The Millon Clinical Multiaxial Inventory – Fourth Edition (MCMI-IV) is the most recent edition of the Millon Clinical Multiaxial Inventory. The MCMI is a psychological assessment tool intended to provide information on personality traits and psychopathology, including specific mental disorders outlined in the DSM-5. It is intended for adults (18 and over) with at least a 5th grade reading level who are currently seeking mental health services. The MCMI was developed and standardized specifically on clinical populations (i.e. patients in clinical settings or people with existing mental health problems), and is not intended to be used with the general population or adolescents.Millon Clinical Multiaxial Inventory-III (MCMI-III) FAQs, Q1: "When is it appropriate to use the MCMI-III test?" However, there is evidence base that shows that it may still retain validity on non-clinical populations, and so psychologists will sometimes administer the test to members of the general population, with caution. The concepts involved in the questions and their presentation make it unsuitable for those with below average intelligence or reading ability.
The MCMI-IV is based on Theodore Millon's evolutionary theory and is organized according to a multiaxial format. Updates to each version of the MCMI coincide with revisions to the DSM.
The fourth edition is composed of 195 true-false questions that take approximately 25–30 minutes to complete. It was created by Theodore Millon, Seth Grossman, and Carrie Millon.
The test is modeled on four categories of scales: 15 Personality Pattern Scales 10 Clinical Syndrome Scales 5 Validity Scales: 3 Modifying Indices; 2 Random Response Indicators 45 Grossman Personality Facet Scales (based on Seth Grossman's theories of personality and psychopathology)
Theory
The Millon Clinical Multiaxial Inventories are based on Theodore Millon's evolutionary theory. Millon's theory is one of many theories of personality. Briefly the theory is divided into three core components which Millon cited as representing the most basic motivations. These core components are which each manifest in distinct polarities (in parentheses): Existence (Pleasure – Pain) Adaptation (Passive – Active) Reproduction (Self – Other) Furthermore, this theory presents personality as manifesting in three functional and structural domains, which are further divided into subdomains: Behavioral Phenomenological Intrapsychic Biophysical Finally, the Millon Evolutionary Theory outlines 15 personalities, each with a normal and abnormal presentation. The MCMI-IV is one of several measures in a body of personality assessments developed by Millon and associates based on his theory of personality.
History
MCMI In 1969, Theodore Millon wrote the book Modern Psychopathology, after which he received many letters from students stating that his ideas were helpful in writing their dissertations. This was the event that prompted him to undertake test construction of the MCMI himself. The original version of the MCMI was published in 1977 and corresponds with the DSM-III. It contained 11 personality scales and 9 clinical syndrome scales.Millon, T. (2008). The logic and methodology of the Millon inventories. Cross-cultural personality assessment. In G. J. Boyle, G. Matthews, & D. H. Saklofske (Eds.). Sage handbook of personality theory and assessment. Vol. 2: Personality theory and assessment. Los Angeles, CA: Sage.
MCMI-II With the publication of the DSM-III-R, a new version of the MCMI (MCMI-II) was published in 1987 to reflect the changes made to the revised DSM. The MCMI-II contained 13 personality scales and 9 clinical syndrome scales. The antisocial-aggressive scale was separated into two separate scales, and the masochistic (self-defeating) scale was added. Additionally, 3 modifying indices added and a 3-point item-weighting system introduced.
MCMI-III The MCMI-III was published in 1994 and reflected revisions made in the DSM-IV. This version eliminated specific personality scales and added scales for depressive and PTSD bringing the total number of scales to 14 personality scales, 10 clinical syndrome scales, and 5 correction scales. The previous 3-point item-weighting scale was modified to a 2-point scale. Additional content was added to include child abuse, anorexia and bulimia. The Grossman Facet scales are also new to this version. The MCMI-III is composed of 175 true-false questions that reportedly take 25–30 minutes to complete.
MCMI-IV The MCMI-IV was published in 2015. This version contains 195 true-false items and takes approximately 25–30 minutes to complete.Millon, T., Grossman, S., & Millon, C. (2015). MCMI-IV: Millon Clinical Multiaxial Inventory Manual (1st ed.). Bloomington, MN: NCS Pearson, Inc. The MCMI-IV consists of 5 validity scales, 15 personality scales and 10 clinical syndrome scales. Changes from the MCMI-III include a complete normative update, both new and updated test items, changes to remain aligned to the DSM-5, the inclusion of ICD-10 code types, an updated set of Grossman Facet Scales, the addition of critical responses, and the addition of the Turbulent Personality Scale.
Format
The MCMI-IV contains a total of 30 scales broken down into 25 clinical scales and 5 validity scales. The 25 clinical scales are divided into 15 personality and 10 clinical syndrome scales (the clinical syndrome scales are further divided into 7 Clinical Syndromes and 3 Severe Clinical Syndromes). The personality scales are further divided into 12 Clinical Personality Patterns and 3 Severe Personality Pathology scales.
Personality scales The personality scales are associated with personality patterns identified in Millon's evolutionary theory and the DSM-5 personality disorders. There are two main categories of personality scales: Clinical Personality Pattern Scales and Severe Personality Pathology Scales. Each of the personality scales contain 3 Grossman Facet Scales for a total of 45 Grossman Facet Scales. When interpreting the personality scales, the authors recommend that qualified professionals interpret the Severe Personality Pathology scales before the Clinical Personality Pattern scales as the pattern of responding indicated by the Severe Personality Pathology scale scores may also affect the scores on the Clinical Personality Pattern scales (i.e. if an individual scores high on the Severe Personality Pathology scale P (Paranoid), this may also explain the pattern of scores on the Clinical Personality Pattern scales).
Grossman Facet Scales The Grossman Facet Scales were added to improve the overall clinical utility and specificity of the test, and attempt to influence future iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The hope was the DSM would adopt the prototypical feature identification method used in the MCMI to differentiate between personality disorders.Millon, T., Davis, R., Grossman, S., & Millon, C. (2009). MCMI-III: Millon Clinical Multiaxial Inventory-III Manual, 4th edition. Minneapolis, MN: NCS, Inc.
There are three facet scales within each of the Clinical Personality Patterns and Severe Personality Pathology scales. Each facet scale is thought to help identify the key descriptive components of each personality scale, making it easier to evaluate slight differences in symptom presentations between people with elevated scores on the same personality scale. For instance, two profiles with an elevated score on the Borderline scale may have differences in their Temperamentally Labile facet scale scores. This would mean, for clinical treatment or assessment planning, you could have a better understanding of how quickly and spontaneously a person's mood may change, compared to others with elevated Borderline scale scores.Millon, T., Millon, C., & Grossman, S. (2015). Millon Clinical Multiaxial Inventory - IV manual (4th ed.). Bloomington: NCS Pearson, Inc.
There are also some noteworthy limitations of the Grossman facet scales. The MCMI personality scales share some of the same test items, leading to strong intercorrelations between different personality scales. Additionally, each facet consists of less than 10 items and the items are often similar to ones in other facets of the same personality scale. Thus, it is unclear how much a facet measures a unique component of a personality scale.Grossman, S. (2004). Facets of personality: A proposal for the development of MCMI-III content scales. Unpublished doctoral dissertation, Carlos Albizu University, Miami, FL. Furthermore, statistical analysis has found some items within the facet scales may not be consistently measuring the same component as other items on that scale, with some item alpha coefficients as low as .51. For these reasons it is recommended to use supplemental information, in addition to that provided by the facet scales, to inform any assessment or treatment decisions.
Summary table of personality scales
Abbreviation DescriptionClinical Personality Patterns 1 Schizoid 2A Avoidant 2B Melancholic 3 Dependent 4A Histrionic 4B Turbulent 5 Narcissistic 6A Antisocial 6B Sadistic 7 Compulsive 8A Negativistic 8B MasochisticSevere Personality Pathology S Schizotypal C Borderline P Paranoid
Clinical syndrome scales 10 Clinical Syndrome Scales correspond with clinical disorders of the DSM-5. Similar to the personality scales, the 10 clinical syndrome scales are broken down into 7 clinical syndrome scales (A-R) and 3 severe clinical syndrome scales (SS-PP). When interpreting the clinical scales, the authors recommend that qualified professionals interpret the Severe Clinical Syndrome scales before the Clinical Syndrome scales as the pattern of responding indicated by the Severe Clinical Syndrome scale scores may also affect the scores on the Clinical Syndrome scales (e.g. if an individual scores high on the Severe P scale Clinical Syndrome scale score (e.g. Thought Disorder), this may also explain the pattern of scores on the other Clinical Syndrome scales).
Summary table of clinical syndrome scales Abbreviation DescriptionSevere Clinical Syndrome SS Thought Disorder CC Major Depression PP Delusional DisorderClinical Syndrome A Generalized Anxiety H Somatic Symptom N Bipolar Disorder D Persistent Depression B Alcohol Use T Drug Use R Post-Traumatic Stress
Validity scales of MCMI
Modifying indices The modifying indices consist of 3 scales: the Disclosure Scale (X), the Desirability Scale (Y) and the Debasement Scale (Z).
These scales are used to provide information about a patient's response style, including whether they presented themselves in a positive light (elevated Desirability scale) or negative light (elevated Debasement scale). The Disclosure scale measures whether the person was open in the assessment, or if they were unwilling to share details about his/her history.
Random response indicators These two scales assist in detecting random responding. In general, the Validity Scale (V) contains a number of improbable items which may indicate questionable results if endorsed. The Inconsistency Scale (W) detects differences in responses to pairs of items that should be endorsed similarly. The more inconsistent responding on pairs of items, the more confident the examiner can be that the person is responding randomly, as opposed to carefully considering their response to items.
Validity The MCMI-IV was updated in 2015, with revised items and a new normative sample of 1,547 clinical patients. The process of updating the MCMI-IV was an iterative process from item generation, through item tryout, to standardization and the selection of final items to be included in the full scale.