Prevalence of Personality Disorders and Clinical Syndromes Using the Millon Clinical Multiaxial Inventory III (MCMI-III) in an Iranian Clinical Sample
Personality objective inventories are commonly used for diagnosis of personality disorders. Personality assessment is effective in diagnosis, prognosis and treatment of psychiatric outpatients and in patients. Comorbid personality disorders and clinical syndromes may be more worth condition of the patients. The present study aimed to examine the diagnosis of personality disorders and clinical syndromes using the Farsi version of Millon Clinical Multiaxial Inventory III (3rd ed.; MCMI-III) in Iranian psychiatric outpatients. This was a descriptive cross-sectional study. The subjects of the project were 737 psychiatric outpatients. They were referred to the psychiatric and psychological clinics at the School of Behavioral Sciences and Mental Health-Tehran Institute of Psychiatry affiliated to Iran University of Medical Sciences, Tehran, Iran. The subjects were selected using convenience sampling during years of 2010-2015 and evaluated by the MCMI-III computerized Farsi version. Data were analyzed by descriptive methods and t test using SPSS/WIN 16.0 program. Results showed that the most frequent of personality disorders were Depressive (2B), Compulsive (7), and Histrionic (4); with double code types of Depressive- Dependent (2B3); and Histrionic- Depressive (42B) combinations. The most frequent of moderate clinical syndrome were Anxiety (A), and Dysthymia (D) and the severe syndromes was Thought Disorder (SS); with double codes of clinical syndromes of Anxiety- Post-Traumatic Stress Disorder (AR). There were significant differences between women and men patients in mean scores of some MCMI-III scales. Women had higher scores in Validity Scales of Disclosure (X) and Debasement (Z) than men. Depressive, Passive-Aggressive (Negativistic) (8A), Self-Defeating (8B) and Borderline (C) personality disorders were the most common in women than men. By contrast, Compulsive (7) personality disorder was the most common in men compare to women. Anxiety, Somatoform (H), Bipolar: Manic (N), Dysthymia (D), and Post-Traumatic Stress Disorder (R), Thought Disorder (SS), and Major Depression Disorder (CC) were the most common in women than men. The prevalence of diagnosis personality patterns and clinical syndromes in Iranian psychiatric outpatients is high and this should be taken into account in their assessment and treatment planning. Using of available sample and lack of random sample; possibility of comorbidity of other mental disorders with main diagnosis are limitations of the study. Utilization of item response theory (IRT); Structural Clinical Interviews for DSM Axis I and Axis II (SCID-I and SCID-II) along with MCMI-III; and MCMI-IV in an Iranian clinical sample are recommended.
Prevalence of Personality Disorders and Clinical Syndromes Using the Millon Clinical Multiaxial Inventory III (MCMI-III) in an Iranian Clinical Sample, International Journal of Biomedical Engineering and Clinical Science.
Vol. 3, No. 4,
2017, pp. 36-47.
Afkham Ebrahimi A, Daneshamooz B. (2000). The comorbidity depression and personality disorders. Iranian Journal of Psychiatry & Clinical Psychology (IJPCP), 5(3): 22-30.
Afkham Ebrahimi A, Salehi M. (2000). Convergent validity of clinical and structural interview findings and MCMI-II profiles in diagnosis of personality disorder. Iranian Journal of Psychiatry & Clinical Psychology (IJPCP), 6(2 & 3): 79-87.
Aghaei, A, Golparvar, M. (2014). Prevalence of personality disorders symptoms among male high school students in Isfahan, Iran. European Journal of Psychology & Educational Studies, 1: 22-29.
Ahmadvand A, Sepehrmanesh Z, Ghoreishi FS, Afshinmajd S. (2012). Prevalence of psychiatric disorders in the general population of Kashan, Iran. Archives of Iranian Medicine, 15(4): 205-209.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed) (DSM–IV).Washington, DC: APA.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington.
Bernstien DP, Kasapis C, Bergman A. (1997). Assessing axis II disorders by informant interview. Journal of Personality disorder, 11: 158-167.
Charter RA, Lopez MN. (2002) Millon Clinical Multiaxial Inventory (MCMI-III): the inability of the validity conditions to detect random responders. Journal of Clinical Psychology, 58(12): 1615-1617.
Chegini M, Delavar A, Gharraee B. (2013). Psychometric characteristics of Millon Clinical Multiaxial Inventory-III. Journal of Modern Psychological Research (JMPR), 8(29): 135-162.
Dadfar F, Dadfar M, Vafa F. (2009). Clinical syndromes in patients with gender identity disorder (GID). Paper presented at the Third National Congress of Family and Sexual Disorders. Shahed University, 2009. 1-3 November, Tehran, Iran.
Dadfar M, Bahrami F, Dadfar F, Younesi SJ. (2010). Reliability and validity of the Temperament and Character Inventory. Journal of Rehabilitation, 11(3): 15-24.
Dadfar M. (1997). Comorbidity of personality disorders in obsessive-compulsive patients compare with normals. Master thesis in clinical psychology, Tehran Psychiatric Institute, Iran University of Medical sciences, Teharn, Iran.
Dadfar M, Kalibatseva Z. (2016). Psychometric properties of the Persian version of the short Beck Depression Inventory with Iranian psychiatric outpatients. Scientifica, 2016:8196463. doi: 10.1155/2016/8196463. Epub 2016 May 17.
Dadfar M, Atef Vahid MK, Kazemi H, Kolivand PH. (2014). Diagnostic indexes in tests of psychology. Mirmah Publication, Tehran, Iran.
Dadfar M, Malakouti K, Bolhari J, Mehrabi F. (2002). The impact of pharmacological treatment on personality disorders of obsessive-compulsive patients. Iranian Journal of Psychiatry and Clinical Psychology (IJPCP), 8(1): 76-87.
Dadfar M, Yekeh Yazdandoost R, Dadfar F. (2009). Study of personality patterns in patients with dender identity disorder (GID). Iranian Journal of Forensic Medicine (IJFM), 15(2): 96-99.
De Bernier GL., Kim YR, Sen P. (2014). A systematic review of the global prevalence of personality disorders in adult Asian populations. Personality and Mental Health, 8(4): 264-275.
Dolan B, Evans C, Norton K. (1995). Multiple axis-II diagnosis of personality disorder. British Journal of Psychiatry, 166: 107-112.
Eftekhar Ardebili M, Dadfar M, Karimi Kaisami E. (2004). Comorbidity of psychiatric disorders in psychiatric outpatient clinic. Iranian Journal of Psychiatry and Clinical Psychology (IJPCP), 10 (1 & 2): 11-21.
Eshghabadi S. (2011). Comparison of psychometric characteristics of MCMI-III scales and MMPI-2 scales in Semnan city. Thesis of MS in psychology: Social Sciences School, Islamic Azad University, Branch of central Tehran.
Farhoudian A, Sharifi V, Amini H, Basirnia A, Mesgarpour B, Mansouri N, Amin-Esmaeeli M, Salesian N, Mohammadi MR, Yousefi-Nooraie R, Rahimi-Movaghar A. (2007). Prevalence of psychiatric disorders in Iran: A systematic review. Iranian Journal of Psychiatry, 2: 137-150.
Ghaderi D, Mostafaei A, Bayazidi S, Shahnazari M. (2016). Investigating the prevalence of personality disorders and its relationship with personality traits among students. International Journal of Medical Research & Health Sciences, 5(4): 119-126.
Gharraee B, Afkham Ebrahimi A. (1999). The code types of MCMI-II in patients with axis I disorders. Iranian Journal of Psychiatry & Clinical Psychology (IJPCP), 5(1 & 2): 92-99.
Grant BF, Chou SP, Goldstien RB, Huang GH, Huang B, Stinson FS, Saba TD, Smith SM, Dawson DA, Pulay AJ, Pickening RP, Ruan WJ. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 national Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69(4); 533-545.
Groth-Marnat G, Wright AJ. (2016). Handbook of Psychological Assessment (6th Edition). John Wiley & sons, Inc.
Grove WM, Vrieze SI. (2009). An exploration of the base rate scores of the Millon Clinical Multiaxial Inventory-III. Psychological Assessment, 21(1): 57-67.
Hills HA. (1995). Diagnosing personality disorders: an examination of MMPI-2 and MCMI-II. Journal of Personality Assessment, 65: 21-35.
Hopwood CJ, Bornstein RF. (2014). Multimethod clinical assessment. The Gilford Press.
Hsu LM. (2002). Diagnostic validity statistics and the MCMI-III. Psychological Assessment, 14(4): 4410-4422.
Huang Y, Kotov R, de Girolamo G. et al (2009). DSM-IV personality disorders in the WHO World Mental Health Surveys. British Journal of Psychiatry, 195(1): 46–53.
Inch R, Crossley M. B. (1993). Diagnostic utility of the MCMI-I and MCMI-II with psychiatric outpatients. Journal of Clinical Psychology, 49(3): 358-366.
Jonson I, Hesee M, Fridell M. (2008). Personality disorder features as predictors of symptoms five years post-treatment. American Journal on Additions, 17(3): 172-175.
Khajeh Mogahy N. (1993). Preliminary preparations of the Persian form of MCMI-II in Tehran city. Master thesis in clinical psychology: Tehran Psychiatric Institute.
Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6): 553-567.
Libb JW, Murray J, Alarcon RD. (1992). Concordance of the MCMI-II, the MMPI, and axis I discharge diagnosis in psychiatric inpatients. Journal of Personality Assessment, 58: 680-690.
Malakouti K, Mehrabi F, Bolhari J, Dadfar M. (2001). The impact of personality disorders on medical treatment of obsessive compulsive patients. Iranian Journal of Psychiatry and Clinical Psychology (IJPCP), 69(4): 13-23.
Martin J, Walcott G, Clarke TR, Barton EN, Hickling FW. (2013). The prevalence of personality disorder in a general medical hospital population in Jamaica. West Indian Medical Journal, 62(5): 463-467.
Mazaheri Meybodi A, Hajebi A, Ghanbari Jolfaei A. (2014). The frequency of personality disorders in patients with gender identity disorder. Medical Journal of the Islamic Republic of Iran (MJIRI), 28(90): 1-6.
Millon Clinical Multiaxail Inventory-III (MCMI-III) FAQs (2014). When is it appropriate to use the MCMI-III test? OMICS International Publishing Group, Available at http: esearch.omicsgroup.org/index.php/Millon_Clinical_Multiaxial_Inventory.
Millon T. (2008). The logic and methodology of the Millon inventories. Cross-cultural personality assessment. In G. J. Boyle, G. Matthews, & D. H. Saklofske (Eds.). Sage handbook of personality theory and assessment. Vol. 2: Personality theory and assessment. Los Angeles, CA: Sage.
Millon, T, Davis R, Millon C. (1997). Diagnostic validity of MCMI-III. Journal of Personality Assessment, 68: 69-88.
Millon T, Davis R, Millon C. (1997). Millon Clinical Multiaxial Inventory-III (MCMI-III) manual. Bloomington, MN: Pearson Assessments.
Millon, T., Grossman, S., & Millon, C. (2015). MCMI-IV: Millon Clinical Multiaxial Inventory Manual (1st ed.). Bloomington, MN: NCS Pearson, Inc
Millon, T., Millon, C., Davis, R., & Grossman, S. (2009). MCMI-III Manual (Fourth ed.). Minneapolis, MN: Pearson Education, Inc.
Newton-Howes G, Tyrer P, Anagnostakis K, Cooper S, Bowden-Jones O, Weaver T; COSMIC study team. (2010).The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams. Social Psychiatry and Psychiatric Epidemiology, 45(4): 453-460.
Noorbala AA, Akhondzadeh Sh. (2015). Mental health study process into prevalence of mental disorders in Iran. Archives of Iranian Medicine, 18(2): 76-84.
Noorbala AA, Bagheri-Yazdi SA, Vaez-Mahdavi MR, Asadi-Lari M, Faghihzadeh S, Mohammad K, Haeri-Mehriz AA, Parsaeia M. (2014). Mental health changes in Tehran during a 12-year period: Comparing national health and disease survey in 1999 and equality project in 2011. Daneshvar Medicine Journal of Shahed University, 113: 37-45.
Noorbala AA, Damari B, Riazi-Isfahani S. (2014). Evaluation of mental disorders incidence trend in Iran. Daneshvar Medicine Journal of Shahed University, 112: 1-11.
Parvizi Fard AA, Birashk B, Atef Vahid MK, Shakeri J. (2001). Comorbidity of mood and anxiety disorders and substance abuse among treatment-seeking addicts and normal individuals. Iranian Journal of Psychiatry and Clinical Psychology (IJPCP), 7(1 & 2): 45-55.
Piersma LL, Boes JL. (1998). MCMI-III as a treatment outcome measure for psychiatric inpatients. Journal of Clinical Psychology, 53(8): 825-831.
Retzlaff P. (1996). MCMI-III validity: Bad test or bad validity study. Journal of Personality Assessment, 66: 431-437.
Retzlaff P, Stoner J, Kleinsasser D. (2002). The use of the MCMI-III in the screening and triage of offenders. International Journal of Offender Therapy and Comparative Criminology, 46(3): 319-332.
Sadeghirad B, Haghdoost AA, Amin-Esmaeili M, Ananloo ES, GHaeli P, Rahimi-Movaghar A, Talbian E, Pourkhandari A, Noorbala AA, Barooti E. (2010). Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. International Journal of Preventive Medicine, 1(2): 81-91.
Salehi M, Malekian A, Haghighi M, Jahangard L, Rahimi E. (2008). Personality disorders in treatment- seeking substance dependent patients. Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), 2(2): 10-14.
Sharifi AA. (2007). Millon Clinical Multiaxial Inventory-III (MCMI-III) manual. Tehran, Psychometric Publication.
Sharifi AA, Moulavi H, Namdari K. (2008). The validity of MCMI-III scales. Knowledge & Research in Applied Psychology, 34: 27-38.
Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, Rahimi-Movaghar A. Twelve-month Prevalence and Correlates of Psychiatric Disorders in Iran: The Iranian Mental Health Survey, 2011. Archives of Iranian Medicine, 18(2): 76-84.
Thuo J, Ndetei DM, Maru M. (2008). The prevalence of personality disorders in a Kenyan inpatient sample. Journal of Personality Disorder, 22: 217–220.
Tyrer P, Mulder R, Crawford M, Newton-Howes G, Simonsen E, Ndetei D, Koldobsky N, Fossati A, Mbatia J, Barrett B. (2010). Personality disorder: a new global perspective. World Psychiatry, 9(1): 56–60.
Walsh K, Hasin D, Keyes KM, Koenen KC. (2016). Associations between gender-based violence and personality disorders in U.S. women. Personality disorders: Theory, research, and treatment, 7(2): 205-210.
Zhang T, Wang L, Good M-J,BJ, Chow A, Dai Y, Yu J, Zhang H, Xiao Z. (2012). Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: A comparison of uni-axial and multi-axial formulation. Social Psychiatry and Psychiatric Epidemiology, 47(9): 1409-1417.
Zimmeraman M. (1994). Diagnostic personality disorders are view of issues and research methods. Archives of Psychiatry, 51: 225-245.
Zimmerman M, Rothschild L, Chelminski I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162(10): 1911-1918.