The Millon Clinical Multiaxial Inventory III: test review and evaluation

Millon Test Summary

Counseling Test Review

What follows in this report is a summary of the Millon Clinical Multiaxial Inventory III, often referred to as the MCMI-III. One of the sources (but certainly not the only one) is the creator of the test, Mr. Million himself. Four other sources covering the Millon test are covered as well. There are a number of sections to this report and they are, in order, general information about the test, a description of the test, a technical evaluation of the test, a practical evaluation of the test and a summary evaluation of the test. A conclusion will wrap up the report.

General Test Information

As noted in the introduction, the title of the test involved here is the Millon Clinical Multi-Axial Inventory III. There is a "sister" test that is very similar and is known as the Millon College Counseling Inventory, with the main difference being that the latter test is catered to the mental health measurement of college students. The creators of the current test and in its current form are Theodore Millon, Carrie Millon, Seth Grossman and Roger Davis. As the title suggests, there have been three iterations of the test. The initial iteration was created in 1969 and was notated at length in Theodore Millon's book that was titled Modern Psychopathology. That test had 11 personality scales as well as 9 clinical syndrome scales (Millon, 1994)(Millon, 2008).

The second iteration, that being MCMI-II came about in 1987 and the number of personality scales went from 11 to 13 while the number of clinical syndrome scales remained at 9. The third iteration, the current MCMI-III was published in 1994 and it was revised when the DSM-IV standard was published. The aggressive/self-defeating scales were dropped in favor of depressive and PTSD, thus raising the total personal scale figure to 14 and the clinical syndrome scale to 10. A total of 5 correction scales were in place as well (Millon, 1994)(Millon, 2008).

The starter kit, as sold on the Pearson website, is $172 or $166, depending on the desired contents of the package. Administration materials and score/reporting documents are available as well on the Pearson website. As for who the test is proper for, the clinical syndrome scales are for anxiety, somatoform, bipolar/manic, delusional disorder, thought disorder, major depression, PTSD, drug dependence, alcohol dependence and dysthymia. These are the very same diagnoses that can be made using the Axis I of DSM-IV. The personal scale measurements are paranoid, schizoid, avoidant, depressive (those last two are related), histrionic, dependent, narcissistic, anti-social/aggressive, compulsive and two more that are also related, those being negativistc/masochistic. General assumptions are that people being scored using the Millon test (or even the related DSM-IV Axis I tests) is that the person being measure falls somewhere in the nexus of this test and it is simply a matter of finding out exactly where they fall (Millon, 1994)(Millon, 2008).

Test Description

The core of the Millon test is the scoring. Every patient that takes the test is assigned a raw score based on the results revealed. This raw score is translates to a Base Rate, or BR for short (Grove & Vrieze, 2009). The raw score's scale ranges from 1 to 115 and a median score is defined as 60, roughly (but not exactly) halfway through the dimensions.The conversion is complex, but a score above 178 or below 34 is almost always indicative of a patient fudging the responses and the test result is generally discarded. In such an instant, the patient is actively hiding something (or a series of things) that are relevant or they are actively lying when answering questions (Millon, 1994)(Millon, 2008).

The purpose of the test is to ascertain, based on the results, the likely mental issues a patient is having based on the results given. Just as a few examples, scores can indicate compulsive behavior, major depression, debasement, somatoform and so forth. If tests results are consistent over time, this usually does a lot to validate and prove the results of the test. There are 28 sub-scales that are broken into 24 clinical scales. The test is a series of 175 true/false questions and it takes about half an hour to complete in most cases. The theory behind the Millon test centers on four main domains or spheres and three polarities. The domain/spheres are abstraction, reproduction, existence and adaptation. The polarities are pleasure vs. pain, self vs. other and passive vs. active (Millon, 1994)(Millon, 2008).

Practical Evaluation

In terms of quality of test materials, the Pearson website shows a good array of tools and tricks that mental health professionals can use quite easily to implement and administer the Millon test in their practice. The buyers are able to mix and match as they see fit so as to get the right mix needed for the individual's use of the test. This is much better than an expensive and/or one-size-fits-all approach that pigeon-holes a mental health professional or practice into spending money that is really wasteful and not purposeful (Millon, 1994)(Millon, 2008).

The ease of the test is quite basic. The very simple nature of the true/false responses is refreshingly easy. The length of the test is a bit long at 30 minutes. However, this test-length squares just fine with the usual 30- to 60-minute sessions that mental health professionals use and the length of the test is no doubt in place so as to measure the consistency of different dimensions at different points in the test rather than just asking the question type once and hoping for an accurate result. The score's extremes lending themselves to the test being skewed is also a good sign, as this shows that there is some q quality control and data checking built into the test. This fetters out test manipulation and subterfuge. In the days of doctor-shopping and prescription bill abuse, that is very prudent (Millon, 1994)(Millon, 2008).

Summary Evaluation & Critique

The strengths of the Millon test include the fact that it is known to dovetail in terms of results quality and content with the famed DSM-III/DSM-IV standard. This helps the Millon's credibility immensely. Millon actually express in an interview that he had had a level of involvement in the DSM-III committee, so that drives the point home even more (Shaughnessy, 2008). Tests are constantly under way to test the efficacy and comparative accuracy of the DSM-III, the DSM-IV, the MBHI, the MBMD and the MCMI-III, the latter of which is covered in this report (Wise, 2010). Another strength is that the test is long enough to give good results but not too long. A third strength is that the results have shown good data over time but changes have been made to account for evolving in the mental health field and to improve the validity and reliability of the tests.

As for a few weaknesses, the Millon test is like any other instrument in that people clever enough can manipulate the results. The second is that if a test result is wrong (regardless of whether it's a test problem or a human problem), the results can be quite bad. Giving a certain drug to someone with a certain mental condition, just to use a generic example, can be quite scary to the drug-user, so doctors need to be careful and diligent when dispensing drugs. Lastly, mental health diagnosis is never an exact science and patients that are obscuring what's really going on (regardless of why) makes things turn out bad for everyone.

As far as recommendations for this test, the continued pattern of dovetailing and comparing this framework and its results to the DSM-IV and other commonly accepted mental health frameworks is the right way to go and it should continue. However, another recommendation is to also include other research and trends to make sure there is not anything legitimate out there that clearly contradicts, or at least brings into question, the efficacy and properness of relying on other frameworks. The simple reason for this is that even the go-to frameworks can sometimes go the wrong direction or simply get things wrong. There always needs to be checks and balances that are reasonable and based on factual and accurate interpretation of results and anomalies.

Another recommendation is to make sure that the tools are only harnessed and used by the proper medical professionals. People without the proper training (e.g. psychiatrists) should be wielding the tools and doctors should proceed with extreme caution and trepidation when patients are self-diagnosing or in any other way seemingly trying to manipulate or influence the outcome. Granted, the Millon test takes that into account in many ways, but deceptive, odd or even sociopathic behavior needs to be identified when it is spotted and nothing replaces the human element of detecting that even if the test being used has that built in as well.

Lastly, and this dovetails with the first recommendation, data that is clearly anomalous when assessing the efficacy, accuracy, validity and reliability of the Millon (or any other) framework should not be ignored. It should be brought to the light and forefront and the chips should be allowed to fall where they may. The people doing the analyzing should indeed be skeptical of anomalous data but not to the point where they unfairly and too hastily dismiss the anomaly as an aberration or simply not applicable to the science in play.

Conclusion

In conclusion, the legitimacy of the Millon test is not in question, just as it is not in question for the DSM test. Some would consider that Millon latching on to DSM as a means to get their own test out there but the author of this paper holds that if the tests were completely different and both yielded "good" results, that would be quite vexing since that would suggest that the mental health science questions that belie each test are not as clearly answered as previously thought. Just as Ford and GM both make good cars that are different, they still have the same general level of quality and safety as well as the fact that they are used for the same things. Doing things a bit differently but for the same reason and with the same result is a good thing, not a bad thing.