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1 PsychologicalReports, 1999,85,341-348.
PsychologicalReports, 1999,85,341-348. O MMPI SCREENING FOR SOMATIZATION ' RICHARD D. WETZEL JOHN BRIM Departrnerzt of Psychiatry Washington Uniuersity School of Medicine, Sf. Louis Private Practice, Arizona Departjnenl of Psychialy Washington University School of Medicine, L. MARTIN Prychiatty Univer.nity of Minnesota Szrmmary.-44 items on the MMPI \\!ere identified which appear to correspond to some checklisr into two and the Full MMPIs were then obtained from 29 women with primary affective disorder and 37 women with foUow-up st~~dy a consecutive series dinic ington University. higher on 44 irems than wirh only depression. These eF- fective in iden&ng the standard MMPl hypochondriasis and Goodwin and Guze (1989) stated that Briquet's syndrome (hysteria) is "a polysymp~otnat~c that begins Me (usually in the teens, & Munoz, 1972) incorporated the Perley-Guze review of symptoms (59 symptoms organized 10 groups refleccing ddferent organ systems or types of problems). criteria for somatizacion disorder in DSM-111, DSM-111-R (American Psychiatric Association, 1980, 1989, 1994, respectively) were designed to shorten the Perley-Guze checkhst patients. A (Dahlstro

2 m, Welsh, & Dahlstrom, 1972), to ide
m, Welsh, & Dahlstrom, 1972), to identify pa- tients have somatization would be helpful since full review is very time consuming. 'Re uests €or reprints should be sent to Richard Wetzel, Ph.D., Department of Psychiatry, ~aLington Place, St. Louis, 63110. 342 R. D. WETZEL. ET AL. The two diagnostic criteria (Briquet's syndrome, somewhat different overlapping samples (Clon- inger, Martin, & Clayton, 1986). diagnosed with either somatization or Briquet's met criteria for both hsorders, for somatization only and the MMPI item pool identify items similar the Perley-Guze criteria for Briquet's syn- 44 items representing 9 of the 10 symptom groups were identified. An unpublished validation study of 100 this scale successful screening for somatization patient endorsing 20 or more these items scored direction at least chi- psychiatry. Only chically (rule out or somatiza- tion however, were study reports Wetzel from items to identify with somatization women already having primary af- (Wood, Othmer, Reich, Viesselrnan, & Brim, Wetzel, Reich, & 1980, 1984) to define patients who chiatric diagnosis (alcoholism, substance abuse, on the they develop after their first extensive efforts were W

3 ashington University psychiatry chic 5
ashington University psychiatry chic 500 study (Cloninger, Martin, Clayton, & Martin, Cloninger, & Clayton, 1985; Guze, Cloninger, Martin, & Clayton, 1986). all, and interviewed from 213 patients Washington University Psychiatry Clinic Thirty MMPIs were discarded following reasons: 31 or more missed items (24 profiles); when 170, the profile was hinated (7 Diagnoses were based available information from evaluation and medical record diagnostic criteria used were those al. (1972). 324 women located for the interviewed and MMPI SCALES: SOMATIZATION 343 to the with hysteria were llkely to have returned an MMPI (40/68 or 59% vs 113/256 or 44%; x2=4.65, p .05) than other psychiatric patients. Only three MMPIs from women eluninated for missing items �( 30) excessive defensiveness �(K 70). Women with primary affective disorder were no more likely return an seen in chic (37/76 or 49% vs 1161248 or 47%; x2 1.00). Eight of their MMPIs were not statistical analyses Analysis for personal (SAS that the two scales and Wetzel (t=4.89, p .05) one or (r= 3.86, p) were significantly d~fferent groups. Table 1 and standard two groups. BRIM-WETZEL SOMATIZATION

4 DISORDER SCALES AND ON STANDARD MMPI
DISORDER SCALES AND ON STANDARD MMPI SOMATIZATION SCALS, VALIDIIT SCALES BY DIAGNOS~S Diagnosis Total Symptom Symptom Group M SD 1M SD Primary Depression 12 = 29 11.9 6.3 6.0 1.6 Somatizauon Disorder )* = 19.8 6.7 3.86' Two or Primary Depression Sornarizarion Primary Depression Somatizadon 23.04 7.92 HS+K HY M SD M SD Primary Depression n 53.2 9.9 67.8 12.5 f 5.15' 4.13* 4.16" L F K F-K M SD M SD M SD Primary Depression n=29 4.6 12.9 n=37 4.4 -1.1 6.9 2.39" 3.21" *p .05. HS = H pochondriasis (I), HS + K = K-corrected Hypochondriasis (1). Hy = Hysteria (3), TSX = total 6erley-~uze equivalent symptoms reported, Groups =Perley-Cuze equivalent classes/organ Lie scale, F= (in)frequency scale, K = Correction scale, F-K = Gough's Dissimulation Index. 3 44 R. D. WETZEL, ET AL. symptoms and discriminate between patients with and tion dlsorder patients' response bias (defensiveness possibhty, variance were wh~ch partialled statistic to control for differences in drtltudes two diagnostic scores between diagnostic remained significant (F,,, = 12.48, p= .05) for total sympton~s chosen and for groups represented p=.05). The discriminative abhty

5 of the somewhat greater than groups e
of the somewhat greater than groups endorsed. DISCUSSION quite important for treatment. Currently, methods for makmg a rap- great deal professional time, highly rapid and quires little professional effort. Two scales, derived from MMPI on the Perley-Guze checkhst, have been hypothesized that women would re- somatic symptoms than women with primary affec- dsorder would. Both count and organs represented were significantly different between the Hypochondriasis medical complaints; subscales, for example. Physicians typically think the contents diverse since complaints refer to ddferent organ systems the Perley-Guze inventory subset and Hysteria scales. Scores on the are correlated Brim-Wetzel scales, the K-corrected combination ~~pochondriasis and the uncorrected combination Brim-Wetzel scales, using the number eight for more symptoms specified, were able to identify 17 of the 37 with somatization dsorder. Only three primary depression 12 whose MMPIs one or fewer scores elevated above T score 70. Using the standard K-corrected Hypochondriasis Hysteria scales, 10 MMPI SCALES: SOMATIZATION TABLE 2 NUMBER Of SUBJECTS ~DENT~FIED AS POSSIBLY HAVING SOMATIZA~ON DISORDER BY CUN~CAL DIAGNOSIS A

6 ND ELEVATION ON MMPl CLINICAL SCALES
ND ELEVATION ON MMPl CLINICAL SCALES Clinical Scales Somatization Disorder �( 70) n=29 n=37 MMPI �MMPI2+70 MMPI �MMPI2+70 Predicted SD+ SD- SD+ SD- SD+ SD- SD+ SD- - - Perley-Guze Items 2 20 and Perley- Guze Groups 2 8 0 1 11 16 9 �HSO �HY70 (without K) 0 12 �HS70 �NY70 0 12 10 15 Hypochondriasis K-corrected Hysteria Hvoochondriasis Total svmvroms endorsed .93 .85 .77 -. Total organ grou s with one or more items endorse] .75 with somatization were correctly Brim-Wetzel to offer a modest irnprove- women with somatization disorder on (pp. 347-3481 indicates the MMPI items used. REFERENCES AMERICAN PSYCHIATRIC ASSOCIATION. 11 969) Diagnostic and statistical ~nanual o/ mental disor- ders. (3rd ed., Rev.) Washington. DC Author. [2nd ed., 19801 AMERICAN PSYCHIATRIC ASSOCIA~ON. (1994) Diagnostic and statistical manual of mentaf dixor- ders. (4th ed.) Washington, DC: American Psychiatric Association. BRIM, J., WETZEL, R. D., REICH, T., WOOD. D., VIESSELMAN, J., & RUTT, C. (1980) Primary and 11. Differences in usual state self-perceptions. Compre- hensive Psychiatry, 2 1, 388-3 95. BRIM. 1.. WETZEL,

7 R. D., REICH, T.. WOOD, D.. VIESSELW
R. D., REICH, T.. WOOD, D.. VIESSELWN, J., &Rum. C. (1984) Primary and 111. Longitudinal daerences depression symptoms. Joztrrral Clinical Psychiatry, 45, 64-69. R., MARTIN. R. L., CLAYTON, I? J., &GUZE, S. B. (1981) follow-up and study anxiety neurosis: preluninary analysis of che St. 500. In Hein & J. Rabkin (Eds.), Anxiety: new research and changing concepfs. New York: Raven. 137-150. CLONINCER, C. R., MARTIN. R. L.. GUZE, S. B., &CLAYTON, P. 1. (1986) A rospective study and folLo\up of somatizorion in men and women. Americal* ]orrrnal ohchialty, 143, 873- 878. DAHLSTROM, W. G., WELSH. G. S., & DAHLSTROM, L. E. (1972) AII MMPI handbook. Vol. 1. Clinical inferprefation. Minneapolis, MN: Univer. Minnesota Press. J. P., ROBINS, E., GUZE. S. B.. WOODRUFF, R. A., WINOKUR, G., &MUNOZ, psychiatric research. of General Prychiaq, 26. 57- 63. GOODWIN, D. W.. & GUZE. Psychiatric diagnosis. (4ch ed.) New York: Oxford Univer. Press. GUZE, S. B. (1976) Cri~ni~rality and the psychiatric ditorden. New York: Oxford Univer. Press. 346 R. D. WETZEL, ET AL. GUZE. S. B., CLONINGER. C. R., ~RTIN, R. L., &CLAYTON. l? J. (1986) A follo

8 wup and fady diagnosis of Briquet's s
wup and fady diagnosis of Briquet's syndrome. British Jonrnal of Psychiatty, 149, 17-23. MARTIN, R. L., CLONINGER, C. R.. GUZE, S. B.. &CLAYTON, I? J. (1985) Mortality in a followup Archives of General Psychiafry, 42, 47- 54. NORTH, C. S., RYALL, 1. M.. RICCI, D. A., & WETZEL. R. D. (1993) Mzrlfiple ersonolifies, multi- ple dirorderx: prvchiafric class$ica~ion and media irrfluerrce. New YO&: Oxford Univer. Press. SAS INSTITUTE. INC. (19671 SASISTAT guide for personal compufers, Versiorz 6 edition. Cary, NC: SAS Instirute, Inc. WOOD, D., OTHMER, S.. REICH, T., MESSELMAN, J., &Rum, Primary and secondary social history Cotnprehensive Prychiatry, 18, 201 -210. Accepted Augrrsf 20, 1999. MMPI SCALES: SOMATIZATION 347 APPENDIX A Scow BY GROUP ON MMPI AND MMPI-2 MMPI MMPI-2 MMPI MMPI-2 Group 1 (4) 36 (F) 44 (F) 51 (F) 190 (F) Group 2 (15) 154 (F) 156 (T) 184 (T) 185 (F) 187 (F) 192 (F) 194 (TI 273 (T) 330 (F) 332 (TI 334 (T) 350 (T) 462 (F) 496 (F) 540 (F) Group 3 (4) 163 (F) 174 (F) 188 (F) 189 (TI Group 4 (4) 55 (F) 175 (F) 230 (F) 543 (F) MMPI-2 (4) 33 40 45 176 MMPI-2 (12) 142 168 198 204 177 17

9 9 182 247 2 95 2 96 298 3 19 Dropped Dro
9 182 247 2 95 2 96 298 3 19 Dropped Dropped Dropped MMPI-2 (4) 152 159 173 175 MMPI-2 (4) 47 101 208 463 Group 5 (5) 18 (F) 23 (T) 29 (T) 63 (F) 155 (F) Group 6 (2) 125 (TI 288 (T) Group 8 (4) 20 (F) 179 (T) 297 (T) 470 (T) 9 (2) (F) 243 (F) Group 10 (5) 84 (TI 88 (F) 158 (F) 339 (TI 526 (T) MMPI-2 (3) 20 18 (Duplicate-One Dropped) 28 (Revised) 143 Dropped MMPI-2 18 (Duplicate-One MMFI-2 (3) 12 166 (Revised) 268 Dropped MMPI-2 (2) 57 224 WI-2 (5) 71 75 146 303 454 348 R. D. WETZEL, ET AL. APPENDIX B MEANS ON BRIM-WETZEL AND MMPI PERLEY-GUZE SCALES Source ~2 Sxx Groups % Sxx 2 20 M SD M SD Groups 28 All, Ar 6,455 16.31 7.43 7.05 1.53 28.40 Males 2,873 16.00 7.58 6.99 1.56 27.81 Legal 1,055 19.53 8.02 7.60 1.38 45.78 Pain 160 14.24 5.42 6.96 1.29 16.25 MedicaVSurgery 36 15.14 5.90 6.94 1.41 19.44 Neurology 67 13.90 6.16 6.64 1.41 20.90 Psychiatry 1,555 13.89 6.62 6.59 1.57 17.30 Females 3,582 16.56 7.30 7.10 1.50 28.92 Legal 1,043 18.70 7.66 7.43 1.42 40.36 Neurology 51 16.27 8.25 6.82 1.67 31.37 Pain 229 15.79 6.12 7.04 1.24 22.71 Psvchiatty of all MMPIs contained on the computer at Washington MMPIs the purpose person requesting be admini