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The BHI was designed to be a psychological test for medical patients. The constructs of the test itself were developed in a health psychology setting, and the test was researched and normed using medical patients. Psychological tests which were initially intended to assess the presence of psychological disorders in medically healthy people can produce scores which are confounded by the patient's medical diagnosis. The strength of the BHI is that it is able to control for a number of factors which can confound other psychological tests not designed for medical patients.
Like the P3, the BHI is unusual in that it is "double normed", meaning that each person's responses produces two sets of scores. This means that the patient's responses can be compared to the average rehabilitation patient, as well as to the average person in the community. As a result, it produces two sets of scores for each person. This makes a more sophisticated analysis possible. Overall, a comparison to persons in the community is especially useful if one is trying to estimate how a person has been impacted by a medical condition. On the other hand, comparing a persons scores to other medical patients enables one to determine if a particular person is reacting differently than does most medical patients. Obviously, an understanding of how to interpret tests such as this is very important. For more information about this, consult the page on The Interpretation of Double-Normed Tests.
The BHI can also be used to assess medical patients with illness, rather than injury. Over the course of the BHI's development, it was administered to persons with a variety of medical conditions, including heart disease and diabetes, and was constructed with such persons in mind. It should be remembered though that while there are certain general psychological reactions to an illness or injury (such as grief over a loss of heath), the patient's medical diagnosis should be taken into consideration when interpreting the BHI results. The nature of the BHI printout facilitates the "clinical cross validation" of an individual profile. As the symptoms are listed according to medical symptom category, the symptomatic complaints can be individually compared to the symptomatology expected from a particular injury or illness condition.
A weakness of the BHI is that it was not intended to assess gross psychopathology, such as schizophrenia. While the test does contain some critical items for such disorders, if it is important to assess such conditions, then other tests would be preferable.
The BHI Advanced Interpretation Guide v3.1 is available free to BHI users (info about the Guide)
For more information or to purchase (voice): 1-888-627-7271
Qualifications to purchase BHI: Specialized degree in the healthcare field (PhD, MD, RN, PT, etc) and an appropriate license or certification.
Qualified professionals can request free BHI information packet (send name, degree and postal address)
Email a request for BHI info to NCS
The MBHI was normed on a sample of hospital patients of various diagnoses. For a number of years it was the only test in Buro's Mental Measurements Yearbook for the assessment of psychosomatic disorders. The MBHI was normed on a sample consisting of a cross-section of medical patients. This make the results applicable to this population, although it is not clear how the observed scores might be affected by various diagnoses.
The MBHI is based on Millon's theory of personality, which may be an advantage or a disadvantage depending on your own theoretical orientation. It also utilizes Millon's base rate scoring system, which attempts to match the frequency of specific profile elevations with the frequency that that particular trait actually appears in the population. This approach has some merits, but is a less frequently used than scaling systems utilizing T-scores. It is described in more detail in the section on the MCMI-III below.
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One of the principal advantages of the MCMI-III is that it is key to DSM-IV diagnoses. A particular strength is the differential diagnosis of Axis II disorders, which is often very helpful. With only 175 items, the MCMI-III assesses anxiety and depressive disorders, personality disorders, psychosis, somatization as well as other disorders.
The MCMI-III does not have norms for medical patients, and this can make interpretation more difficult in a medical setting. As with the MBHI, it also utilizes Millon's base rate scoring system, a system with which most psychologists are less familiar than the more common T-score scaling system. Since there is not a patient normative sample group, more caution must be exercised when interpreting the MCMI-III's somatization score.
For psychologists interpreting the MCMI-III, the following rules of thumb have been gleaned from the test manual. First of all, it it easy to forget that on the MCMI-III, a BR60 score represents the median score, as opposed to the more familiar T50 score equaling the mean. A BR0 score is always the lowest possible one, while a BR115 score is always the highest possible score attainable on any given scale. A BR75 is generally thought to indicate the presence of a "trait", while a BR85 score suggests that the full syndrome is more likely to be present and be prominent. These results of course must be interpreted in light of the person's validity scores and the context of the overall evaluation.
It must also be recalled that a base rate score is criterion referenced, not norm referenced. What this means is that base rate scores are totally independent of percentile rank. For example, a BR75 score for some scales approaches the 50th percentile, while a base rate score for other scales is closer to the 5th percentile rank. Base rates do not tell you if a score is common or not, the tell you if the trait is present or not. Thus, for disorders that are common in psychiatric patients, such as depression, the average patient will receive a high base rate score.
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The advantage of the MMPI-2 is that it is the most used and most researched psychological test in the world. As it is approaching 60 years of age, the body of literature available on it is enormous. It is also an instrument with which most psychologists have had specific training. A particular strength of the MMPI-2 is its measures of validity. When there is a question about patient motivation, or patient tendencies to minimize or magnify their symptom report, the MMPI-2 has great strength. The MMPI-2 features printouts adapted for use with chronic pain or general medical patients.
The MMPI-2 was developed with psychiatric patients, not medical patients. Although a great deal of research has been done with the MMPI-2 in various medical conditions, when the MMPI is administered to persons with medical disorders, interpretation becomes more difficult ( Naliboff, B. D., Cohen, M. J., Yellenan; 1982). The experienced examiner is able to make corrections for this, but nevertheless this has been seen by some as a weakness.
A disadvantage of the MMPI-2 is its length. At 567 items, it is the longest of all commonly used personality inventories.
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The advantage of the PAI is that it assesses a broad range of psychological conditions, including anxiety, depression, mania, schizophrenia and some characterlogical disorders. It also has three normative samples including a census matched community sample, a psychiatric patient sample, and a college sample, which provides a broad basis for comparison. It also has four validity measures. The PAI subscales do seem to be especially useful for more detailed analysis.
One of the disadvantages of the PAI is its length. At 344 items, it is nearly as long as the BHI and MCMI-III combined. When compared to the MMPI however, it is about 40% shorter. Although normative information is available on a patient sample, the PAI automated interpretation system itself is based on the community sample.
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Qualifications to purchase: Licensed psychologist or graduate degree in psychology and psychometric training
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The P3 differs significantly from the other instruments mentioned here. At only 45 items, it is less than a third the length of the next shortest test listed here, the MBHI. Obviously, the advantage of a shorter test is that it takes less time to administer, and this is an important consideration where time is a factor. As a consequence of its short length, however, the P3 has only three scales. These scales are depression, anxiety and somatization, three of the most commonly observed problems in persons suffering from chronic pain.
The P3's forte is being used by itself as a screening device, and it can also be used in combination with other tests as part of a battery. As the P3 was normed on a chronic pain population (including pain related to cancer, orthopedic and other conditions), this can provide information not available on other, larger measures. For example, research has found that most chronic pain patients are depressed. However, the P3 can help determine if a particular pain patient is unusually depressed for a person with that condition.
Like the BHI, the P3 is unusual in that it is "double normed", meaning that each person's responses produces two sets of scores. This means that the patient's score can be compared to the average chronic pain patient, as well as to the average person in the community. This makes a more sophisticated analysis possible. The P3's two norm groups were very different, and produces two contrasting scores for each person. Obviously, an understanding of how to interpret tests such as this is very important. For more information about this, consult the page on The Interpretation of Double-Normed Tests.
For more information or to purchase (voice): 1-888-627-7271
Qualifications to purchase P3: Specialized degree in the healthcare field (PhD, MD, RN, PT, etc) and an appropriate license or certification.
Qualified professionals can request free P3 information packet (send name, degree and postal address)
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