This article was downloaded by: [New York University] On: 10 October 2014, At: 11:16 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Personality Assessment Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjpa20
MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients Robin Dee Post & Maria Gasparikova-Krasnec Published online: 10 Jun 2010.
To cite this article: Robin Dee Post & Maria Gasparikova-Krasnec (1979) MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients, Journal of Personality Assessment, 43:2, 155-159, DOI: 10.1207/s15327752jpa4302_8 To link to this article: http://dx.doi.org/10.1207/s15327752jpa4302_8
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Journal of Personality Assessment, 1979,43, 2
MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients ROBIN DEE POST University of Colorado Medical Center
..
and
MARIA GASPARIKOVA-KRASNEC Washington State University
Downloaded by [New York University] at 11:16 10 October 2014
Summary: Sixty psychiatric inpatients were assigned to oneofthreegroupson the basis ofFand K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for helpWvalidityprofiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help"profi1es were perceived as "actingout" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% ofthe seclusions in the patients sampled. Although the "plea for help" profile is considered invalid in some scoring system, results suggest that this validity profile may be useful in treatment planning.
Research on the MMPI validity scales suggests that they have important characterological and behavioral implications, as well as serving as indices of testtaking attitudes and dissimulation. Results suggest that F scale elevations are positively related to behavioral disorganization (Cough, 1946) and a higher incidence of aggressive, antisocial behavior in a delinquent population (Gynther, 1961). The Kscale has beenviewed by researchers as a measure of ego defenses (Wheeler, Little, & Lehner, 1951) and as a measure of emotional adjustment (Sweetland & Quay, 1953). In a sample of schizophrenic inpatients, Gross (1959) found that patients who were rated as having a severe behavioral disturbance obtained a caret-shaped (A) profile on the validity scales, (low L, high F, and low K). The present study was designed to assess whether the MMPI validity scales F and K are useful in generating predictions about the behavior of psychiatric inpatients and staff reactions to these patients. On a short-term psychiatric inpatient unit, it was observed that patients with F scales that were elevated relative to K scales, i.e., patients with "plea for help" profiles (Caldwell& O'Hare, 1975) have a higher incidence of impulse control problems on the ward and often engender feelings of frustration in theward The authors thank Dan~elGreenberg for h ~ assistance s in the collection of data, as well as W. Charles Lobitz, Robert Heaton, Ronald Franks, and Ins Holtje for t h e ~ r adv~ce.This artlcle IS based on a paper presented at the Western Psychological Association annual meetmg, San Francisco, Apr~l,1978.
staff. Data were collected to assess whether these observations reflect a genuine difference in the behavi~or of patients who obtain "plea for help" profiles, as opposed to patients who obtain average validity scale elevations or hyperdefensive profiles. The "plea for help" profile is one in which raw Fscores are at least 11 points higher than raw K scores. This profile is alternately viewed as a sign of malingering or as a statement that the patient is feeling emotionally depleted, chaotic, and in need of external assistance. In the hyper-defensive profile, K is elevated above F, suggesting that the patient is guarded, and wishes t o minimize or deny problems. This profile is frequently ,seen among psychiatric inpatients who are seeking a rapid discharge from the hospital. The average inpatient profile is characterized by a moderately high elevation on Fzhat is elevated several points above K. While patients obtaining this profile tend to report psychiatric symptoms and emotional problems, they are less likely to experience the intense feelings of panic and inability to cope with problems that are often reported by the "plea for help" patients. Method Subjects Subjects were patients on an adult psychiatric inpatient unit. A11 patients had completed Lhe MMPI at the beginning of their hospitalization. From a sample of 127patients who completed M MPIs between 1975 and 1977, 60 patients met
MMPI Validity Scales and Behavioral Disturbance Table 1 MMPI Validity Scale Cut-off Scores for Patients with "Plea for Help," Hyper-defensiveand Average MMPI Profiles Range of Scores Lower Upper
"Plea for Help" Profile Average Profile
Downloaded by [New York University] at 11:16 10 October 2014
Hyper-defensive Profile
F K F K F K
the criteria for assignment to one of the following three groups, on the basis of their scores on the Fand Kvalidity scales: l a ) Twenty patients were selected who obtained "plea for helpWvalidityprofiles. Raw F scores were at least 11 points higher than raw K scores.' The average raw F score in this group was 23.45 ( T > 95) the average raw Kscore was 7.50 (T= 41). See Table 1for validity scale cut-off points for each of the three groups; (b) Twenty patients were included who had obtained hyper-defensive profiles. Raw K scores were at least 13 points higher than raw F scores. The average raw F score for patients in this group was 4.25 ( T = 53). Raw K was 20.0 (T= 63). In selectingpatients for these two groups, the criterion utilized was the difference between F and K raw scores, rather than the absolute elevation of the scales; (c) Twenty patients were selected who obtained validity scores approximating the average profile for the ward (Fgreater than K, with moderate elevations on F ) . The average gaw Fscore was 12.30 ( T = 50) and the average raw K scores was 12.50 ( T = 70). An average ward profile was computed based on the F and K scores of theentire sampleof 127 MMPIs. Subjects were selected for this group whose scores most closely approximated the average profile for the entire ward, i.e., those who had raw F scores that were within a range three points above or below K (thus yielding a T score in which I An F-Kd1fferenceof9po1ntsormore1sfrequently cons~deredto ~nvalidatethe MMPI (Gough, 1950). A more strmgent F-Kdifference of I I points was used in Caldwell and O'Hare (1975) as more useful for discriminating invahd profiles.
17 5 9 10 0 17
33 12 15 15 9 29
Mean "Ore
Mean F-K Difference
23.45 7.50 12.70 12.30
+15.95
4'25 20.00
-15.75
+.40
F is moderately higher than K ) . Of the 60 patients included in thestudy, 23 were males and 37 females. Approximately 26% of the patients were diagnosed as having a thought disorder, 58% as having a personality disorder, and 15% as having an affective disorder. The sample is representative of the patient population typically hospitalized in this setting. The average age of patients in the study was 30.34 years. There were no significant differences between groups in age.
Procedure StafS ratings. Ten ward staff were asked to rate the patients on three dimensions: (a) use of the hospitalization, (b) patient's tendency to "act-out" conflicts while on the ward, and (c) feelings of frustration staff may have experienced toward the patient. "Acting-outWwasdefined as self-destructive behavior, excessive use of alcohol and drugs, as well as inappropriate sexual and aggressive behavior. Ratings were made on a series of 4-point scales with higher scores indicating that the patient posed a more serious problem. An average rating was obtained for each patient on each of the three evaluative dimensions. Staff members were asked to evaluate only those patients they remembered clearly. The ten staff members who participated in the study had at least two years experience on the unit. They included nurses, mental health assistants, a social worker, and an occupational therapist. Staff members were not informed of the purpose of the study until after they had completed their ratings.
R. D. POST and M. GASPARIKOVA-KRASNEC Table 2 Mean Staff Ratings of Patients with Hyper-defensive, Average, and "Plea for Help" MMPI Profiles Use of the Hospitalization
Downloaded by [New York University] at 11:16 10 October 2014
Feelings of Frustration Acting-out
Hyper-defens~ve Profile
Average Profile
"Plea for Help" Profile
F
1.45 1.53 0.59
1.26
1.35 2.05 1.84
01.4 1 3.24* 12.39*
1 .52 1 .05
Patients' hospital records. Patients' ing "aci.ed-out" more frequently than charts were reviewed to ascertain whether patients in the other two groups, F(2,57) < .01. there were observable differences in the = 1 2 . 3 9 , ~ behavior of patients with the three MMPI LRngth of Stay validity profiles. Patients' activities are Mean length of stay was 24.95 days charted at each nursing shift, e.g., at least for the "plea for help" patients, 17.10 three times a day. At the time of the study days for the average profile patients, and charts were unavailable for two of the pa- 19.70 for the hyper-defensive patients. tients rated by staff, and two patients with The difference in length of stay between -equivalent MMPI validity scores were the patient groups was not significant F substituted. Charts were reviewed by a (2,57) = 1.09, n.s. It is thus unlikelly that medical student, who was blind to the pa- differences obtained between groups are tients' MMPI profile. a function of longer hospital stays on the Frequency counts were tabulated for part of patients in the "plea for help" the following target behaviors: (a) alcohol group. and drug abuse, (b) sexual "acting-out," (c) fighting or other physically aggressive Patients' Hospital Records behavior, (d) incidents of self-injurious Analyses of variance performed on behavior, i.e., cutting self, over-medicat- data obtained from patients' hospital ing self, and (e) number of times patient records yielded significant differences was placed in seclusion because of poorly between patient groups with resp~ectto controlled behavior. Length of stay in the sexual "acting-out," aggressive behavhospital was also recorded for each pa- ior, and self-inflicted physical harm, but tient to assure that differences between not alcohol and drug abuse. (See Table3 groups of patients were not merely a func- for a frequency count and F scores.) tion of number of days in the hospital. With respect to self-inflicted physical harm, the "plea for he1p"group accounted Results for 32 recorded incidents out of a total of Staff Ratings 38. There was only one incident of selfStaff evaluation data were analyzed, injurious behavior reported for the hyperusing an analysis of variance, fixed ef- defensive patient group, F (2,57) =: 7.27, fects design. All three groups were seen p < .01. Results of Duncan's test indicate by staff as utilizing their hospitalization that there was a higher frequency of selfequally well, F (2,57) = .41, n.s. (See destructive actnons in the "plea for help" Table 2 for means.) The analysis of vari- patient group than in the other patient ance performed on staff frustration data groups. With respect to sexual "actingproduced significant results, F (2,57) = out" and aggression, the "plea for help" 3.24, p c .O5). Results of Duncan's test patients obtained significantly higher indicate that the "plea for help7'patients mean scores than other patients, but were viewed by staff as engendering there were few occurrences in either of greater feelings of frustration than pa- these categories. A total "acting-out" tients in the other two groups. The pa- score was obtained by summing number tients in this group were also seenas hav- of incidents across all four behavioral
158
MMPI Validity Scales and Behavioral Disturbance Table 3 Frequency Count of Inappropriate or Self-destructive Behavior for Patients with Hyper-defensive, Average, and "Plea for Help" MMPI Profiles
Downloaded by [New York University] at 11:16 10 October 2014
Total Incidents of Acting-Out Alcohol and Drug Abuse Sexual Acting-Out Aggression Self-Inflicted Physical Harm Number of Seclusions
Hyper-defensive Profile
Average Profile
"Plea for Help" Profile
6 2 0 3
12 7 0 0 5 2
60 13 6 9 32 24
1
3
categories. The average number of incidents recorded for the hyper-defensive patients was 0.30, for average profile patients, 0.60, and for "plea for help" patients, 3.00, F (237) = 7.63, p < .01. On the average, high F scale patients were involved in approximately three episodes of self-destructive behavior during the course of their hospitalization. Results of Duncan's test indicate that the frequency of self-destructive "actingout" was significantly higher in the "plea for help" patient group than in the other two groups. To further insure that the differences obtained on the total "acting-out" measure were not due primarily to length of hospitalization, a daily rate of "actingout7'was computed for eachpatient. The number of incidents of 'acting-out" recorded for each patient was divided by the number of days in the hospital to yield a daily rate score. The mean daily rate was .I5 for "plea for helpWpatients, .03 for average profile patients, and .02 for hyper-defensive profile patients. The daily rate of "acting-out" was significantly higher in the "plea for help" ~ .01. patients, F (2,V) = 11 . 9 3 , < The propensity for "acting-out" in the "plea for help" patients is further validated by the number of seclusions required by this patient group. Of 29 recorded incidents of seclusion, 24 occurred in the "plea for helpWgroup,F(2,57) = 8.21, p < .01. Duncan's test indicated that patients in this group required significantly more seclusions than the other two groups. Thus the "plea for help" patients who constitute one-third of the
F
7.63* 1.84 4.17* 3.86* 7.27* 8.21*
patients sampled, account for 83%ofthe seclusions and 77% of the incidents of inappropriate "acting-out" on the unit.
Discussion Results of the study suggest that patients with "plea for help" profiles were perceived as having poorer impulse control and a greater frequency of inappropriate and destructive behavior on the unit than patients with hyper-defensive or average MMPI validity scale profiles. Staff members tend to experience greater feelings of frustration when working with these patients, a frustration possibly engendered by the recurrence of inappropriate, self-destructive actions. Patients with average and hyperdefensive profiles did not appear to differ significantly from one another with respect to staff perceptions of behavioral disturbance. Review of the patients' charts suggest that the patients with "plea for helpn MMPI validity profiles did engage in more inappropriate, self-destructive behavior while on the unit and needed to be secluded more frequently than patients in the other two groups. As the groupsdid not differ significantly with respect to length of hospitalization, the greater frequency of "acting-out" in the "plea for help" group is not merely a function of these patients remaining in the hospital longer and therefore having more opportunities to "act-out." To control more thoroughly for length of stay as a potentially confounding variable, daily rates of "acting-out" were computed and '"plea for help" patients had significantly higher rates of "acting-out" than patients in the
Downloaded by [New York University] at 11:16 10 October 2014
R. D. POST and M. GASPARIKOVA-KRASNEC other groups on this measure, as well. The validity scales were initially used as indicators of test-taking attitudes and dissimulation. A large F-K discrepancy is considered in some scoring systems to invalidate the MMPI (Caldwell, & 0'Hare, 1975; Gough, 1950). The present study suggests that the "plea for help" F-K configuration, when obtained in an inpatient psychiatric population, may be clinically useful as an indicator of behavioral disorganization. Results of the present study are consistent with previous research which has found the Fand Kconfigurations to have both characterological and behavioral implications (Gough, 1946; Gross, 1959; Gynther, 1961; Sweetland & Quay, 1953). The P and K validity scales may be used to alert staff to potential management problems posed by patients who are disposed to "act-out" when they are feeling stressed. The presence of a highly elevated F score and low K score may alert staff to carefully assess the impulse control available to patients and make decisions about limit-setting, privileges, and treatment strategy with this assessment in mind. Similarly, the presence of an average or hyper-defensive validity profile may increase staff's confidence that a patient has the internal controls necessary to adequately handle greater freedom and responsibility within the hospital setting.
159
References Caldwell, A. B., & O'Hare, C. A handbook of MMPIpersonality types. Santa Monica, Calif.: Clinical Psychological Services, 1975. Gough, H. G. Diagnostic patterns in the MMPI. Journal of Clinical Psychology, 1946,2,23-37. Gough, H . G. The Frninus Kdissirnulati~onindex for the Minnesota Multiphasic Personality Inventory. Journal of Consulting Psychology, 1950,14,408-413. Gross, L. R. MMPI L-F-K relationships with criteria of behavioral disturbance and social adjustment in a schizophrenic population. Journal of Consulsing Psychology, 1959, 23, 319323. Gynther, M. Theclinicalutility of"invalid"MMP1 F scores. Jourwal of Consultzng Psychology, 1961,25, 540-542. Sweetland, A,, &Quay, H. A note on the Kscale of the Minnesota Multiphasic Personality Inventory. Journal of Consulting Psychology, 1953, 17, 314-316. Wheeler, W. M., Little, K. B., & Lehner, A. R. The internal structure of the MMPI. Journalof Consulting Psychology, 1951,15, 134-141.
Robin Dee Post Div. of Clinical Psychology C-258 University of Colorado Med. Ctr. 4200 East Ninth Denver, Colorado 80262 Received: April 24,1978 Revised: August 21,1978
Journal of Personality Assessment Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hjpa20
MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients Robin Dee Post & Maria Gasparikova-Krasnec Published online: 10 Jun 2010.
To cite this article: Robin Dee Post & Maria Gasparikova-Krasnec (1979) MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients, Journal of Personality Assessment, 43:2, 155-159, DOI: 10.1207/s15327752jpa4302_8 To link to this article: http://dx.doi.org/10.1207/s15327752jpa4302_8
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Journal of Personality Assessment, 1979,43, 2
MMPI Validity Scales and Behavioral Disturbance in Psychiatric Inpatients ROBIN DEE POST University of Colorado Medical Center
..
and
MARIA GASPARIKOVA-KRASNEC Washington State University
Downloaded by [New York University] at 11:16 10 October 2014
Summary: Sixty psychiatric inpatients were assigned to oneofthreegroupson the basis ofFand K MMPI validity scales. Staff ratings of patient behavior and recorded incidents of "acting-out" behavior were obtained for patients with: (a) "plea for helpWvalidityprofiles, (b) hyper-defensive profiles, and (c) average profiles. Patients with "plea for help"profi1es were perceived as "actingout" more frequently and engendering more feelings of frustration than patients in the other groups. These patients account for 77% of the incidents of inappropriate, destructive behavior and 83% ofthe seclusions in the patients sampled. Although the "plea for help" profile is considered invalid in some scoring system, results suggest that this validity profile may be useful in treatment planning.
Research on the MMPI validity scales suggests that they have important characterological and behavioral implications, as well as serving as indices of testtaking attitudes and dissimulation. Results suggest that F scale elevations are positively related to behavioral disorganization (Cough, 1946) and a higher incidence of aggressive, antisocial behavior in a delinquent population (Gynther, 1961). The Kscale has beenviewed by researchers as a measure of ego defenses (Wheeler, Little, & Lehner, 1951) and as a measure of emotional adjustment (Sweetland & Quay, 1953). In a sample of schizophrenic inpatients, Gross (1959) found that patients who were rated as having a severe behavioral disturbance obtained a caret-shaped (A) profile on the validity scales, (low L, high F, and low K). The present study was designed to assess whether the MMPI validity scales F and K are useful in generating predictions about the behavior of psychiatric inpatients and staff reactions to these patients. On a short-term psychiatric inpatient unit, it was observed that patients with F scales that were elevated relative to K scales, i.e., patients with "plea for help" profiles (Caldwell& O'Hare, 1975) have a higher incidence of impulse control problems on the ward and often engender feelings of frustration in theward The authors thank Dan~elGreenberg for h ~ assistance s in the collection of data, as well as W. Charles Lobitz, Robert Heaton, Ronald Franks, and Ins Holtje for t h e ~ r adv~ce.This artlcle IS based on a paper presented at the Western Psychological Association annual meetmg, San Francisco, Apr~l,1978.
staff. Data were collected to assess whether these observations reflect a genuine difference in the behavi~or of patients who obtain "plea for help" profiles, as opposed to patients who obtain average validity scale elevations or hyperdefensive profiles. The "plea for help" profile is one in which raw Fscores are at least 11 points higher than raw K scores. This profile is alternately viewed as a sign of malingering or as a statement that the patient is feeling emotionally depleted, chaotic, and in need of external assistance. In the hyper-defensive profile, K is elevated above F, suggesting that the patient is guarded, and wishes t o minimize or deny problems. This profile is frequently ,seen among psychiatric inpatients who are seeking a rapid discharge from the hospital. The average inpatient profile is characterized by a moderately high elevation on Fzhat is elevated several points above K. While patients obtaining this profile tend to report psychiatric symptoms and emotional problems, they are less likely to experience the intense feelings of panic and inability to cope with problems that are often reported by the "plea for help" patients. Method Subjects Subjects were patients on an adult psychiatric inpatient unit. A11 patients had completed Lhe MMPI at the beginning of their hospitalization. From a sample of 127patients who completed M MPIs between 1975 and 1977, 60 patients met
MMPI Validity Scales and Behavioral Disturbance Table 1 MMPI Validity Scale Cut-off Scores for Patients with "Plea for Help," Hyper-defensiveand Average MMPI Profiles Range of Scores Lower Upper
"Plea for Help" Profile Average Profile
Downloaded by [New York University] at 11:16 10 October 2014
Hyper-defensive Profile
F K F K F K
the criteria for assignment to one of the following three groups, on the basis of their scores on the Fand Kvalidity scales: l a ) Twenty patients were selected who obtained "plea for helpWvalidityprofiles. Raw F scores were at least 11 points higher than raw K scores.' The average raw F score in this group was 23.45 ( T > 95) the average raw Kscore was 7.50 (T= 41). See Table 1for validity scale cut-off points for each of the three groups; (b) Twenty patients were included who had obtained hyper-defensive profiles. Raw K scores were at least 13 points higher than raw F scores. The average raw F score for patients in this group was 4.25 ( T = 53). Raw K was 20.0 (T= 63). In selectingpatients for these two groups, the criterion utilized was the difference between F and K raw scores, rather than the absolute elevation of the scales; (c) Twenty patients were selected who obtained validity scores approximating the average profile for the ward (Fgreater than K, with moderate elevations on F ) . The average gaw Fscore was 12.30 ( T = 50) and the average raw K scores was 12.50 ( T = 70). An average ward profile was computed based on the F and K scores of theentire sampleof 127 MMPIs. Subjects were selected for this group whose scores most closely approximated the average profile for the entire ward, i.e., those who had raw F scores that were within a range three points above or below K (thus yielding a T score in which I An F-Kd1fferenceof9po1ntsormore1sfrequently cons~deredto ~nvalidatethe MMPI (Gough, 1950). A more strmgent F-Kdifference of I I points was used in Caldwell and O'Hare (1975) as more useful for discriminating invahd profiles.
17 5 9 10 0 17
33 12 15 15 9 29
Mean "Ore
Mean F-K Difference
23.45 7.50 12.70 12.30
+15.95
4'25 20.00
-15.75
+.40
F is moderately higher than K ) . Of the 60 patients included in thestudy, 23 were males and 37 females. Approximately 26% of the patients were diagnosed as having a thought disorder, 58% as having a personality disorder, and 15% as having an affective disorder. The sample is representative of the patient population typically hospitalized in this setting. The average age of patients in the study was 30.34 years. There were no significant differences between groups in age.
Procedure StafS ratings. Ten ward staff were asked to rate the patients on three dimensions: (a) use of the hospitalization, (b) patient's tendency to "act-out" conflicts while on the ward, and (c) feelings of frustration staff may have experienced toward the patient. "Acting-outWwasdefined as self-destructive behavior, excessive use of alcohol and drugs, as well as inappropriate sexual and aggressive behavior. Ratings were made on a series of 4-point scales with higher scores indicating that the patient posed a more serious problem. An average rating was obtained for each patient on each of the three evaluative dimensions. Staff members were asked to evaluate only those patients they remembered clearly. The ten staff members who participated in the study had at least two years experience on the unit. They included nurses, mental health assistants, a social worker, and an occupational therapist. Staff members were not informed of the purpose of the study until after they had completed their ratings.
R. D. POST and M. GASPARIKOVA-KRASNEC Table 2 Mean Staff Ratings of Patients with Hyper-defensive, Average, and "Plea for Help" MMPI Profiles Use of the Hospitalization
Downloaded by [New York University] at 11:16 10 October 2014
Feelings of Frustration Acting-out
Hyper-defens~ve Profile
Average Profile
"Plea for Help" Profile
F
1.45 1.53 0.59
1.26
1.35 2.05 1.84
01.4 1 3.24* 12.39*
1 .52 1 .05
Patients' hospital records. Patients' ing "aci.ed-out" more frequently than charts were reviewed to ascertain whether patients in the other two groups, F(2,57) < .01. there were observable differences in the = 1 2 . 3 9 , ~ behavior of patients with the three MMPI LRngth of Stay validity profiles. Patients' activities are Mean length of stay was 24.95 days charted at each nursing shift, e.g., at least for the "plea for help" patients, 17.10 three times a day. At the time of the study days for the average profile patients, and charts were unavailable for two of the pa- 19.70 for the hyper-defensive patients. tients rated by staff, and two patients with The difference in length of stay between -equivalent MMPI validity scores were the patient groups was not significant F substituted. Charts were reviewed by a (2,57) = 1.09, n.s. It is thus unlikelly that medical student, who was blind to the pa- differences obtained between groups are tients' MMPI profile. a function of longer hospital stays on the Frequency counts were tabulated for part of patients in the "plea for help" the following target behaviors: (a) alcohol group. and drug abuse, (b) sexual "acting-out," (c) fighting or other physically aggressive Patients' Hospital Records behavior, (d) incidents of self-injurious Analyses of variance performed on behavior, i.e., cutting self, over-medicat- data obtained from patients' hospital ing self, and (e) number of times patient records yielded significant differences was placed in seclusion because of poorly between patient groups with resp~ectto controlled behavior. Length of stay in the sexual "acting-out," aggressive behavhospital was also recorded for each pa- ior, and self-inflicted physical harm, but tient to assure that differences between not alcohol and drug abuse. (See Table3 groups of patients were not merely a func- for a frequency count and F scores.) tion of number of days in the hospital. With respect to self-inflicted physical harm, the "plea for he1p"group accounted Results for 32 recorded incidents out of a total of Staff Ratings 38. There was only one incident of selfStaff evaluation data were analyzed, injurious behavior reported for the hyperusing an analysis of variance, fixed ef- defensive patient group, F (2,57) =: 7.27, fects design. All three groups were seen p < .01. Results of Duncan's test indicate by staff as utilizing their hospitalization that there was a higher frequency of selfequally well, F (2,57) = .41, n.s. (See destructive actnons in the "plea for help" Table 2 for means.) The analysis of vari- patient group than in the other patient ance performed on staff frustration data groups. With respect to sexual "actingproduced significant results, F (2,57) = out" and aggression, the "plea for help" 3.24, p c .O5). Results of Duncan's test patients obtained significantly higher indicate that the "plea for help7'patients mean scores than other patients, but were viewed by staff as engendering there were few occurrences in either of greater feelings of frustration than pa- these categories. A total "acting-out" tients in the other two groups. The pa- score was obtained by summing number tients in this group were also seenas hav- of incidents across all four behavioral
158
MMPI Validity Scales and Behavioral Disturbance Table 3 Frequency Count of Inappropriate or Self-destructive Behavior for Patients with Hyper-defensive, Average, and "Plea for Help" MMPI Profiles
Downloaded by [New York University] at 11:16 10 October 2014
Total Incidents of Acting-Out Alcohol and Drug Abuse Sexual Acting-Out Aggression Self-Inflicted Physical Harm Number of Seclusions
Hyper-defensive Profile
Average Profile
"Plea for Help" Profile
6 2 0 3
12 7 0 0 5 2
60 13 6 9 32 24
1
3
categories. The average number of incidents recorded for the hyper-defensive patients was 0.30, for average profile patients, 0.60, and for "plea for help" patients, 3.00, F (237) = 7.63, p < .01. On the average, high F scale patients were involved in approximately three episodes of self-destructive behavior during the course of their hospitalization. Results of Duncan's test indicate that the frequency of self-destructive "actingout" was significantly higher in the "plea for help" patient group than in the other two groups. To further insure that the differences obtained on the total "acting-out" measure were not due primarily to length of hospitalization, a daily rate of "actingout7'was computed for eachpatient. The number of incidents of 'acting-out" recorded for each patient was divided by the number of days in the hospital to yield a daily rate score. The mean daily rate was .I5 for "plea for helpWpatients, .03 for average profile patients, and .02 for hyper-defensive profile patients. The daily rate of "acting-out" was significantly higher in the "plea for help" ~ .01. patients, F (2,V) = 11 . 9 3 , < The propensity for "acting-out" in the "plea for help" patients is further validated by the number of seclusions required by this patient group. Of 29 recorded incidents of seclusion, 24 occurred in the "plea for helpWgroup,F(2,57) = 8.21, p < .01. Duncan's test indicated that patients in this group required significantly more seclusions than the other two groups. Thus the "plea for help" patients who constitute one-third of the
F
7.63* 1.84 4.17* 3.86* 7.27* 8.21*
patients sampled, account for 83%ofthe seclusions and 77% of the incidents of inappropriate "acting-out" on the unit.
Discussion Results of the study suggest that patients with "plea for help" profiles were perceived as having poorer impulse control and a greater frequency of inappropriate and destructive behavior on the unit than patients with hyper-defensive or average MMPI validity scale profiles. Staff members tend to experience greater feelings of frustration when working with these patients, a frustration possibly engendered by the recurrence of inappropriate, self-destructive actions. Patients with average and hyperdefensive profiles did not appear to differ significantly from one another with respect to staff perceptions of behavioral disturbance. Review of the patients' charts suggest that the patients with "plea for helpn MMPI validity profiles did engage in more inappropriate, self-destructive behavior while on the unit and needed to be secluded more frequently than patients in the other two groups. As the groupsdid not differ significantly with respect to length of hospitalization, the greater frequency of "acting-out" in the "plea for help" group is not merely a function of these patients remaining in the hospital longer and therefore having more opportunities to "act-out." To control more thoroughly for length of stay as a potentially confounding variable, daily rates of "acting-out" were computed and '"plea for help" patients had significantly higher rates of "acting-out" than patients in the
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R. D. POST and M. GASPARIKOVA-KRASNEC other groups on this measure, as well. The validity scales were initially used as indicators of test-taking attitudes and dissimulation. A large F-K discrepancy is considered in some scoring systems to invalidate the MMPI (Caldwell, & 0'Hare, 1975; Gough, 1950). The present study suggests that the "plea for help" F-K configuration, when obtained in an inpatient psychiatric population, may be clinically useful as an indicator of behavioral disorganization. Results of the present study are consistent with previous research which has found the Fand Kconfigurations to have both characterological and behavioral implications (Gough, 1946; Gross, 1959; Gynther, 1961; Sweetland & Quay, 1953). The P and K validity scales may be used to alert staff to potential management problems posed by patients who are disposed to "act-out" when they are feeling stressed. The presence of a highly elevated F score and low K score may alert staff to carefully assess the impulse control available to patients and make decisions about limit-setting, privileges, and treatment strategy with this assessment in mind. Similarly, the presence of an average or hyper-defensive validity profile may increase staff's confidence that a patient has the internal controls necessary to adequately handle greater freedom and responsibility within the hospital setting.
159
References Caldwell, A. B., & O'Hare, C. A handbook of MMPIpersonality types. Santa Monica, Calif.: Clinical Psychological Services, 1975. Gough, H. G. Diagnostic patterns in the MMPI. Journal of Clinical Psychology, 1946,2,23-37. Gough, H . G. The Frninus Kdissirnulati~onindex for the Minnesota Multiphasic Personality Inventory. Journal of Consulting Psychology, 1950,14,408-413. Gross, L. R. MMPI L-F-K relationships with criteria of behavioral disturbance and social adjustment in a schizophrenic population. Journal of Consulsing Psychology, 1959, 23, 319323. Gynther, M. Theclinicalutility of"invalid"MMP1 F scores. Jourwal of Consultzng Psychology, 1961,25, 540-542. Sweetland, A,, &Quay, H. A note on the Kscale of the Minnesota Multiphasic Personality Inventory. Journal of Consulting Psychology, 1953, 17, 314-316. Wheeler, W. M., Little, K. B., & Lehner, A. R. The internal structure of the MMPI. Journalof Consulting Psychology, 1951,15, 134-141.
Robin Dee Post Div. of Clinical Psychology C-258 University of Colorado Med. Ctr. 4200 East Ninth Denver, Colorado 80262 Received: April 24,1978 Revised: August 21,1978
