The comparative validity of MCMI-II and MMPI-2 personality disorder scales with forensic examinees.

This study demonstrated the convergent and discriminant validity of the MMPI-2 and MCMI-II personality disorder scales with forensic examinees. Based on averaged correlational data, the scales performed comparably with previous findings in psychiatric samples. Furthermore, the scales demonstrated increased convergent correlations. Improved convergence was obtained for the Antisocial, Sadistic, Borderline, Schizotypal and Paranoid scales. Decreased convergence on the Dependent and Avoidant scales was also obtained.

Gender role expectations of pain: relationship to sex differences in pain.

Empirical research supports the existence of sex differences in pain; yet these differences are poorly understood. Although biological mechanisms have been posited to explain variability, results of pain modeling manipulations suggest social learning may be a stronger influence on pain response. In this report we use the term sex to refer to the biological category of male or female. We use the term gender to refer to the socially acquired aspects of being male or female sometimes referred to as femininity and masculinity. This study investigated a new measure, the Gender Role Expectations of Pain questionnaire (GREP), which was designed to measure sex-related stereotypic attributions of pain sensitivity, endurance, and willingness to report pain. Subjects were 156 male and 235 female undergraduates at a southeastern university. Psychometric investigation of the questionnaire revealed a 5-factor solution that closely mirrored the theoretical construction of the items. Test-retest reliability was also shown for individual items on a separate sample of 28 subjects. Results supported hypotheses about gender role: both men and women rated men as less willing to report pain than women (F(1,389) = 336, P <.001); both men and women rated women more sensitive (F(1,389) = 9.5, P <.05) and less enduring of pain (F(1,389) = 65.7, P <.001) than men; and men rated their own endurance as higher than the typical man (F(1,389) = 65.7, P <.001). Sex accounted for 46% of the variance in willingness to report pain. Results suggest that the GREP distinguished between the socially learned reactions to pain for men and women. It is recommended that the influence of gender-related expectations for pain be assessed in all studies investigating human sex differences in pain.

Clinical pain perception and hormone replacement therapy in postmenopausal women experiencing orofacial pain.

OBJECTIVE: The purpose of this study was to examine the magnitude of the relation between a postmenopausal woman's hormonal replacement status and clinical pain report in a sample of women experiencing orofacial pain. DESIGN: To accomplish this, pain ratings were collected during a routine chronic pain evaluation at an orofacial pain clinic from a sample of 87 postmenopausal women. RESULTS: Results of ANCOVA (controlling for pain duration) demonstrated that postmenopausal women receiving hormone replacement therapy (HRT) reported higher levels of pain than postmenopausal women not taking HRT. Numeric pain rating scales revealed large effect sizes for worst pain report (0.62), moderate differences for average (0.48) and current (0.39) pain levels, and trivial differences for least pain (0.04). Effect sizes for the McGill Pain Questionnaire indicated somewhat smaller differences (0.35-0.24) between the two groups. CONCLUSIONS: This study is among the first to examine the relation between a woman's hormonal status and clinical pain perception and is the first to investigate the role of HRT in a postmenopausal woman's orofacial pain report in a clinical treatment setting. This area of inquiry is particularly salient given the high percentage of women who choose to initiate HRT either after hysterectomy or with the onset of menopause.

Predicting treatment compliance following facial pain evaluation.

The purpose of this study was to document compliance to treatment follow-up for facial pain patients referred for outside services. In addition, we generated a multidimensional model of the psychosocial constructs associated with chronic pain to determine whether these factors were predictive of compliance across recommended therapy modalities or with an overall measure of compliance. These constructs included pain report, depressive symptoms, anxiety, cognitive coping strategies, and physical activity reduction. The sample consisted of 80 facial pain patients evaluated at a tertiary care, facial pain clinic at a large university medical center. Compliance ratings ranged from 93% to 50% and are consistent with the literature that indicates that compliance differs across treatment modality. Furthermore, compliance rates were lower for the more nontraditional facial pain treatments performed by physical therapists or psychologists. Depression was negatively associated with compliance to medication changes, therapeutic injections, and splint therapy, but not psychological counseling or physical therapy. Increased pain was only associated with physical therapy. Measures of psychological distress (depression and anxiety) and pain were predictive of the overall measure of compliance. These results suggest that psychological distress can be a barrier for positive patient outcomes through reduced treatment compliance.

Sex differences in the perception of noxious experimental stimuli: a meta-analysis.

Fillingim and Maixner (Fillingim, R.B. and Maixner, W., Pain Forum, 4(4) (1995) 209-221) recently reviewed the body of literature examining possible sex differences in responses to experimentally induced noxious stimulation. Using a 'box score' methodology, they concluded the literature supports sex differences in response to noxious stimuli, with females displaying greater sensitivity. However, Berkley (Berkley, K.J., Pain Forum, 4(4) (1995) 225-227) suggested the failure of a number of studies to reach statistical significance suggests the effect may be small and of little practical significance. This study used meta-analytic methodology to provide quantitative evidence to address the question of the magnitude of these sex differences in response to experimentally induced pain. We found the effect size to range from large to moderate, depending on whether threshold or tolerance were measured and which method of stimulus administration was used. The values for pressure pain and electrical stimulation, for both threshold and tolerance measures, were the largest. For studies employing a threshold measure, the effect for thermal pain was smaller and more variable. The failures to reject the null hypothesis in a number of these studies appear to have been a function of lack of power from an insufficient number of subjects. Given the estimated effect size of 0.55 threshold or 0.57 for tolerance, 41 subjects per group are necessary to provide adequate power (0.70) to test for this difference. Of the 34 studies reviewed by Fillingim and Maixner, only seven were conducted with groups of this magnitude. The results of this study compels to caution authors to obtain adequate sample sizes and hope that this meta-analytic review can aid in the determination of sample size for future studies.

Comparative validity of MMPI-2 and MCMI-II personality disorder classifications.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) overlapping and nonoverlapping scales were demonstrated to perform comparably to their original MMPI forms. They were then evaluated for convergent and discriminant validity with the Million Clinical Multiaxial Inventory-II (MCMI-II) personality disorder scales. The MMPI-2 and MCMI-II personality disorder scales demonstrated convergent and discriminant coefficients similar to their original forms. However, the MMPI-2 personality scales classified significantly more of the sample as Dramatic, whereas the MCMI-II diagnosed more of the sample as Anxious. Furthermore, single-scale and 2-point code type classification rates were quite low, indicating that at the level of the individual, the personality disorder scales are not measuring comparable constructs. Hence, each instrument is providing similar and unique information, justifying their continued use together for the purpose of diagnosing personality disorders.

Personality disorder correspondence among the MMPI, MBHI, and MCMI.

MMPI, MBHI, and MCMI personality disorder scales were analyzed for convergent and discriminant validity. Friedman's ANOVA indicated that there were no significant differences among the sample's averaged scale scores. Further analyses of these data, however, demonstrated that the Millon instruments classified significantly more of the sample as personality disordered when compared to Morey's MMPI personality disorder scales. In addition, codetype correspondence among the three instruments was only 4 to 6%. When the instruments were analyzed in a pair-wise fashion, codetype correspondence increased to approximately 10 to 20%. These data indicate that these personality disorder scales do not demonstrate construct equivalence, particularly at the level of the individual profile.

Personality style codetype concordance between the MCMI and MBHI.

Personality scale profiles of Millon's Clinical Multiaxial Inventory and Behavioral Health Inventory were analyzed for codetype concordance using a sample of psychiatric patients with medical symptoms (N = 91). Results indicated that at least half of the sample would be diagnosed with a personality disorder by each instrument. Approximately 95% of the sample produced at least one elevated scale. The tests were not significantly different with respect to their classification rates of pathology or number of scales elevated and demonstrated significant and positive correlations between complementary scales. Nonetheless, codetype correspondence was found to be 29.67% for single scales and 20.88% for two-point codetypes. Correlational data, factor analysis, and paired mean score comparisons were used to analyze these findings.

Personality disorder correspondence between the million behavioral health inventory (MBHI) and the minnesota multiphasic personality inventory (MMPI).

The MBHI and MMPI personality disorder scales were analyzed for convergent and discriminant validity. Correlational data demonstrated that six of the eight scales were significantly related, while the remaining two scales approached significance. Further analyses of these data, however, demonstrated that none of the scales correlated significantly better with its convergent scale compared to nonconvergent scales. The MBHI classified significantly more of the sample as personality disordered (93%) compared to the MMPI personality disorder scales (17%). Furthermore, the MBHI tended to describe the sample as falling within the Anxious cluster of personality disorders, whereas the MMPI described them within the Dramatic cluster. Single scale codetype correspondence was found to be 15%, while two-point concordance was 12.5%, indicating very low congruence between personality style codetypes. These two measures do not appear to be measuring the same personality style constructs.