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improve the ecological validity of the data. This would also hold true in research studies involving mental illness in different cultures. That is, the meaning of a concept in one culture may be different from that in another.

      Concept Check

       What are five critical areas mental health professionals cover in an initial clinical interview?

       Why is it important for mental health professionals to understand the cultural context of an individual’s mental disorder? What kinds of information does the CFI help mental health professionals obtain?

       In terms of assessment, what are four types of reliability you should be concerned with, and why?

       In terms of assessment, what are five types of validity you should be concerned with, and why?

      Models of Assessment

      In this section, I will consider different ways of assessing signs and symbols. These range from simply asking a person about his or her symptoms to comparing the person to others who have a similar disorder. Specifically, I will discuss symptom subtests such as the Beck Depression Inventory, personality inventories that are based on psychometric formulations such as the Minnesota Multiphasic Personality Inventory, projective techniques such as the Rorschach inkblot test and the Thematic Apperception Test, neuropsychological approaches such as intelligence tests, and neuroscience approaches.

      Symptom Questionnaires

      At times, it is important to know what a person’s symptoms are and how that person may compare with others in terms of reporting these symptoms. A variety of questionnaires have been developed that focus on particular sets of symptoms such as those associated with pain, sleep disorders, anxiety, and depression.

      Beck Depression Inventory (BDI): a questionnaire useful for determining the level of depressive symptoms that a person is reporting

      The Beck Depression Inventory (BDI) has been used in both clinical and research settings to assess symptoms associated with the experience of depression (A. T. Beck & Beck, 1972). The BDI has 21 items, each of which is presented in a four-choice format where the individual is asked to indicate which choice best fits his or her current experience. Here is an example:

       I am not particularly discouraged about the future.

       I feel discouraged about the future.

       I feel I have nothing to look forward to.

       I feel the future is hopeless and that things cannot improve.

      A questionnaire such as the BDI is useful for determining the level of depressive symptoms that a person is reporting. Given that the measure has been in use for more than 40 years, there is considerable clinical and research data available in terms of level of depressive severity. The measure is also useful for noting changes in depression level during various types of treatment. During psychotherapy, for example, the measure could be given weekly to document changes in depressive experiences. A newer version of the scale (BDI-II) was developed in 1996 in response to the publication of DSM–IV, which changed a number of the diagnostic criteria for depression.

      Personality Tests

      For at least the past 2,000 years, there has been an understanding that individuals have a particular style for relating to the world and others. At the beginning of the last century, the personality styles of introversion and extraversion were studied. There was also an effort to examine the relationship between personality styles and psychopathology. A number of questionnaires have been developed to this end. One of the best known of these is the Minnesota Multiphasic Personality Inventory (MMPI).

      Minnesota Multiphasic Personality Inventory (MMPI)

      The Minnesota Multiphasic Personality Inventory (MMPI) is an assessment measurement of personality traits that is composed of more than 500 items of a true–false nature. The person taking the test simply indicates yes or no to statements such as, “I have trouble falling asleep.” The test was developed in an interesting manner. The authors, S. R. Hathaway and J. C. McKinley, began with a large pool of items and then reduced these to 504 items that were determined to be independent of one another. They then gave these items to psychiatric inpatients at the University of Minnesota Hospital. These inpatients were further divided by diagnosis, and the responses of each group were compared with non-patients who had come to the hospital as visitors or relatives. The idea was to develop a scoring scheme that would differentiate those with mental disorders from those without. In this sense, the content of the item was less important than its ability to discriminate between those individuals with a specific disorder and those without, as well as between disorders.

      Minnesota Multiphasic Personality Inventory (MMPI): an assessment measurement of personality traits, used in psychopathology to identify response patterns suggesting a psychological disorder based on empirical comparison to the general population

      In 1989, a new version of the MMPI, the MMPI-2, was released, which improved the generalizability of the test. The new test was “normed” on a better representation of the general population in terms of race, age, occupational level, income, and geographic location. The new version contains 567 items and uses a true, false, or can’t say format. One real advantage of the MMPI and MMPI-2 is that they were developed in a more empirical manner by comparing how the pattern of responding matched populations with specific disorders versus healthy individuals rather than the content of the items. It is also possible, by using a normal statistical curve, to determine how extreme an individual’s responses are. Thus, the scales are presented in a dimensional manner, and it’s easy to determine if a person endorses more or less of a category of experiences than the general population.

      The clinical scale in the MMPI uses the following categories:

       Hypochondriasis—Individuals who endorse these items show an excessive concern with bodily symptoms.

       Depression—Individuals who endorse these items display characteristics of depression such as trouble sleeping, loss of appetite, feeling sad, suicidal thoughts, and loss of interest in positive events.

       Hysteria—Individuals who endorse these items tend to view and experience the world in an emotional manner. They may overdramatize their situation. They may also experience emotional difficulties through bodily symptoms such as headaches or upset stomach when in a difficult psychological situation.

       Psychopathic deviate—Individuals who endorse these items display antisocial tendencies and experience conflicts with their environment. They may also exploit others without remorse.

       Masculinity–femininity—These items reflect the degree to which an individual endorses the traditional gender role of males or females.

       Paranoia—Individuals who endorse these items display suspiciousness of others. They also view the world in terms of “who is out to get them.”

       Psychasthenia—Individuals who endorse these items display excessive anxiety and obsessive behavior.

       Schizophrenia—Individuals who endorse these items display bizarre disorganized thoughts along with a lack of normal contact with reality including social aloofness. Various sensory problems such as hallucinations may be present.

       Hypomania—Individuals who endorse these items experience high-energy states associated with poor judgment and impulse control.

       Social introversion—These items reflect the extent to which an individual’s answers indicate social introversion and extraversion.

      By placing the responses of an individual to questions in each of the categories on a normal distribution, it is possible to see which categories deviate from responses seen in the general population (see Figure 4.1).

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