The Millon Clinical Multiaxial Inventory (MCMI-III)

The third edition of this popular test, the Millon Clinical Multiaxial Inventory (MCMI-III), has been published in 1996. With 175 items, it is much shorter and simpler to administer and to interpret than the MMPI-II. The MCMI-III diagnoses personality disorders and Axis I disorders but not other mental health problems. The inventory is based on Millon's suggested multiaxial model in which long-term characteristics and traits interact with clinical symptoms.

The questions in the MCMI-III reflect the diagnostic criteria of the DSM. Millon himself gives this example (Millon and Davis, Personality Disorders in Modern Life, 2000, pp. 83-84):

"... (T)he first criterion from the DSM-IV dependent personality disorder reads 'Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others,' and its parallel MCMI-III item reads 'People can easily change my ideas, even if I thought my mind was made up.'"

The MCMI-III consists of 24 clinical scales and 3 modifier scales. The modifier scales serve to identify Disclosure (a tendency to hide a pathology or to exaggerate it), Desirability (a bias towards socially desirable responses), and Debasement (endorsing only responses that are highly suggestive of pathology). Next, the Clinical Personality Patterns (scales) which represent mild to moderate pathologies of personality, are: Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive (Sadistic), Compulsive, Negativistic, and Masochistic. Millon considers only the Schizotypal, Borderline, and Paranoid to be severe personality pathologies and dedicates the next three scales to them.

The last ten scales are dedicated to Axis I and other clinical syndromes: Anxiety Disorder, Somatoform Disorder, Bipolar Manic Disorder, Dysthymic Disorder, Alcohol Dependence, Drug Dependence, Posttraumatic Stress, Thought Disorder, Major Depression, and Delusional Disorder.

Scoring is easy and runs from 0 to 115 per each scale, with 85 and above signifying a pathology. The configuration of the results of all 24 scales provides serious and reliable insights into the tested subject.

Critics of the MCMI-III point to its oversimplification of complex cognitive and emotional processes, its over-reliance on a model of human psychology and behavior that is far from proven and not in the mainstream (Millon's multiaxial model), and its susceptibility to bias in the interpretative phase.

The Psychopath, Sociopath, Antisocial

Roots of the Disorder

Is the psychopath, sociopath, and someone with the Antisocial Personality Disorder one and the same? The DSM says "yes". Scholars such as Robert Hare and Theodore Millon beg to differ. The psychopath has antisocial traits for sure but they are coupled with and enhanced by callousness, ruthlessness, extreme lack of empathy, deficient impulse control, deceitfulness, and sadism.

Like other personality disorders, psychopathy becomes evident in early adolescence and is considered to be chronic. But unlike most other personality disorders, it is frequently ameliorated with age and tends to disappear altogether in by the fourth or fifth decade of life. This is because criminal behavior and substance abuse are both determinants of the disorders and behaviors more typical of young adults.

Psychopathy may be hereditary. The psychopath's immediate family usually suffer from a variety of personality disorders.

Cultural and Social Considerations

The Antisocial Personality Disorder is a controversial mental health diagnoses. The psychopath refuses to conform to social norms and obey the law. He often inflicts pain and damage on his victims. But does that make this pattern of conduct a mental illness? The psychopath has no conscience or empathy. But is this necessarily pathological? Culture-bound diagnoses are often abused as tools of social control. They allow the establishment, ruling elites, and groups with vested interests to label and restrain dissidents and troublemakers. Such diagnoses are frequently employed by totalitarian states to harness or even eliminate eccentrics, criminals, and deviants.

Characteristics and Traits

Like narcissists, psychopaths lack empathy and regard other people as mere instruments of gratification and utility or as objects to be manipulated. Psychopaths and narcissists have no problem to grasp ideas and to formulate choices, needs, preferences, courses of action, and priorities. But they are shocked when other people do the very same. 

Most people accept that others have rights and obligations. The psychopath rejects this quid pro quo. As far as he is concerned, only might is right. People have no rights and he, the psychopath, has no obligations that derive from the "social contract". The psychopath holds himself to be above conventional morality and the law. The psychopath cannot delay gratification. He wants everything and wants it now. His whims, urges, catering to his needs, and the satisfaction of his drives take precedence over the needs, preferences, and emotions of even his nearest and dearest.

Consequently, psychopaths feel no remorse when they hurt or defraud others. They don't possess even the most rudimentary conscience. They rationalize their (often criminal) behavior and intellectualize it. Psychopaths fall prey to their own primitive defense mechanisms (such as narcissism, splitting, and projection). The psychopath firmly believes that the world is a hostile, merciless place, prone to the survival of the fittest and that people are either "all good" or "all evil". The psychopath projects his own vulnerabilities, weaknesses, and shortcomings unto others and force them to behave the way he expects them to (this defense mechanism is known as "projective identification"). Like narcissists, psychopaths are abusively exploitative and incapable of true love or intimacy.

Narcissistic psychopath are particularly ill-suited to participate in the give and take of civilized society. Many of them are misfits or criminals. White collar psychopaths are likely to be deceitful and engage in rampant identity theft, the use of aliases, constant lying, fraud, and con-artistry for gain or pleasure.

Psychopaths are irresponsible and unreliable. They do not honor contracts, undertakings, and obligations. They are unstable and unpredictable and rarely hold a job for long, repay their debts, or maintain long-term intimate relationships.

Psychopaths are vindictive and hold grudges. They never regret or forget a thing. They are driven, and dangerous.

I wrote this in the Open Site Encyclopedia:

"Always in conflict with authority and frequently on the run, psychopaths possess a limited time horizon and seldom make medium or long term plans. They are impulsive and reckless, aggressive, violent, irritable, and, sometimes, the captives of magical thinking, believing themselves to be immune to the consequences of their own actions.

Thus, psychopaths often end up in jail, having repeatedly flouted social norms and codified laws. Partly to avoid this fate and evade the law and partly to extract material benefits from unsuspecting victims, psychopaths habitually lie, steal others' identities, deceive, use aliases, and con for "personal profit or pleasure" as the Diagnostic and Statistical Manual puts it."