The Millon® Clinical Multiaxial Inventory-IV (MCMI®-IV) (2015)

by Theodore Millon, Ph.D., D.Sc., Seth Grossman, Psy.D., & Carrie Millon, Ph.D.

The newest iteration of Dr. Millon’s flagship inventory, the MCMI-IV, is a full reflection of the substantial revision to Millon’s theory introduced in Disorders of Personality – 3rd Edition (Millon, 2011), that also expands on several advances introduced in the MCMI-III in recent years.This thoroughly modernized instrument, a true integration of theoretical and empirical methodologies, gives the clinician clear indication of the level of personality functioning, and focuses on therapeutic alliance-building by highlighting basic personologic motivations.

The MCMI-IV features an updated set of Grossman Facet Scales, which also help guide therapy by identifying the most salient domains of an individual’s personality (e.g., interpersonal, cognitive). Noteworthy responses have been significantly expanded in this edition, offering both immediate notification of critical areas (e.g., violence potential, self-destructive potential) as well as for potential differential diagnostic needs for DSM constructs falling out of the MCMI-IV’s main measurement areas (e.g., ASD, ADHD). The result of this new instrument’s comprehensive approach is a highly personalized reflection of the individual completing the inventory, with significant directives for effective, targeted, and comprehensive treatment.

The MCMI (Millon Clinical Multiaxial Inventory) is distinguished from other inventories primarily by its brevity, its theoretical anchoring, multiaxial format, tripartite construction and validation schema, use of base rate scores, and interpretive depth. Each generation of the MCMI inventory has attempted to keep the total number of items small enough to encourage its use in all types of diagnostic and treatment settings, yet large enough to permit the assessment of a wide range of clinically relevant multiaxial behaviors. At 195 items, the MCMI-IV inventory is much shorter than comparable instruments. Terminology is geared to a fifth-grade reading level. The great majority of individuals can complete the MCMI-IV in 25 to 35 minutes, facilitating relatively simple and rapid administrations while minimizing patient resistance and fatigue.

Theoretical Anchoring

Diagnostic instruments are more useful when they systematically merge comprehensive clinical theory with solid empirical methodology. Unfortunately, theory has taken a back seat to empirically-driven methods. As a result, few diagnostic measures regard clinical theory. The MCMI is different. Each of its personality scales is an operational measure of a syndrome derived from a theory of personality (Millon, 1969, 1981, 1986a, 1986b, 1990, 2011; Millon & Davis, 1996). The scales and profiles of the MCMI thus measure these theory-derived and theory-refined variables directly and quantifiably. With a firm foundation in measurement, scale elevations and configurations can be used to suggest specific patient diagnoses and clinical dynamics, as well as testable hypotheses about social history and current behavior.

Coordination to DSM-5

No less important than its link to theory is the coordination between a clinically-oriented instrument and official diagnostic constructs. Few diagnostic instruments currently available have been constructed to be as consonant with the official nosology at the MCMI. In the DSM-5 official criteria, diagnostic categories are precisely specified and operationally defined. The structure of the MCMI inventory maintains a distinction between personality disorders and clinical symptomology of the former multiaxial system, while keeping apace of the diagnostic criteria refinements of the current DSM. Therefore, separate scales distinguish the more enduring personality characteristics of patients from the more acute clinical disorders they display. Profiles based on all clinical scales may be interpreted to illuminate the interplay between long-standing characterological patterns and the distinctive clinical symptoms currently manifest.

Test Development

Item selection and scale development progressed through a sequence of three validation steps: (1) theoretical-substantive; (2) internal-structural; and (3) external-criterion. In the theoretical-substantive stage, items for each syndrome were generated to conform both to theoretical requirements and to the substance of DSM criteria. In the internal-structural stage, these “rational” items were subjected to internal consistency analyses. Items having higher correlations with scales for which they were not intended were either dropped entirely or re-examined against theoretical criteria and reassigned or reweighted. Only items surviving each successive validation stage were included in subsequent analyses. In the external-criterion phase, items were examined in terms of their ability to discriminate between clinical groups, rather than between clinical groups and normal subjects. This tripartite model of test construction attempts to synthesize the strengths of each construction phase by rejecting items that are found to be deficient in particular respects, thus ensuring that the final scales do not consist of items which optimize one particular parameter of test construction, but instead conjointly satisfy multiple requirements, increasing the generalizability of the end product.

Base Rate Scores

An important feature which distinguishes the MCMI inventory from other inventories is its use of actuarial base rate data, rather than normalized standard score transformations. T-scores implicitly assume the prevalence rates of all disorders to be equal, that is, there are equal numbers of depressives and schizophrenics, for example. In contrast, the MCMI inventory seeks to diagnose the percentages of patients that are actually found to be disordered across diagnostic settings. These data not only provide a basis for selecting optimal differential diagnostic cutting lines, but also ensure that the frequency of MCMI generated diagnoses and profile patterns will be comparable to representative clinical prevalence rates.

Computer Scoring and Interpretation

Computer programs are available for rapid and convenient machine scoring in all major computing environments. Interpretive reports are available at two levels of detail. The PROFILE REPORT presents the patient’s MCMI scores and profile, and is useful as a screening device to identify patients that may require more intensive evaluation or professional attention. The NARRATIVE REPORT integrates both personological and symptomatic features of the patient, and are arranged in a style similar to those prepared by clinical psychologists. Results are based on actuarial research, the MCMI’s theoretical schema, and relevant DSM diagnoses within a multiaxial framework. A process-oriented therapeutic guide is included in the narrative report.

Clinical Uses

The primary intent of the MCMI inventory is to provide information to clinicians, that is, psychologists, psychiatrists, counselors, social workers, physicians, and nurses, who must make assessments and treatment decisions about persons with emotional and interpersonal difficulties. Because of its simplicity of administration and the availability of rapid computer scoring and interpretation, the MCMI inventory can be used on a routine basis in outpatient clinics, community agencies, mental health centers, college counseling programs, general and mental hospitals, as well as independent and group practice offices, and in the courts.

Research

Over 600 research studies have used the MCMI inventory in a significant manner. Objective, quantified, and theory-grounded individual scale scores and profile patterns can be used to generate and test a variety of clinical, experimental, and demographic hypotheses. Research support is also available through Pearson Assessments.

Scales

The MCMI-IV consists of a total of twenty-five scales: Fifteen Clinical Personality Patterns scales: Schizoid, Avoidant, Melancholic, Dependent, Histrionic, Turbulent (NEW in the MCMI-IV), Narcissistic, Antisocial, Sadistic, Compulsive, Negativistic, and Masochistic; three Severe Personality Pathology scales: Schizotypal, Borderline, and Paranoid; seven Clinical Syndrome Scales: Anxiety, Somatoform, Bipolar Spectrum, Persistent Depression, Alcohol Dependence, Drug Dependence, and Posttraumatic Stress Disorder; three Severe Clinical Syndrome scales: Schizophrenic Spectrum, Major Depression, and Delusional Disorder; three Modifying Indices, an Inconsistency scale, and a Validity scale. The personality scales parallel the personality disorders of the DSM-5, as refined by theory. They are grouped into two levels of severity, the Clinical Personality Patterns scales and Severe Personality Scales. The clinical symptomology scales represent syndromal conditions frequently seen in clinical settings. They are also grouped into two levels of severity, the Clinical Syndromes scales and the Severe Syndrome Scales. The three Modifying Indices – Disclosure, Desirability, and Debasement – assess response tendencies which are connected with particular personality patterns or syndromal conditions.

The MCMI-IV also features Grossman Facet Scales, which provide information specifying the patient’s scores on several of the personologic/clinical domains described in previous sections of this Website, such as problematic interpersonal conduct, cognitive styles, expressive behaviors, and the like. They thereby contribute useful diagnostic information that should help clinicians better understand the particular realms of functioning on which the patient’s difficulties manifest themselves. They should also provide the clinical practitioner with guidance for selecting specific therapeutic modalities that are likely to maximize the achievement of positive treatment goals.

Scale descriptions and detailed data on test development and validation may be obtained by reading the current (2015) MCMI-IV test manual.