a Clinical Scales CHAPTER 4 ‘The clinician will need to become thoroughly familiar with the clinical scales reviewed in this chapter, for the information presented forms the basis for understanding combina- tions of scales to be described in Chapter 6. For each scale the following areas will be sur- veyed: 1. The content areas tapped by the scale 2, How the scale was developed and the cri- terion group 3. General psychometric and clinical infor- mation 4, Interpretation and behavioral correlates of high scores in psychiatric and normal populations 5, Interpretations of low scores, usually in anormal population 6. The effects on scale scores in adults of moderator variables such as gender, age, education, and social class (ethnic group membership will be discussed in Chapter 8) 7. A summary table of interpretations for the levels of elevation of the scale Although a few comments have been made about the behavioral correlates of : ie atic research has been done. The question of whether thé specific elevation of the low point is critical has scarcely been examined. This neglect of investigation of low points on the MMPI in part reflects the tradition that ow points represent adjustment, not psycho- ‘pathology (Carson, 1969); there is some de- bate, however, regarding the interpretation of low points (Listiak & Stone, 1971). While interpretation of high-point pairs or codetypes is the primary focus on the MMPI, low points on several scales deserve careful attention regardless of the codetype or overall elevation of the profile. Specific- ally, those MMPI scales for which low points ‘need particular attention are Scales 3 (Hyste- Femininity), 6 (Paranoia), and 9(Hypomania). lis chapter will discuss, therefore, low points on each of these scales, although it is not clear that these scales will be low points, onthe MM ¢ of the use of uniform T scores. All MMPI-2 scales have been trun- 135 K BK ZL136 Chapter 4. cated at a T score of 30, which also limits how low scores can go. Clinicians should remem- + Ber that Uniform T scores are used for all of * the clinical scales except for Scales 5 and 0 (Social Introversion), which still use linear T scores. Clinicians mphasize interpre- tation of the codetype (the one or two highest Clinical scales elevated at or above a T score of 65) of the MMPI-2. Most of them, how- ever, also rely on individual scales to modify and supplement their interpretations. Con trary to widespread assumptions, little actu- arial research has been done on the behav- ioral correlates of individual MMPI scales. Some investigators (Boerger, Graham, & ! Lilly, 1974; Hedlund, 1977; Hovey & Lewis, 1967; Zelin, 1971) have begun to examine the correlates of individual MMPI scales, and their results will be reported throughout this \ chapter. Obviously, there has been little re- i search on the behavioral correlates of indi- | vidual MMPI-2 scales. | \ ‘Thereader should note that comments in | the text to specific T scores reflecting high | \ scores, moderate scores, and low scores on a specific scale refer to the MMPI-2. Rather | than indicate parenthetically each time the comparable score on the MMPI, these scores will only be noted in the tables describing the | interpretation of each scale below. SCALE 1: HYPOCHONDRIASIS (Hs) A.wide variety of vague and nonspecific com- plaints about bodily functioning are tapped the 32 items (33 items on the MMPI) of Scale 7. These complaints tend to focus on the abdomen and back, and they persist de- spite all reassurances and negative medical tests to the contrary. Scale Tis designed to as- $e85 a neurotic concern over bodily function- ing (Le., psychotic concerns about bodily functioning are not found on this scale). The criterion group used in developing the sale was a group of hypochondriacs with abnormal, psychoneurotic concern over bod- ily functioning (McKinley & Hathaway, 1940). (The development of Scale / was de- scribed in detail in Chapter 1; the reader should review that material if necessary. The reader also should note that the current DSM-IILR [American Psychiatric Associa- tion, 1987] definition of hypochondriasis em- phasizes the fear or belief of the existence of a serious disease rather than abnormal con- cern over bodily functioning.) ‘Examples of Scale / items with the devi- ant answer indicated in parentheses are: “I hardly ever feel pain in the back of my neck.” (false) “1 have a great deal of stomach trou- ble.” (true) “The top of my head sometimes feels tender.” (true)! Most of the items on Scale _/ also scored on the other clinical scales; onl items are unique to the scale. A majority of the items (20) overlap with Scale 3 (Hysteria) and are scored in the same direction. Only of the items overlap with scales from the psy- chotic tetrad (the Paranoia, Psychasthenia, Schizophrenia, and Hypomania scales), 4 items with Scale 8 (Schizophrenia), and 1 item with Scale 6 (Paranoia). The deviant response for tw of the items on Scale / is “false”; hence, a ten- dency toward a “false” response set will ele vate scores on this scale. The scale items ap- pear to be obvious in content (Dahlstrom, Welsh, & Dahlstrom, 1972), although Chris- tian, Burkhart, and Gynther (1978) found that students rated Scale / items as neutral (neither obvious nor subtle) when asked how clearly these items were indicative of a psy- chological problem. Factor analyses of the items in several different populations have consistently iden- tified one commoni factor, which has been la-beled poor physical health (Comrey, 1957a; Eichman, 1962; O*Connor & Stefic, 195! Stein, 1968) and a second factor, labeled gas- wrointestinal difficulties (Comrey, 1957a; O'Connor & Stefic, 1959). The 33-item Tryon, Stein, and Chu (Stein, 1968) Bodily Symptoms scale (see Chapter 5), which was developed by a cluster analysis of all 550 items on the MMPI, con- tains 23 items from Scale /. Wiggins’ (1966) _ -snateat scales of Organic Symptoms and Poor Health trom the MMPI, which were de- veloped on a rational or intuitive basis (see Chapter 5), ‘also overlap substantially with Scale /. The 36-item Organic Symptoms scale has 13 items in common with Scale / and the 28-item Poor Health scale also contains 13 Scale / items. Butcher, Graham, Williams, and Ben-Porath’s (1989) content scale of Health Concerns from the MMPI-2 (see Chapter 5) has 23 items of its 36 items in com- mon with Scale 7. Thus, it seems whether an empirical, ra- tional, or statistical procedure is used, a gen- eral dimension of poor physical health and vague somatic complaints can be identified in the MMPI-2 item pool in a variety of popula- tions, and Scale / adequately assesses this di- mension. A person who is actually physically ill will obtain only a moderate elevation (T score Of 38 to 64) on Scale 7. Such persons will en- dorse their legitimate physical complaints, but they will not endorse the entire gamut of vague physical complaints tapped by the scale. Scale 2 (Depression) is more likely to be clevatéd by actual physical ilIness than Scale 1. Tf-a client with actual physical iliness ob- tains a T score of 65 or higher on Scale 7, there are Wikely to be hypochondriacal Tea- tures in addition to the physical condition, d the client is probably trying to manipu- ‘iit or control sighficant thers Tr theenviron: ment with the hypochondriacal complaints. Al- though the client may vehemently argue that the complaints reflect legitimate physical con- Clinical Scales 137 cerns, the clinician should not ignore the ele- vation on Scale /. The hypochondriacal fea- tures in these individuals usually are evident despite their protests to the contrary. Scale / is a crude index of psychological mindedness or sophistication, with high scor- ers lacking these attributes. It also is nega- tively correlated with intelligence (Brower, 1947), This would substantiate the lack of psychological mindedness in high scorers. Such persons are uninterested_in_exploring any psychological reasons for their bodily complaints, In fact, pity the clinician who di- rectly suggests such a relationship; the client concludes that the clinician is poorly trained since he or she does not recognize the symp- toms as genuine. With disparaging comments about their clinician’s lack of training and skills to understand them, these clients trudge off to seek a more favorable second, third, and fourth opinion. The robustness of these hypochondri: cal features often amazes the neophyte clini cian, who seemingly can readily recognize the client’s motives. Despite, or perhaps because of, the transparency of the motives, any form of psychological intervention is almost surely doomed to fail. Thus, Scale / can be under- stood as a characterologic scale (e., it re- flects a long-term personality style that is sta- ble over time and resistant to change). High scorers (T scores of 65 or higher) on Scale 7 in any population are character- ized by their abnormal concern over bodily functions and vague hypochondriacal com- plaints, which attests to the construct validity of the scale, In addition, high scorers are de- scribed as pessimistic, sour on life, and évi- dencing long-standing personal inadequacy and ineffectualness. They seem to relish exag- gerating the ills of the world and of their own situation. They rarely express hostility overtly; instead, they express their resent- ment covertly by using physical complaints to control and manipulate others. Finally, the} are unlikely to be diagnosed psychotic, al-