 2 or 3. If an item was endorsed in the nonscored direction, it was assigned a weight of 0. If an item was endorsed in the scored direction, it was assigned a weight of 1, 2, or 3 depending on how prototypical the item was for that scale with the most prototypical items assigned a weight of 3.

The replacement of one-quarter of the items from the original MCMI limits the general­ izability of its results to the MCMI-11. Even though the scales still have the same name, the actual items composing a scale may have changed substantially. The introduction of the in­ creased weighting of prototypical items on each MCMI-11 scale also alters the relationship among the items within the scale and with other scales.

MCMI-III (Third Edition)

The third edition of the MCMI (Millon et al., 1994, 1997) appeared in 1994 with four major changes. First, 95 (95/175 = 54.3%) new items were introduced to parallel the substantive nature of the then forthcoming DSM-IV criteria (American Psychiatric Association, 1994). Second, two new scales were added: one personality style (Depressive) and one clinical syndrome scale (Posttraumatic Stress Disorder). Third, a small set of items was added to strengthen the Noteworthy responses in the areas of child abuse, anorexia, and bulimia. Finally, the weighting of items was reduced to only two levels with the more prototypical items for a specific scale adding two points to the raw score.

The generalizability of the research results from the MCMI-11 to the MCMI-III need to be made cautiously because over one-half of the items were changed. The emphasis in these new items also tended to be on DSM-IV criteria. It appears that the emphasis in the MCMI-111 is toward the DSM-IV criteria for personality disorders; whereas the emphasis in the MCMI-11 was toward Millon’s theory. Assignment: Clinical Personality Assessments

ADMINISTRATION

The first issue in the administration of the MCMI-III is ensuring that the individual is invested in the process. Taking a few extra minutes to answer any questions the individual may have about why the MCMI-111 is being administered and how the results will be used

 

 

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will pay excellent dividends. This issue may be even more important with the MCMI-111 than with other self-report inventories because of the relatively limited number of items on each scale and the extensive item overlap that quickly compounds the effect of the individual distorting responses to even a few items. The clinician should work diligently

to make the assessment process a collaborative activity with the individual to obtain the desired information. This issue of therapeutic assessment (Finn, 1996; Fischer, 1994) was

covered in more depth in Chapter 2 (pp. 43-44). Reading level is a crucial factor in determining whether a person can complete the

MCMI-III; inadequate reading ability is a major cause of inconsistent patterns of item endorsement. Millon et al. (1997) suggest that most clients who have had at least 8 years of formal education can take the MCMI-111 with little or no difficulty because the items are written on an eighth-grade level or less. If there is some concern about the person’s reading level, he or she can be asked to read a few items out loud to obtain a quick estimate of whether reading is a problem. In those individuals for whom reading is difficult, the MCMI-III can be presented by CD or audiocassette tape.

SCORING

Scoring the MCMI-111 by hand is a complex process that commonly results in scoring errors (Millon et al., 1997, p. 112). If computer scoring is not available, each MCMI-III should be hand scored and profiled independently by two different individuals and their scores verified to catch such errors. If the MCMI-III is administered by computer, the computer automatically scores it. If the individual’s responses to the items have been placed on an answer sheet, these responses can be entered into the computer by the clinician for scoring or they can be hand scored. If the clinician enters the item responses into the computer for scoring, they should be double entered to identify any data entry errors.

The first step in hand scoring is to examine the answer sheet carefully and indicate omitted items and double-marked items by drawing a line through both the “true” and “false” responses to these latter items in brightly colored ink. Also, cleaning up the answer sheet is helpful and facilitates scoring. Responses that were changed need to be erased completely if possible, or clearly marked with an “X” so that the clinician is aware that this response has not been endorsed by the client. Assignment: Clinical Personality Assessments

The next step is to determine whether any of the three Validity (V) scale items (65, 110, 157) have been endorsed as being “True.” If two or more of these items have been endorsed as being “True,” scoring is unwarranted and should stop; it is probably unwarranted even if only one of them has been endorsed as “True.”

The number of omitted items, which is the total number of items not marked and double marked, is scored without a template. There is no standard place on the profile form on which the number of omitted items is reported so the clinician should make it explicit if, and how many, items have been omitted when it does occur. All the other scales except for Scale X (Disclosure) are scored by placing a plastic template over the answer sheet with a small box drawn at the scored (deviant) response–either “true” or “false”-for each item on the scale. The responses on the MCMI-111 are weighted either “1” or “2,” with the responses weighted “2” being prototypic for that scale. The sum of these weighted responses equals the client’s raw score for that scale; this raw score is recorded in the proper space on the

 

 

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Critical Items (Noteworthy Responses)

Critical items on the MCMI-III are identified as Noteworthy Responses (Millon et al., 1997, Appendix E). These Noteworthy Responses are divided into six categories: (1) Health Preoccupations; (2) Interpersonal Alienation; (3) Emotional Dyscontrol; (4) Self­ Destructive Potential; (5) Childhood Abuse; and (6) Eating Disorders. The deviant response to all these items is “True.” These items are intended to alert the clinician to specific items that warrant close review. All the items except one within Health Preoccupations are found on Scale H (Somatoform). The Eating Disorder items are not scored on any extant MCMI­ III scale and must be reviewed directly. Items 154 and 171 reflect suicide attempts and suicidal ideation that need to be reviewed any time they are endorsed or omitted. Assignment: Clinical Personality Assessments

APPLICATIONS

As a self-report inventory, the MCMI-111 is used routinely in clinical settings as well as correctional and substance abuse settings. However, the MCMI-III is not to be used “with normal populations or for purposes other than establishing a diagnostic screening and clinical assessment. … To administer the MCMI-111 to a wider range of problems or class of subjects, such as those found in business or industry, or to identify neurologic lesions, or to use it for the assessment of general personality traits among college students is to apply the instrument to settings and samples for which it is neither intended nor appropriate” (Millon et al., 1997, p. 6). Choca (2004) has suggested that there is nothing wrong with giving the MCMI-III to normal individuals or other samples on which the MCMI-III was not standardized, as long as the clinician keeps in mind the standardization group to which the person is being compared.

The MCMI-111 also is used in forensic settings, and several authors have provided guidelines for its use (McCann, 2002; Schutte, 2001 ). There has been substantial debate whether the MCMI-III meets the federal standards for evidence in the legal settings with advocates pro (Craig, 2006; Dyer, 2005) and con (Lally, 2003; Rogers, Salekin, & Sewell, 1999). Review of these issues is beyond the scope of this text. The forensic psychologist does need to be well informed about all these issues before using the MCMI-III.

Somewhat different issues must be considered in the administration of the MCMI-III in forensic settings compared with the more usual clinical setting. These issues were reviewed in Chapter 6 on the MMPI-2 (pp. 197-198) and will not be reiterated here. These issues need to be considered carefully because the validity (modifier) scales on the MCMI-III appear to be relatively insensitive to response distortions (Morgan, Schoenberg, Dorr, & Burke, 2002; Schoenberg, Dorr, & Morgan, 2003), although Schoenberg, Dorr, and Morgan (2006) developed a discriminant function that looked promising in identifying college students who were simulating psychopathology. Assignment: Clinical Personality Assessments

Millon et al. (1997) have stated that in child-custody settings when “custody battles reach the point of requiring psychological evaluation, they constitute such a degree of interpersonal difficulty that the evaluation becomes a clinical matter” (p. 144). McCann, Flens, and Campagna (2001) have reported normative data for 259 child-custody examinees. The mean MCMI-III profile for these examinees was an elevation on Scale Y (Social Desirability) and subclinical elevations on Scales 4 (Histrionic), 5 (Narcissistic), and 7

 

 

Millon Clinical Multiaxial Inventory-III 277

(Compulsive). Lampel (1999) reported elevations on the same four MCMI-III scales in 50 divorcing couples. Halon (2001) has questioned whether elevations on these four scales in child-custody samples reflect personality difficulties or normal personality characteristics.

PSYCHOMETRIC FOUNDATIONS

Demographic Variables

Age

There are minimal effects of age on any of the MCMI-III scales (Raddy et al., 2005). There is a slight tendency for raw scores to decrease slightly past the age of 50 except on Scales 4 (Histrionic), 5 (Narcissistic), and 7 (Compulsive). Raw scores increased slightly in individuals over 50 on these three scales. Dean and Choca (2001) reported similar results when male psychiatric patients were classified as younger (18 to 40) or older (60+). The older patients had lower scores on all MCMI-III scales except Scales 4 (Histrionic), 5 (Narcissistic), and 7 (Compulsive). Assignment: Clinical Personality Assessments

Gender

Gender does not create any general issues in MCMI-111 interpretation because separate base rate (BR) scores are used for men and women. Any gender differences in how individuals responded to the items on each scale are removed when the raw scores are converted to BR scores. Lindsay, Sank.is, and Widiger (2000) reported that women were more likely to endorse the items on Scale 4 (Histrionic).

Education

There is no research that has looked at the effects of education on MCMI-111 scales.

Ethnicity

About 15% of the development and cross-validation for the MCMI-III were nonwhite. Millon et al. (1997) reported that some differences were found for the demographic vari­ ables (unspecified), but these differences appear to reflect known differences in prevalence of the disorder. Some ethnic differences were noted on the MCMI-1 and MCMl-11, but no published research has looked at the effects of ethnicity on the MCMI-111. There have been several dissertations that examined ethnic differences on the MCMI-111. This ab­ sence of such research on the MCMI-111 is remarkable because it is so common with the MMPI/MMPI-2. Until such research is published on the MCMI-III, the MCMI-III should be used cautiously with nonwhite individuals. Assignment: Clinical Personality Assessments

Reliability

The MCMI-III Manual (Millon et al., 1997, Table 3.3, p. 58) reports the reliability data for 87 individuals who were retested after an average of 5 to 14 days. The test-retest correlations ranged from .82 to .96 across the scales with a median of .91, which is very stable. Measures of the internal consistency of each scale (Cronbach’s Alpha) also were quite good with only

 

 

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Table 8.7 Standard error of measurement for MCMI-111 scales in male psychiatric patients•

Raw Scores

SEM in BR Units at Base Rate

Scale M SD SEM Alpha* 60 75 85

Personality Styles J (Schizoid) 9.83 5.52 4.47 .81 3.35 2.23 5.14 2A (Avoidant) 8.94 6.64 5.91 .89 3.56 1.35 3.72 2B (Depressive) 9.58 6.77 6.02 .89 3.32 1.66 4.98 3 (Dependent) 8.55 5.86 4.98 .85 4.01 2.81 5.02 4 (Histrionic) 11.80 5.47 4.43 .81 NA NA NA 5 (Narcissistic) 13.06 4.75 3.18 .67 6.28 5.34 4.71 6A (Antisocial) 10.78 6.02 4.64 .77 3.45 2.59 2.16 6B (Sadistic) 9.67 6.06 4.79 .79 1.04 1.46 5.43 7 (Compulsive) 14.12 5.34 3.52 .66 3.69 NA NA BA (Negativistic) 10.39 6.51 5.41 .83 4.07 1.48 4.44 BB (Masochistic) 7.32 5.69 4.95 .87 1.62 1.01 5.86

Severe Personality Styles S (Schizotypal) 8.01 6.65 5.66 .85 1.77 1.77 4.60 C (Borderline) 10.02 6.67 5.67 .85 2.64 3.17 3.53 P (Paranoid) 8.96 6.55 5.50 .84 1.64 4.00 5.45

Clinical Syndromes A (Anxiety) 8.25 5.71 4.91 .86 5.09 2.65 2.65 H (Somatoform) 7.23 4.76 4.09 .86 1.95 7.33 7.33 N (Bipolar: Manic) 6.99 4.39 3.12 .71 2.57 4.81 6.41 D (Dysthymia) 9.55 6.03 5.31 .88 3.39 1.32 5.65 B (Alcohol Dependence) 8.93 6.00 4.92 .82 3.86 2.03 3.46 T (Drug Dependence) 8.86 6.29 5.22 .83 1.92 5.56 NA

R (PTSD) 8.92 6.47 5.76 .89 1.74 3.47 NA

Severe Clinical Syndromes SS (Thought Disorder) 8.77 6.15 5.35 .87 l.50 4.68 NA CC (Major Depression) 9.54 6.61 5.95 .90 1.34 4.20 5.04 PP (Delusional Disorder) 3.79 3.83 3.03 .79 2.64 5.61 7.26

Validity Scales (Modifier Scales) X (Disclosure) 119.85 34.43 NA NA Y (Desirability) 11.92 4.74 4.07 .86 6.14 4.91 NA Z (Debasement) 14.46 8.84 8.40 .95 1.55 1.79 NA

*N = 1,924. 0 Haddy et al. (2005).

 

 

Millon Clinical Multiaxial Inventory-III 279

six scales (5 [Histrionic]-.67; 6A [Antisocial]-.77; 6B [Sadistic/Aggressive]-.79; 7 [Compulsive]-.66; N [Bipolar: Manic]-.71; PP [Delusional Disorder]-.79) below .80.

The standard error of measurement for all MCMI-III scales is provided in Table 8.7 at BR scores of 60, 75, and 85 for male psychiatric patients (Haddy et al., 2005). (There were not a sufficient number of women in this sample to compute standard errors of measurement

for them. The standard errors of measurement for raw scores in men and women were generally similar suggesting that the standard errors of measurement for men could be used in women, too.) The standard error of measurement was calculated in raw score units for each scale and then converted in BR scores at these three points. For example, the standard error of measurement for Scale I (Schizoid) is 3.35, 2.23, and 5.14 at BR scores of 60, 75, and 85, respectively. These values change because the distribution is not uniform around these numbers. When the SEM is about 3 BR points for one of these scales, the individual’s true score will be within ±3 BR points two-thirds of the time.

The standard error of measurement for BR scores around 75 tends to be small, which means that BR scores above that cutting score are very likely to remain elevated despite any error of measurement. On the other hand, the standard error of measurement for BR scores around 85 tends to be about twice as large as at 75, which means that BR scores above cutting scores of 85 are more likely to change. Assignment: Clinical Personality Assessments

The maximum BR score on Scales 4 (Histrionic) and 7 (Compulsive) in men is 84 and 83, respectively. Thus, it is not possible for a man to have a BR score above 85 on this scale and the standard error of measurement could not be calculated. The maximum BR on these same two scales in women is 92 and 91, respectively.

CONCLUDING COMMENTS

The MCMI-III is the self-report inventory most widely used to assess personality disorders. The MCMI-III should be considered any time the presence of a personality disorder is expected in an individual; it is a frequently overlooked set of diagnoses given the more dramatic symptoms in most Axis I disorders. Computer scoring is almost mandatory for the MCMI-111 given its complexity and time-consuming nature. Clinicians must understand the derivation and use of BR scores for the accurate interpretation of the scale scores.

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Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A. M., & Kaemmer, B. (1989). MMPI-2: Manual for administration and scoring. Minneapolis: University of Minnesota Press.

 

 

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Charter, R. A., & Lopez, M. N. (2002). MCMI-III: The inability of the validity conditions to detect random responders. Journal ofClinical Psychology, 58, 1615-1617.

Choca, J. P. (2004). Interpretive guide to the Millon Clinical Multiaxial Inventory (3rd ed.). Wash­ ington, DC: American Psychological Association.

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Lally, S. J. (2003). What tests are acceptable for use in forensic evaluations?: A survey of experts. Professional Psychology: Research and Practice, 34, 491-498.

Lampel, A. K. (1999). Use of the MCMI-III in evaluating child custody litigants. American Journal ofForensic Psychology, 17, 19-31.

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McCann, J. T., Flens, J. T., & Campagna, V. (2001). The MCMI-III in child custody evaluations: A normative study. Journal ofForensic Psychology Practice, 1, 27-44.

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Millon, T., Davis, R., & Millon, C. (1994). MCMI-Ill manual. Minneapolis, MN: National Computer Systems.

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Morgan, C. D., Schoenberg, M. R., Dorr, D., & Burke, M. J. (2002). Overreport on the MCMI-III: Concurrent validation with the MMPI-2 using a psychiatric inpatient sample. Journal of Per­ sonality Assessment, 78, 288-300.

Paulhus, D. L. (1984). Two-component models of socially desirable responding.Journal ofPersonality and Social Psychology, 46, 598-609.

Retzlaff, P. D. (1995). Tactical psychotherapy of the personality disorders: An MCMI-III-based approach. Needham Heights, MA: Allyn & Bacon.

Retzlaff, P. D., Ofman, P., Hyer, L., & Matheson, S. (1994). MCMI-11 high-point codes: Severe personality disorder and clinical syndrome extensions. Journal of Clinical Psychology, 30, 228-234.

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