The MMPI-2 Chronic Fatigue Syndrome Profile
Linda Miller-Iger, PhD. The Chronic Fatigue Syndrome Institude, Anaheim Hills CA. Originally published in the CFIDS Chronicle, 1992.
As the number of chronic fatigue syndrome patients who need to establish their right to disability benefits at the state or federal level grows, the Minnesota Multiphasic Personality Inventory (MMPI) takes on even greater importance as an objective, empirically based assessment instrument able to identify chronic fatigue syndrome.
The MMPI: A Widely
Used Assessment Tool
The usefulness of the MMPI can be attributed to its validity scales. These validity scales indicate how open and honest the person was when he/she took the MMPI. Because of the validity scales and the MMPI's high level of reliability, the MMPI is and has been important in aiding diagnosis and assisting patients to establish eligibility for Social Security and state disability benefits.
The MMPI-2 was developed in 1989 and became widely distributed and accepted in 1991. With the advent of the major restructuring of the MMPI-2, Butcher, Dahlstrom, Graham, Tellegen & Kraemmer, its developers, promised that there would be no significant alterations in profile configuration between the original MMPI and the MMPI-2. According to Ben-Porath and Butcher, "the stability of the 13 basic scales was retained" in the MMPI-2. Specific profiles such as depression, malingering, hypochondriasis, and chronic fatigue syndrome have remained the same. Some changes, however, were made, including:
The First Study of
CFS Patients Using the MMPI
The mean for each of the clinical scales for female chronic fatigue syndrome patients was large, with very small standard deviations suggesting that a high percentage of the sample endorsed each of the clinical scales at about the same level. The chronic fatigue syndrome MMPI profile for females was then compared with established profiles for normals, hypochondriasis, malingering, and depression, and found to be different from each of those.
A New Study
The mean education for females was 14.7 years with a standard deviation of 2.1. The mean education for males was 14 years with a standard deviation of 1.9. The mean age for female patients was 40.78 years with a standard deviation of 9.7. The mean age for males was 42.75 with a standard deviation of 19.5.
As in the original MMPI-1 study, the sample of chronic fatigue syndrome patients was divided into females and males consistent with statistical interpretative profiles for the normative sample. The mean and standard deviations were found for three validity and ten clinical scales. Raw scores were converted to T scores, separate T score conversions were used for males and females. T scores, again, are based on a mean of 50 and a standard deviation of 10. One and one-half standard deviations with the MMPI-2 are considered clinically significant. For clinical purposes, following standardized procedure, K corrections were made.
A New MMPI Profile
for Female CFS Patients
The chronic fatigue syndrome MMPI-2 profile for female patients was then compared with the MMPI-1 profile for female CFS patients. We found that the two profiles were almost identical.
A New MMPI Profile
for Male CFS Patients
The mean for each of the clinical scales for male MMPI-1 CFS patients was large with very small standard deviations suggesting, again, that a high percentage of the sample endorsed each of the clinical scales at about the same level. The chronic fatigue syndrome MMPI profile for males was then compared to normals, hypochondriasis, malingering, and depression, and found to be unique and different from each of those.
Using the same procedure, an MMPI-2 profile for male CFS patients was created. Clinical significance was achieved on the following scales: 1 (Hypochondriasis), 2 (Depression), 3 (Hysteria), 7 (Psychasthenia) and 8 (Schizophrenia). The mean for each of the clinical scales for the male patients was large with small standard deviations, again suggesting a large number of the sample endorsed each of the clinical scales at about the same level. T test comparisons were made between the MMPI-2 chronic fatigue syndrome male patient sample and the MMPI-2 normative group. They were found to be significantly different on Scales F, 1, 2, 3, 4, 6, 7, 8 and 0. The chronic fatigue syndrome MMPI-2 profile for male patients was then compared with the chronic fatigue syndrome MMPI-1 profile for male patients. In contrast to that for female CFS patients, the two profiles were found to be different. Clinical significance was no longer achieved on Scale 4 (Psychopathic Deviate). In 1991, Munley found, "the MMPI-2 clinical T scores for women appear to show more similarity to the original norms than do new MMPI-2 norms for men." In another study, Munley and Zarantonello (1990) found in comparing the MMPI-1 to the MMPI-2, "the male code type profiles show a more pronounced change in elevation than do the female profiles."
Analysis of the Female
Chronic Fatigue Syndrome MMPI-2 Profile
This profile is consistent with the profile of chronic illness found by Naliboff, Cohen, & Yellin, 1982. Testing results indicate a significant level of distress and concern about bodily processes and physical health. Patients with profiles like this are more often seen on medical, rather than psychiatric, services, although there is indication of a significant level of depression. The patient may see the depression as secondary to her somatic complaints. Suicidal ideation must be ruled out.
The female patient may have deep concerns and even fearfulness about the possibility of a complete physiological breakdown. It is important to note that others with profiles similar to this do experience physiological breakdown in middle to late age as a result of continuous autonomic nervous system arousal, which may be the result of processing stress physiologically, rather than through the emotions. The patient probably is in a constant state of tension and anxiety.
The patient favors traditional female defenses of repression and denial. When these defenses fail, she probably feels overwhelmed. The emotional swing between denial and feeling overwhelmed may be disconcerting to the patient. Testing results indicate the use of obsessive-compulsive defenses which aid by restricting behaviors and utilizing repetitive problem- solving strategies even when they are no longer working.
As evidenced by the testing, the female patient is experiencing difficulty concentrating, memory loss, difficulty maintaining attention and may, at times, feel confused, with a possible blurring of reality and fantasy. Testing results indicate the patient may be withdrawing from others and restricting activities. The female patient appears to have traditional values with an emphasis on home and family, yet there is indication of unexpressed anger, chaotic interpersonal relationships, and impulsivity. There is strong indication of suspiciousness of the motives of others and difficulty with authority figures.
Comparison of the
MMPI-2 Profiles for Male and Female CFS Patients
A Major Alteration
In closing, I would like to note my appreciation to Scott Fleishman and Bob Iger for "crunching the numbers" and to Scott Fleishman for conducting the literature search.
Ben-Porath VS, Butcher JN. The Comparability of MMPI and MMPI-2 Scales and Profiles. Psychological Assessment: A Journal of Consulting and Clinical Psychology, (4),345-347, 1989.
Butcher JN, Dahlstrom WG, Graham JR, Tellegen, Kraemmer. The MMPI-2. Univ. of MN Press, 1989.
Greene RL. The MMPI-2/MMPI: An Interpretive Manual. Needham Heights, MA, 1991.
Lashar D. The MMPI: Clinical Assessment and Automated Interpretation. Los Angeles: Western Psychological Services, 1974.
Munley MH, Zarantonello MM. A Comparison of MMPI Profile Types with Corresponding Estimated MMPI-2 Profiles. J Clin Psychology, 46(6),809-810, 1990.
Munley PH. A Comparison of MMPI-2 and MMPI T-Scores for Men and Women. J Clin Psychology, 47(1),87-91, 1991.
Naliboff BD, Cohen MJ, Yellin AN. Does the MMPI differentiate chronic illness from chronic pain? Pain, 13(4),333-341, 1982
Vincent KR. The Fragile Nature of MMPI Code Types. J Clin Psychology, 46(6),800-802, 1990.
* Miller-Iger, Linda. 1990. "The MMPI As An Aid to CFS Diagnosis". CFIDS Chronicle, Spring/Summer 1990
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