Scale 6 Elevations in MMPIs of Persons Accused of Child Sexual AbuseHollida Wakefield, M.A., and Ralph Underwager, Ph.D. *Over the past three years we have been involved in over two hundred cases of child sexual abuse. Often, the person accused has stoutly denied the allegations. In many of these cases we have performed a psychological evaluation of the person accused. In other cases, we have received test results of evaluations performed elsewhere. Many of the individuals we have seen who have been accused of sexual abuse but deny the allegations (the majority of whom subsequently have been determined by the justice system not to have abused children) have shown an elevation on scale 6 (paranoia) because of responses in the scoreable direction on several of the seventeen persecutory items in this scale. (i.e., Someone has it in for me, I am sure I am being talked about, I believe I am being plotted against, I know who is responsible for most of my troubles, People say insulting and vulgar things about me, I have certainly had more than my share of things to worry about, I have no enemies who really wish to harm me {scored false}). In response to the scale 6 elevations that we were often seeing in persons accused of sexual abuse, we conducted a study comparing the MMPIs of eighty-one persons accused of sexual abuse to two groups — persons who were being evaluated for other reasons and acknowledged sex offenders. Subjects Accused Group The accused group consisted of eighty-one
individuals who were accused of child sexual abuse and denied the
accusations who were seen in our clinic for psychological evaluations.
Seventy-one were males and ten were females. No attempt was made to
separate individuals later determined to be guilty from those determined
not to be guilty; the criteria was that they were accused of child sexual
abuse and denied the accusations. Evaluation Group This group consisted of thirty-four individuals
(nineteen male and fifteen female) who underwent custody evaluations at
our clinic unrelated to sexual abuse or who were evaluated for readiness
for marriage or remarriage. In the latter case, these individuals
wanted to enter into a marriage approved of by their church and had to be
evaluated and determined to be psychologically healthy and ready for the
marriage. We used this as a control group in that persons in both
the accused group and the evaluation group were from the non-psychiatric
population and were being evaluated for reasons other than psychotherapy. Offenders Group This group consisted of twenty-one admitted sex
offenders who were treated at our clinic. The behaviors included
sexual abuse of children, incest, rape and exhibitionism. All in this
group were male. Age of Subjects The subjects ranged in age from 21 to 74 with no significant age differences between groups (the mean ages were: accused males, 37; accused females, 36; evaluation males, 36; evaluation females, 34; sex offenders, 35) Procedure The mean T scores with K corrections were calculated for each group and we checked for statistically significant differences between groups by means of the t-test. The two female groups were compared with one another and the three male groups with one another. We classified the MMPIs by code types. The number of persecutory items answered in the
score able direction was determined for each profile. For this
analysis we combined the males and females and compared between the three
groups. In a few cases, when we had received test results
administered at other places, we only had the profile and not the answer
sheets and were unable to determine the number of persecutory items
endorsed. The seventeen items were the persecutory items used by
Hams and Lingoes (Dahlstrom, Welsh & Dahlstrom, 1972) with the addition of
item # 294, I have never been in trouble with the law. (The
persecutory items are found in Appendix A.) Results T scores of MMPI scales The mean score for each scale for each group is shown in Table 1. Table 1
In comparing the mean scale values of the accused and the evaluation groups for both males and females, the only statistically significant difference was on scale 6 (paranoia). The sex offender group, however, differed from the two other male groups on several other scales. In comparison to the accused group it had significantly higher elevations on scales F, 2 (depression), 3 (hysteria), 4 (psychopathic deviate), 7 (psychasthenia), and 8 (schizophrenia). It was not significantly higher on 6. The Sex Offender's mean scale 4 was 76.10 which was the only mean elevation above 70. In comparison to the evaluation group the sex offender group was significantly higher on 3 (hysteria), 4 (psychopathic deviate), 6 (paranoia), 7 (psychasthenia), 8 (schizophrenia), and 9 (hypomania) and was significantly lower on K (defensiveness).
Table 2
The mean profiles for the five groups are plotted in Appendix B.
Persecutory Items For this comparison, males and females were grouped together. The mean number of persecutory items marked in the scoreable direction by each of the three groups along with the t-test statistics for comparison between groups is shown in Table 3. The mean number of persecutory items was 4.58 for the accused group, 1.52 for the evaluation group and 3.00 for the sex offenders. These differences are statistically significant.
Table 3
Not all of the accused subjects marked a large number of persecutory items in the scoreable direction. Another way to look at the data is to see how many subjects in each group endorsed a large number of these items. This is shown in Table 4. Almost half of the accused subjects marked five or more persecutory items in the scoreable direction compared to only one of the evaluation subjects and three of the sex offenders.
Table 4
The distribution for the number of persecutory items marked in the scoreable direction is shown in Figure 1:
Figure 1 Number of Persecutory Items
The MMPI code types were different for the three groups. The Accused group not only had 14 individuals (17%) who were spike 6 profiles, but scale 6 appeared in two and three-point elevations (>70) for 11 (14%) subjects. Table 5 shows the code types for the three groups: Table 5 MMPI Code Types for Accused, Evaluation and Offenders
The code types for the twenty-one sex offenders were consistent with what others have reported for this population. Only three individuals produced within normal limits profiles (these three had comparatively less serious sexual offenses). Of the remaining eighteen, all but one (a spike 9) contained an elevation on 4. The most common code type was 4-8/8-4 (five individuals) which indicates serious disturbance. No one in the accused or the evaluation group was a 4-8/8-4.
Discussion The accused group differed significantly from the evaluation group both in scale 6 elevation and in the number of persecutory items endorsed. It did not differ from the offenders group in scale 6 elevation but it did in the number of persecutory items endorsed. This suggests that the scale 6 elevations are occurring for different reasons in the two groups. In the sex offenders, the elevation on 6 reflects the psychopathology of these persons. For persons accused of child sexual abuse, the scale 6 elevation reflects their actual situation. Six is a relatively short scale and the addition of five or six persecutory items marked in the scoreable direction can result in an elevation above 70. In addition, all but two of the seventeen persecutory items are scored on other scales in addition to 6 (seven are scored on F, six on scale 4, seven on scale 8, and two on scale 9). When these items are marked in the scoreable direction, this will also be reflected in some elevation on these scales along with 6. Consequently, when individuals endorse several persecutory items, they are fairly likely to produce pathological MMPI profiles. Appendix C shows several MMPIs of individuals accused of sexual abuse who endorsed persecutory items and the result such endorsement had on the overall profile. An elevation on scale 6 (paranoia) must therefore be interpreted very cautiously in persons accused of sexual abuse. The endorsement of the persecutory items reflects their current reality. They have been accused, arrested, written up in the newspaper, fired from jobs, and isolated by family and friends. In such cases, an elevation on scale 6 should not be interpreted as indicating hostility, oversensitivity, projection, or paranoia. If a person has been falsely accused of sexually abusing a child, many of the persecutory items will accurately reflect their situation. Thus an elevation on scale 6 shows that they have a good grasp of reality, not that they are suspicious, paranoid, or overly sensitive.
MMPIs of Sex Offenders There have several studies on the MMPI profiles of sex offenders, including persons convicted of sexual abuse of children. In an early study, Swenson and Grimes (1958) reported on forty-five men referred by the court for presentence evaluation. All were convicted of sexual abuse of children. These men produced a normal Rorschach Ink Blot Test, but their composite MMPI profile was pathological with an elevation on scale 4 (psychopathic deviate). They were seen as rebellious and asocial in their interpersonal relationships. Toobert, Bartelme, and Jones (1959) gave the MMPI to 120 convicted pedophiles in the State of California. Their results suggest that the pedophile is sexually dissatisfied, has strong religious interests, is inadequate in peer relationships, has high guilt and is very sensitive to the evaluation of others. He is more seriously maladjusted than his fellow felons. Toobert, et al. conclude that the pedophile is not always aggressive and sexually active, but instead shows weakness, inadequacy, low self-regard, and family disturbance in childhood, and therefore identifies with the weaker and less emotionally sophisticated child. Kirkland and Bauer (1982) compared the MMPI scores of ten incestuous fathers with a matched control group of fathers who had not committed incest. They report that nine of the ten incest fathers exhibited score elevations (>70) on at least two of the ten clinical MMPI scales, enough to indicate serious emotional disturbance. As a group, the incestuous men scored significantly higher on three subscales; scales 4 (psychopathic deviate), 7 (psychasthenia), and 8 (schizophrenia). High scores on these three scales are associated with poor impulse control, poor judgment, lack of insight, social isolation, and insecurity. Many of the high scorers were seriously worried about their masculinity and could not sustain a mature sexual relationship. Anderson and Kunce (1979) found that sex offenders showed one of three types of MMPI profile: F-8 (schizophrenia); 4-9 (psychopathic deviate-hypomania); and 2-4 (depression-psychopathic deviate). The F-8 type showed long-term socially maladjusted behavior, bad judgment, high likelihood of degrading the victim, and more signs of emotional disturbance. Of this type, 40% were convicted of sexual abuse of children. The 4-9 type had a better pre-crime adjustment than did the other two types; 50% were convicted of sexual abuse. The 2-4 type was older and less well educated. Two-thirds had a history of alcohol abuse and one-half had served time in prison earlier; 51 % of this group were convicted of sexual abuse. Armentrout and Hauer (1978) report a 4-8 MMPI code as the mean profile for sex offenders against children. They also report that the offenders who raped children had higher elevations on 8 than those who sexually molested but did not rape. Panton (1978) compared MMPI profiles of thirty rapists, twenty child rapists, and twenty-eight nonviolent child molesters. He reports that the profiles of the child molesters indicated self-alienation. low self-esteem, self-doubt, anxiety, inhibition of aggression, aversion to violence, need for reinforcement, feeling of inadequacy, insecurity, and fear of heterosexual failure. He also reported a 4-8 code with the rapists showing higher elevations on 8 than did the molesters. In a later study comparing incestuous and non-incestuous child molesters (1979). he found that the incestuous sample had a higher elevation on scale 0 (introversion). Both groups had highest scale elevations on 4 and profile configurations indicative of self-alienation, despondency, rigidity, inhibition, feelings of insecurity, and fear of not being able to function adequately in heterosexual relationships. Scott and Stone (1986) studied MMPIs of four groups of subjects from incest families in a treatment programs: natural father perpetrators, stepfather perpetrators, daughter victims, and non-participating mothers. The stepfathers' mean profile was significantly more elevated than the natural fathers but the mean profiles of neither group were pathological. However. both groups differed from their matched controls. The authors interpret their results as indicating that the perpetrator groups were not pathological but that the two-point code types yield important clinical characteristics. One-third of the stepfathers were 49/94, indicating deficits of moral conscience with energized, narcissistic, and rationalized behaviors. The natural fathers showed a more passive-aggressive style including immaturity, unrecognized dependency needs, and egocentricism. Langevin, Paitich, Freeman, Mann, and Handy (1978) gave the MMPI and the 16 PF to 425 sexually anomalous males and 54 controls. They reported that the pedophiles showed considerable emotional disturbance as measured by these tests. McCleary (1975) studied the MMPI profiles of two groups of child molesters, those with no prior arrests and those with one or more prior arrests. The group with prior arrests had elevations on scales 4 (psychopathic-deviate) and 8 (schizophrenia) and showed more psychopathology than the group with no prior arrests. Rader (1977) found that all of his sex offenders had scale elevation means above the elevations of normal individuals. The three most frequently occurring code types were 4-9/9/4, 4-8/8-4, and 4-3/3-4 (3 is hysteria). The 4-9/9-4 is characterized by impulsivity, irresponsibility, anti-social behavior, and an enduring tendency to get into trouble. The 3-4/4-3 is characterized by poorly controlled anger, an inordinate need for attention and approval, oversensitivity, and immaturity. The 4-8/8-4 is characterized by poor judgment, unpredictability, low self-concept, bizarre behaviors, a rich fantasy life, fear of emotional involvement, and a schizoid social adjustment. Rader found that among sex offenders in general (not just child sex offenders). the more disturbed profiles were produced by offenders committing more violent sex crimes. "All (of the sex offenders) had scale elevation means elevated above the standard normative means, suggesting that all these groups (assaulters, rapists, and exhibitionists) are more 'deviate' than the general population" (p. 67). The study suggests a more or less linear relationship between the severity of the sexual offense and the abnormality of the MMPI profile. McIvor and Duthie (1986) compared twelve men who had molested younger children to twelve men who molested older children. They report that the men who molested younger children generally had more elevated MMPI profiles with significantly higher elevations on scales 2 (depression), 5 (masculinity-femininity), and 8 (schizophrenia). Hall, Maiuro, Vitaliano, and Procter (1986) report a study of offense data and MMPI profiles of 406 hospitalized men who had sexually assaulted children. They differentiated MMPI codes for varying offense variables. The MMPI discriminated at a statistically significant level between offense data but the authors discount these results as not very useful. But they report the overall 2-point MMPI code was 4-8, replicating several earlier studies. Scale 2 was the third elevated scale in their sample. Two-thirds of the sample had more than two MMPI clinical scales significantly elevated. They suggest that this finding means that sexual offenders against children are a more heterogeneous group than initially thought. Their procedures, however, eliminated two-thirds of the original population from which the study sample was drawn on the basis of low intellectual functioning or invalid MMPI profiles. Erickson, Luxenberg, Walbek and Seely (1987) examined the MMPIs of 403 convicted sex offenders and compared code types between rapists, child molesters, incest offenders, first offenders and recidivists. They found differences between the different types of sex offenders and a variety of code types. Nineteen percent of the profiles for the entire group were within normal limits. Scale 4 was included as one of the two peak codes in 59% of the profiles. The most common two point codes were 4-2/2-4, 4-5/5-4, 4-8/8-4, and 4-9/9-4. As compared to rapists, the sex offenders against children were more likely to have 2-4/4-2 profiles and less likely to have 4-9/9-4 profiles. Recidivists were more disturbed than first offenders. The child molesters with 4-8/8-4 and 2-4/4-2 profiles were almost exclusively extrafamilial while the 3-4/4-3 profiles were the modal code for incestuous biological fathers. Erickson, et. al conclude that except for elevations on scale 4, no psychological characteristic was truly typical of all sex offenders. Taken as a whole, the data indicate that pedophiles generally do not have normal MMPIs and that the pathology is most likely to be seen in the elevation of the scales which reflect poor impulse control, antisocial behavior, poor judgment, a history of acting out, lack of self-esteem, feelings of inadequacy, a schizoid social adjustment, much time spent in fantasies, and/or thought disorders and confusion. The more aberrant the behavior of the pedophile, the more likely it is that he will have a pathological MMPI. For example, anal or vaginal penetration of very young children, violence, and unusual and bizarre behavior as part of the sexual contact is highly pathological behavior and we would expect persons engaging in these behaviors to show significant emotional pathology. As the specific sexual behavior of perpetrators gets further and further away from the boundaries of acceptable sexual acts, the more pathological is the person who engages in the behavior.
Use of the MMPI for Persons Accused of Sexual Abuse The MMPI deservedly is the most widely used psychological test. The mass of research, the demonstrated validity, reliability and efficacy of the MMPI means that it must be accorded more weight and significance in assessment than any other procedure, including clinical interviews. It is difficult for many psychologists to accept the fact that actuarial and empirically-based techniques can often do better than the brilliant, insightful, and frequently complex formulations of the clinician's mind. But they can (Meehl, 1954). Therefore we regard the MMPI studies of sex abusers, although there are problems with them, as among the more reliable sources of information about persons accused of child sexual abuse. When the alleged abuse behaviors are very low frequency,( i.e., urolagia or coprophagia, anal or vaginal penetration of a very young child [which would be excruciatingly painful to the child], ritual torture of animals), and the alleged abuser has a normal MMPI, the psychologist must pay attention to the discrepancy. However, when a person accused of sexual abuse denies the allegations the MMPI profiles must be carefully interpreted in terms of K as well as the persecutory items which may be endorsed. The MMPI must not be used as a paper and pencil "lie detector" but some subjects approach the test as though this is its purpose. Consequently, some individuals may produce high elevations on K. An elevated K is not unusual in persons taking the MMPI for court, custody evaluations, or other situations where they believe it is important to look as good as possible. Indeed, this could be considered a healthy response to the situation. It is therefore inappropriate to interpret a high K as indicating severe defensiveness as a personality characteristic, to conclude that the person is using denial as a way of not facing his own abusive behavior, or to ascribe a character deficit of being a liar. If K is so high that the profile is invalid, the individual can be asked to retake it and told not to try to look healthier than he is (Fowler, 1981).
Conclusions The MMPI can be useful in evaluating persons accused of sexual abuse who deny the accusations. When the individual accused of sexual abuse produces a within normal limits MMPI and the behaviors alleged to have occurred are extremely pathological and of low frequency, it becomes less likely that the person did, in fact behave as accused. But the MMPI in these accused persons must be looked at carefully, particularly in terms of elevations on scale 6 and concurrent elevations on other scales because of the overlap with the persecutory items. Endorsement of several of the persecutory items may be reflecting the individual's current reality, and not psychopathology.
APPENDIX A
APPENDIX B Mean Profiles of Groups
APPENDIX C
ReferencesAnderson, W. & Kunce, J. (1979). Sex offenders: Three personality types. Journal of Clinical Psychology, 35, 671-676. Annentrout, J. A. & Hauer, A. L. (1978). MMPIs of rapists of adults, rapists of children, and non-rapist sex offenders. Journal of Clinical Psychology, 34, 330-332. Dahlstrom, W. G., Welsh, G. S. & Dahlstrom, L. E. (1972). An MMPI Handbook. Volume I: Clinical Interpretation. Minneapolis: University of Minnesota Press. Erickson, W. D., Luxenberg, M. G., Walbek, N. H., Seely, R. K. (1987). Frequency of MMPI two-point code types among sex offenders. Journal of Consulting and Clinical Psychology, 55, 566-570. Fowler, R. (11981, December). Workshop on the MMPI, Guadalupe. Hall, G. C. M., Maiuro, R..D., Vitaliano, P. P. & Procter, W. C.(1986). The utility of the MMPI with men who have sexually assaulted children. Journal of Consulting and Clinical Psychology, 54, 493-496. Kirkland, K. D. & Bauer, C. A. (1982). MMPI traits of incestuous fathers. Journal of Clinical Psychology, 38, 645-649. Langevin, R. (1983). Sexual Strands: Understanding and Treating Sexual
Anomalies in Men ( McCleary, C. P. (1975). Personality differences among child molesters. Journal of Personality Assessment, 39, 591-593. McIvor, D. L. & Duthie, B. (1986). MMPI profiles of incest offenders: Men who molest younger children and men who molest older children. Criminal Justice and Behavior: An International Journal, 13, 450-452. Meehl, P. E. (1954). Clinical versus Statistical Prediction. Minneapolis: University of Minnesota Press. Panton, J. H. (1978). Personality differences appearing between rapists of adults, rapists of children, and non-violent sexual molesters of children. Research Communications in Psychology, Psychiatry and Behavior, 3, 385-393. Rader, C. M. (1977). MMPI profile types of exposers, rapists, and assaulters in a court services population. Journal of Consulting and Clinical Psychology, 45, 61-69. Scott, R. L. & Stone, D. A. (1986). MMPI profile constellations in incest families. Journal of Consulting and Clinical Psychology, 54, 364-368. Swenson, W. M., & Grimes, B. P. (1958). Characteristics of sex offenders admitted to a Minnesota state hospital for pre-sentence psychiatric evaluation. Psychiatric Quarterly, supple. 32, part 1, 110-123. Toobert, S., Bartelme, K. F., & Jones, E. S. (1958-59) Some factors related to pedophilia. International Journal of Social Psychiatry, 44, 272-279.
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