Personal inventory by beverly sloan PsyD

Personal inventory by beverly sloan

1. Personality Assessment
Inventory
Beverly Sloan, PsyD, LPC-S, LPA
Region 2 SMHM
UTMB-CMC MENTAL HEALTH SERVICES
Copyright UTMB 2018. All Rights Reserved.
ACA/NCCHC Credit: 3 hours
3 Hours -Category 1 Psychologists and Continuing Education
Requirements for Social Workers and Licensed Professional Counselors
Approval and course #UTMB.MHS.12

2. This is the first part of a three part program on how to
administer and interpret the Personality Assessment
Inventory (PAI). In this course, you will learn how to
administer, score, and interpret the test. Part 2 is in a
classroom setting where you will view and interpret
PAI profiles. Part 3 is the administration of the PAI
and writing an evaluation under supervision.
This course meets the requirements of Category I
Psychologists and Continuing Education requirements
for Social Workers and Licensed Professional
Counselors.
Personality Assessment Inventory

3. 1.Understand the steps to interpretation of the PAI.
2.Be able to identify the validity scales of the PAI and
how to interpret them.
3.Be able to identify the clinical scales of the PAI and
how to interpret them.
Objectives

4. Leslie Morey developed PAI in 1991 as a self
administered, objective personality and
psychopathology test.
It is ranked 4
th
in terms of objective tests in
graduate testing course work.
It is among the most widely used measures in
legal cases.

5. There are four sets of scales:
•4 validity scales
•11 clinical scales covering major categories of
the DSM
•5 treatment scales
•2 interpersonal scales

6. The PAI scales are designed to measure particular
constructs that are represented by the names of the
individual scales
It was designed with construct validationin
mind. It attempts to sample information
relevant to the major facets of important
clinical constructs as well as information
about the different levels of intensity.

7. The PAI does not use separate norms for men and
women. Instead, items were selected to have the same
meaning regardless of gender.
Average scores for men and women are
primarily different on ANT and ALC, on which
men tend to score roughly 5 T points higher
than women.

8. ADMINISTRATION
•PAI takes about 1 hour or less to administer.
•It is important to develop and maintain rapport
between the clinician and the examinee in order to
get a clear picture of what is going on with the
patient.
•When giving this test it is assumed that the patient is
physically and emotionally capable of completing a
self-report instrument.
•4
th
grade reading levelis needed to complete the
test.
•It may be necessary to first administer a brief test of
reading comprehension.

9. ADMINISTRATION (cont)
•Oral administration may be necessary but if so it would
be best to use the audiotape or to have the patient mark
their own responses otherwise it would appear to be
more of an interview and some research suggest that the
respondent might not give true responses in that case.
•Discourage the patient from interacting with anyone
during the testing session. Idea is to take it under direct
supervision of examiner.
•Be sure to give feedback to the client. Addressing the
positives of the test first and focusing on the referral
question. Encourage input from the client to verify,
modify or reject test findings. You should not let the
client read the automated report.

10. STRENGTHS
•Relevance across a broad range of symptomology
•Ease of administration and scoring
•Provides information critical to making diagnostic and
treatment decisions
•Established reliability and validity
•Cost-effectiveness
•Ease of profile interpretation---very straightforward
•Availability of multiple scales of validity
•Compatibility with contemporary theory and practice
•Can aid in formulating a treatment plan

11. WEAKNESSESS
•Some items are transparent enough that they can
lead to intentional manipulation.
•Limited content coverage of some clinical syndromes,
such as dissociative disorders or eating disorders.
•It is designed as a clinical instrument therefore its
coverage of normal personality constructs is limited.
•It is not designed for use with individuals under the
age of 18.

12. How To Score The PAI
•Each item receives different weighting this weight is
determined entirely by the response of the client not
by the test or evaluating clinician. (True, Mostly True,
Slightly True, False)
•If 18 or more items are left unanswered the client
should be asked to review and complete these items
if possible. Scores on a scale or subscale should not
be interpreted if more than 20% of the items on that
scale are left unanswered.
•Each scale has a mean of 50t and a standard
deviation of 10tin the community.
•Scoring is typically done via computer program but
can be hand scored using templates.

13. Steps for Interpretation:
Determine if results are an accurate reflection of the
experience of the client or (alternatively) whether the
results may be distorted in some way.
How the test is presented to the client can have an
effect on the results.
Example:If you tell an individual this test is going to be
used to determine if you need medication or not this will
have an effect on that person’s test taking mindset.

14. Steps for Interpretation:
2.Consider the appropriate frame of reference
against which to evaluate the profile.
–community versus clinical comparisons,
–distorted versus non-distorted comparisons
–comparisons in specific referral contexts.

15. Steps for Interpretation:
The profile skylineprovides a reference point for
scores that are unusual in a clinical setting. It
serves primarily to illustrate differences in scores
in clinical and community settings and does not
constitute a cutting score for any decisions about
clinical scale elevations.
–The skyline is a reference line that represents a
point that lies 2 standard deviationsabove the
mean of the clinical standardization sample.

16. Profile scales

18. Steps for Interpretation:
•After a problem that merits clinical attention has been
identified the contextual reference point needs to shift
to a clinical focus.
•The test manual includes an appendix that presents
standard scores based on the clinical standardization
sample.

19. Steps for Interpretation:
–Contrasting the various peaks and valleys of
this skyline with the 70t community reference
line illustrates the different expectancies found
in clinical and community settings.
–If you will notice the RXR (Treatment Rejection
Scale) has a skyline below 70t. This means
that in the clinical setting this scale will
generally be lower than in the community.
This is because individuals in a clinical setting
are interested in treatment, whereas those in
the community setting are not.

20. Steps for Interpretation:
–When there appear to be profile elevations that
suggest problems of clinical significance, the
interpreter should also evaluate the profile
against the context of a clinical population.
–When such problems do not appear to be
present, the initial comparison to the
community norms will be more informative for
interpreting the person’s personality
characteristics.

21. Steps for Interpretation:
3.Response Style--Determining how the
respondent approached the test (defensive
manner).
•Comparing the profile with other similar
profiles allows the interpreter to take into
account the typical effects of defensive
responding on the profile. When you re-
standardize the profile based on the response
style you can look and see problem areas
and exaggerations. This is done when the
test is computer scored.

22. Steps for Interpretation:
Interpretation of individual scales
•Each scale is designed to measure major facets of
different clinical constructs. Assuming little or no
profile distortion the initial focus of interpretation
should be on those full scales that obtain scores of
70t or greater.
•Next would be to look at elevations on the subscales.
These subscales can serve to clarify the meaning of
full-scale elevations.

23. Steps for Interpretation:
•Interpreting Profile Configuration
–This is using a combination of scales to gain
interpretation.
–There are 4 different forms.

24. Steps for Interpretation:
–Profile code types---using the 2 most
elevated clinical scales (two point code).
Doing this alone tends to ignore the
information provided by the other scales,
which may be meaningful.
–Mean Profile Comparison—Comparing the
profile with those of others who share some
particular similarity. Again alone it may not
fully capture the elements of the PAI.

25. •Conceptual indexes---Look for indicator pattern
suggested by theory. Some of theindexesare
Malingering and Defensiveness index, Violence
Potential index, Suicide Potential index, Treatment
Process index
•Actuarial rules---apply multivariate functions to
combine scale scores. Using this approach provides
objective and empirically based decision rules that
can be constructed to make particular discrimination
(i.e. difference between a bona fide schizophrenia
and simulated schizophrenia).
Steps for Interpretation:

26. Assessing Profile Validity
What are some reasons a test may NOT be valid?
•Sometimes a person may want to deceive the test giver and
therefore will distort their responses to appear either better or
worse than they actually are.
•Person may have limited insight or self-deception.
•Person may be confused, careless, or indifferent to taking the
test.

27. •Elevated scores on any of these scales suggest that
other profile information should be viewed with
caution and that any interpretation of results should
be tentative. If the results are 2 standard deviations
above the mean of the representative CLINICAL
sample on these scales the profile is likely to be
seriously distortedand the clinical scales should not
be interpreted at all.
Assessing Profile Validity

28. •There are 3 different types of distortion.
1.Those arising from test protocols that were
completed carelessly, randomly, or
idiosyncratically.
2.Those that might lead the interpreter to draw a
more negative conclusion from the data.
3.Those that might lead the interpreter to draw a
more positive conclusion from the data.
•The PAI has 4 validity scales.
Assessing Profile Validity

29. Detecting Careless or Idiosyncratic
Responding
•ICN: Inconsistency---this scale reflects the
consistency of responses. It is comprised of
10 pairs of items with related content. 5 pairs
should be answered similarly and 5 pairs
should be answered oppositely. The pairs
differ from one another so that the scale does
not reflect any particular construct other than
response style.

30. ICN:Inconsistency Scale (cont)
•ICN elevations are not due to one trying to appear in a
better light because it measure consistency and these
individuals will still answer consistently just in a more
positive manner. This area will be discussed later.
•A common cause of ICN elevations is reading
comprehension due to the confusion with items
involving negations such as I have no trouble falling
asleep.
•The PAI requires a 4
th
grade reading level.

31. ICN:Inconsistency Scale (cont)
•Low scores on ICN (below 64t) suggest that the
respondent did respond consistently and probably
attended appropriately to the items.
•High scores (at or above 73t) indicate that the
respondent did not attend consistently.
•A completely random profile results in an average ICN
score of 73t.
•No matter the reason for the invalid profile when ICN is
in this range a clinical interpretation should not be
given.

32. INF: Infrequency
•This scale is useful in the identification of
individuals who complete the PAI in an atypical way
because of carelessness, confusion, reading
difficulties, or other sources of random responding.
•Half of the items are expected to be answered false
(My favorite poet Is Raymond Kerteze) and the
other half should be answered very true (Most
people would rather win than lose).

33. INF: Infrequency (cont)
•The items were selected on the basis of very low
endorsement frequencies in both normal and clinical
subjects; this contrasts with scales such as the MMPI’s F
scale, on which items were selected on the basis of
infrequency in the normative sample. Such scales often yield
elevations in clinical populations because the item may
reflect valid responding in a clinical respondent but invalid in
normal population.
•The item content for the INF was written so it would be
infrequent yet not bizarre sounding. It is primarily a measure
of carelessness in responding.
•Lowscores (below 60t) suggest that the respondent did
attend appropriately it item content in responding.

34. INF: Infrequency (cont)
•Moderateelevations (between 60t and 75t) indicate some
unusual responses to INF items. At the higher end of this
range consider potential reading difficulties, random
responding, confusion, errors in scoring, idiosyncratic
responses, or failure to follow test instructions. You may
want to inquire about the INF responses before interpreting
the clinical scales.
•Highscores (at or above 75t) suggest respondent did not
attend appropriately to item content.
•Completely random respondingresults in an average INF
score of 86t.

35. INF: Infrequency (cont)
•Regardless of cause test results should be assumed to
be invalid and no clinical interpretation is recommended
although an examination of specific INF items may yield
useful information. For example if all the endorsed INF
items come from the second half of the test the
examinee may have completed the first have
appropriately and score estimates can be extrapolated
form the responses to the first 160 items. (See test
manual)
•Rememberthat ICN and INF elevations can also arise
from reading or language problems, confusion or clerical
scoring errors on the part of the person taking it or the
person entering the data.

36. Random Responding
•The most prominent characteristic of a profile that
consists of random responsesis that both INF and
ICN fall above the thresholds for profile validity.
•If both INF and NIM are elevated and the scores are
comparable (within 10t of one another) then random
responding is suggested
•Malingering protocolstend to lead to profiles in which
NIM greatly exceeds INF, typically by 20t or more.
•Fewer than half of the subscales are elevated above
70t in the random response profile.

37. Profile Distortion
•In general malingering profiles tend to be more
elevated than random profilesbecause responses
are consistently pathological rather than randomly
either pathological or healthy.

38. Detecting Negative Profile Distortion
•This means making the profile appear more
pathological than the clinicians behavioral
observation would indicate.
•One such type of profile would be malingeringwhich
involves the exaggeration of symptoms with the
motivationof achieving some secondary gain.

39. Detecting Negative Profile Distortion
•There are other sources of negative profile
distortionthat are not intentional. Several
different forms of mental disorders lead
individuals to perceive themselves, other
people, or situations in a manner that is more
negative than what might be warranted. These
individuals are not malingeringin fact they do
have a significant and perhaps severe form of
mental disorder.
•An example of this would beMajor Depression.

40. Detecting Negative Profile Distortion
Three such indicators are NIM scale, the Malingering
index, and the Rogers Discriminant Function.
•A forth the Cashel discriminate function, may have
some use in this regard as well; however, because
this measure was developed to identify positive
profile distortion, it will be discussed with these
indicators.

41. NIM: Negative Impression
•As mentioned earlier the NIM is NOT a malingering
scale. It was designed to alert the interpreter to the
possibility that the results of the test may portray an
impression of the individual that is more negative
than what might otherwise be merited.

42. NIM: Negative Impression (cont)
•NIM items are clearly endorsed with greater
frequency in clinical patients than in normal adults.
Individuals with clear cut and severe emotional
problems can and will get elevated scores on NIM
and more disturbed populations obtain higher scores
than do those who are less impaired.
•The mean of outpatient mental health patients is 59t
whereas inpatient was 65t.

43. •The NIM scale includes 2 types of items.
•Some present an exaggerated or distorted
impression of the self in present situations.
•Some represent extremely bizarre and unlikely
symptoms.
NIM: Negative Impression (cont)

44. •With an elevated NIM one must use caution in
interpreting results.
•This scale is a useful beginning point in the detection
of malingering.
•These items were written to sound as if they
represented pathological symptoms, but they are in
fact extremely rare or nonexistent in clinical
populations.
•Individuals with severe dissociative disorders
sometimes obtain marked elevations on NIM.
NIM: Negative Impression (cont)

45. •Generally, low scores (below 73t) on NIM suggest
that there is little distortion in a negative direction on
the clinical scales.
–Moderate elevations (between 73t and 84t)
suggest an element of exaggeration of complaints
and problems.
•The likelihood of distortion increases in the range
from 84t to 92t. Elevations in this range may be
indicative of a cry for help or an extremely negative
evaluation of oneself and one’s life.
NIM: Negative Impression (cont)

46. •High scores(at or above 92t) suggest that the
respondent attempted to portray himself in an especially
negative manner. The item content suggests the strong
possibility of careless responding, extremely negative
self-presentation, or malingering.
•Regardless of the cause the test is invalid and an
interpretation of the clinical scales should emphasis that
the respondent is trying to infer these symptoms instead
of actually having them.
•Malingererstend to obtain T score of 110.
•Random Respondinghas an average T score of 96.
NIM: Negative Impression (cont)

47. •In summary the NIM scale has a place in the
assessment of malingering on the PAI but it also has
limitations.
•It is NOT A MALINGERING SCALE per se.
•It is an indication of negative self impression and one
must remember that there are mental disorders in
which negative self impression is a symptom.
NIM: Negative Impression (cont)

48. The MALINGERING INDEX
(Foundon the Structural Summary sheets)
•NIM 110t
•NIM –INF 20t
•INF-ICN 15t
–PAR-P –PAR-H 15t
•PAR-P –PAR-R 15t
•MAN-I –MAN-G 15t
•DEP85 AND RXR 45t **
•ANT-E –ANT-A 10

49. Malingering Index
•These 8 features of the PAI profile tend to be observed
much more frequently in the profiles of persons
simulating mental disorder than in actual clinical patients.
It is scored by determining the number of positive
features and thus scores can range from zero to 8.
•**This item reflexes mistaken assumptions about
individuals with mental disorders, in particular, the belief
that individuals suffering from such disorders lack insight
into the nature and severity of their conditions.
•For Example: On the PAI it is very uncommon to find
respondents who report both a significant degree of
distress (DEP) and little motivation to change (RXR).

50. •A Malingering index score of 3 or aboveshould raise
questions of malingering.
•Scores of 5 or moreare highly unusual in clinical
samples and tend to occur only when sever mental
disorder is being feigned.
Malingering Index

51. Rogers Discriminant Function
•The Rogers index is a discriminant function that was
developed to distinguish the PAI profiles of bona fide
patients from those of individuals simulating such
patients.
•A score greater than 0 suggests malingering and
scores less than 0 suggest no effort at negative
distortion.
•It is free of influence by psychopathology.

52. Rogers Discriminant Function (cont)
•The NIM scale is influenced by psychopathology and
the Malingering index is somewhat influenced by
psychopathology.
•When NIM is elevated but the Rogers function is
average and the Malingering index falls somewhere
in between, the pattern suggests symptoms of true
psychopathology. There may be a distortion of the
profile in a negative direction.

53. Identifying Positive Distortion
–PIM: Positive Impression
•The contents of this scale indicate a favorable
impressionor the denial of relatively minor faults.
•These items are endorsed with greater frequency in
normal adults than in clinical patients.
•Marked elevations in clinical patients are particularly
rare.

54. Identifying Positive Distortion (cont)
•There are a number of reasons people might not
report negative characteristics.
1.Respondent indeed does not have negative
characteristics or at least few.
2.Respondent is not telling the truth.
3.Respondent lacks insight.

55. •Low scoreson PIM (<44t) are strongly indicative of
honest responding.
•Scores between 44t and 57tsuggest that the
respondent did not attempt to present an
unrealistically favorable impression in completing the
test, although scores in the upper end of this range
tend to be unusual in clinical settings.
•Moderate elevations(between 57t and 68t) suggest
responding in a manner to portray himself as
relatively free of the common shortcomings to which
most individuals will admit.
Identifying Positive Distortion (cont)

56. PAI INDIVIDUAL SCALES
•SOM: SOMATIC COMPLAINTS
•ANX: ANXIETY
•ARD: ANXIETY-RELATED DISORDERS
•DEP: DEPRESSION
•MAN: MANIA
•PAR: PARANOIA
•SCZ: SCHIZOPHRENIA
•BOR: BORDERLINE FEATURES
•ANT: ANTIOSOCIAL FEATURES
•ALC: ALCOHOL PROBLEMS
•DRG: DRUG PROBLEMS

57. •Each scale was designed to measure the major
facets of a particular clinical construct. Most of the
clinical scales offer subscales that can be interpreted
as well. Because of this two identical elevations on
a particular scale may be interpreted differently
depending on the configuration of the subscales.
PAI INDIVIDUAL SCALES

58. SOM: SOMATIC COMPLAINTS
•Complaints and concerns about physical functioning and
health matters in general. It has little ability to distinguish
between functional and organic somatic features.
•EX: Someone with a neurological disorder may have similar
elevations to those of a 65 year old Alcoholic.
•Conversion (SOM-C)—rare symptoms of sensory or motor
dysfunction associated with conversion disorder; can
elevate in certain medical conditions.
•Somatization (SOM-S)—frequent occurrence of various
common physical symptoms and vague complaints of ill
health and fatigue.

59. SOM: SOMATIC COMPLAINTS (cont)
•Health concerns (SOM-H)—a preoccupation with health
and physical problems.
•DX:somatoform disorders.
•Elevations may also be seen with serious medical
conditions with the average SOM score being around 65t.
•Chronic alcoholicstend to have elevations on SOM. Drug
abusers tend to have a disregard for their health thus a low
SOM-H will be seen here.
•Obsessive-Compulsivedisorder who tend to focus on
health-related issues will be high particularly on SOM-H.
•There can be elevations on SOM with Schizophrenicswho
have somatic delusions or side effects from antipsychotic
medications.

60. ANX: ANXIETY
•This is a nonspecific indicator of the degree of
tension and negative affect experienced by the
respondent.

61. ANX: ANXIETY (cont)
•Cognitive (ANX-C) ---focuses on ruminative worry
and concern about current issues that results in
impaired concentration and attention.
•Affective (ANX-A)—focuses on the experience of
tension, difficulty in relaxing, and the presence of
fatigue as a result of high perceived stress.
•Physiological (ANX-P)—focuses on overt physical
signs of tension and stress, such as sweaty palms,
trembling hands, complaints of irregular heartbeats,
and shortness of breath.
•DX: No specific diagnosis as anxiety is a symptom of
various diagnosis.

62. ANX: ANXIETY (cont)
•Obsessive-compulsivedisorder or phobias will see
ANX-C elevations.
•Panic Disorder, agoraphobia or PTSD will see ANX-
P elevations.
•In Adjustment D/Oyou might see ANX elevations
along with STR elevations.
•Schizophrenicswill have ANX elevations when they
are in the recovery phase of their illness.
•Antisocial Personality Disorderswill have very low
scores on ANX.

63. ARD: ANXIETY-RELATED DISORDERS
•Aspects of this scale measure the extent of
behavioral expression of anxiety.

64. ARD: ANXIETY-RELATED DISORDERS
(cont)
•Obsessive-Compulsive(ARD-O) ---focuses on
intrusive thoughts or behaviors, rigidity, indecision,
perfectionism, and affective constriction.
•Phobias(ARD-P) ---focuses on common phobic fears,
such as social situations, public transportation, heights,
enclosed spaces, or other specific objects. Those with
Antisocial Personalities have low ARD-P scores.
•Traumatic Stress(ARD-T) ---focuses on the experience
of traumatic events that cause continuing distress and
that are experienced as having left the client changed or
damaged in some fundamental way.
•DX:Diagnosis is more subscale dependent.

65. DEP: DEPRESSION
•Covers the major elements of the depressive
syndrome while also providing items that would prove
useful across the full range of severity of
symptomatology.

66. DEP: DEPRESSION (cont)
•Cognitive (DEP-C)--focuses on thoughts of worthlessness,
hopelessness, and personal failure as well as indecisiveness
and difficulties in concentration.
•Affective (DEP-A)—focuses on feeling of sadness, loss of
interest in normal activities, and anhedonia.
•Physiological (DEP-P)—focuses on level of physical
functioning, activity, and energy, including disturbance in
sleep pattern, changes in appetite, and weight loss.

67. DEP: DEPRESSION (cont)
•DX: Depressive Mood disorders: When all three
subscales exceed 70t likely to have Major Depression,
whereas if have DEP elevation without DEP-P elevation
this might be dysthymic disorder. When STR and DEP
are both elevated this suggests situational depression of
some kind. A DEP elevation can also reflect distress
secondary to anxiety disorders, PTSD, a somatoform
disorder or a substance abuse disorder.

68. Should make sure to look at the SUI
Scale to assess suicidality
•DEP-Celevations respond best to cognitive therapy
•DEP-Pelevations respond best to medication
•DEP-Ais an indication of one’s current life
satisfaction

69. MAN: MANIA
•This scale was designed to assess signs of a manic
episode. Elevations on the full scale of MAN tend to
be rarer in clinical settings than any other clinical
scales of the PAI. Therefore, the critical thresholds
for identifying MAN scores are lower than other
clinical scales.

70. MAN: MANIA (cont)
•Activity Level (MAN-A)—focuses on over-involvement
in a wide variety of activities in a somewhat
disorganized manner and the experience of
accelerated thought processes and behavior.
•Grandiosity (MAN-G)—focuses on inflated self-
esteem, expansiveness, and the belief that one has
special and unique skills or talents.
•Irritability (MAN-I)—focuses on the presence of
strained relationships due to the respondent’s
frustration with the inability or unwillingness of others
to keep up with their plans, demands, and possible
unrealistic ideas.

71. MAN: MANIA (cont)
•DX: When all 3 subscales are elevated a manic
episode within a bipolar disorder is the central
consideration.
•If there is a stronger MAN-G elevationthis may be
a narcissistic or Antisocial Personality Disorder.
•MAN-I elevationsreflect impulse control disorder
with anger management as an issue with AGG
elevations or also intermittent explosive disorder.
•TREATMENT: Elevations on MAN are generally a
sign of a negative prognosis.

72. PAR: PARANOIA
This scale focuses on symptoms of paranoia.
•Hypervigilance (PAR-H)—focuses on suspiciousness
and the tendency to monitor the environment for real
or imagined slights by others.
•Persecution (PAR-P)—focuses on the belief that one
has been treated inequitably and that there is a
concerted effort among others to undermine one’s
interests.
•Resentment (PAR-R)—focuses on bitterness and
cynicism in interpersonal relationships and a
tendency to hold grudges and externalize blame for
any misfortunes.

73. PAR: PARANOIA (cont)
•DX:Paranoid personality disorder or paranoid
delusional disorder. In the personality disorder you
will see PAR-Pwithin normal limits whereas with a
delusional disorder all three subscales are likely to be
elevated with PAR-P to be higherthan the others. If
SCZ is elevated you have Schizophrenia, paranoid
typeand if MAN is elevated you have grandiosity
and impaired judgment as well.
•Borderline Personality Disorderand Antisocial
personality disordermay also display elevations on
PAR with PAR-R to be elevated.

74. SCZ: SCHIZOPHRENIA
•This scale is designed to assess three aspects of
schizophrenia.
•Psychotic Experiences (SCZ-P)—focuses on the
experience of unusual perceptions and sensations,
magical thinking, and other unusual ideas that may
involve delusional beliefs.
•Social Detachment (SCZ-S)—focuses on social
isolation, discomfort, and awkwardness in social
interactions.
•Thought Disorder (SCZ-T)—focuses on confusion,
concentration problems, and disorganization of
thought processes.

75. SCZ: SCHIZOPHRENIA (cont)
•DX: Although elevations on SCZ typically indicate
sever psychopathology; they may not be specific to
schizophrenia. Information from other assessment
sources may provide important supplements for
differential diagnosis of schizophrenia.

76. SCZ: SCHIZOPHRENIA (cont)
•TREATMENT: Elevations on this scale are generally
a poor sign of prognosis. SCZ-P elevationmay
suggest a need for medication.
•SCZ-T elevationreflect cognitive disruption that may
also be treated through medication.
•SCZ-S elevationssuggest need for supportive
therapy and alliance formation to aid in the
development of social skills.

77. BOR: BORDERLINE FEATURES
•This scale assesses a number of elements related to
borderline personality disorder and due to its complexity
there are 4 subscales.
•Affective Instability (BOR-A)—focuses on emotional
responsiveness, rapid mood changes, and poor emotional
control.
•Identity Problems (BOR-I)—focuses on uncertainty about
major life issues and feelings of emptiness, lack of
fulfillment, and an absence of purpose.
•Negative Relationships (BOR-N)—focuses on a history of
ambivalent, intense relationships in which one has felt
exploited and betrayed.

78. BOR: BORDERLINE FEATURES (cont)
•Self-Harm (BOR-S)—focuses on impulsively in areas that
have high potential for negative consequences.
•DX:Although an elevation on the full-scale may not
necessarily mean the person meets the criteria for
borderline personality disorder it does indicate the
characteristics exist and they can be associated with Axis I
diagnoses as well.
•When 3 or 4 of the subscales are elevated above 70t the
probability of borderline personality disorder goes up.
When a single subscale drives the elevation then there are
probably other diagnoses that are better suited to the
individual.

79. BOR: BORDERLINE FEATURES (cont)
•BOR-A elevationscould indicate histrionic personality
disorder or bipolar disorder whereas low scores could
indicate schizoid or obsessive-compulsive personality
disorder.
•BOR-I elevationsindicate problems that are dissociative
in nature.
•BOR-N elevationssuggest substance abuse or
somatization disorder.

80. ANT: ANTIOSOCIAL FEATURES
•This scale, along with BOR, specifically assesses
character pathology. This scale follows Cleckley’s
description of antisocial personality and the psychopath.
•Antisocial Behaviors (ANT-A)—focuses on a history of
antisocial acts and involvement in illegal activities.
•Egocentricity (ANT-E)—focuses on a lack of empathy or
remorse and a generally exploitative approach to
interpersonal relationships.
•Stimulus-Seeking (ANT-S)—focuses on a craving for
excitement and sensation, a low tolerance for boredom,
and a tendency to be reckless and risk-taking.

81. ANT: ANTIOSOCIAL FEATURES (cont)
•DX:Full scale elevations on ANT suggest Antisocial
personality disorder particularly if ANT-A is elevated.
•Other possible diagnoses are borderline or
narcissisticpersonality disorder. On Axis I the most
common diagnosis is substance abuseand bipolar
disorder especially if there are elevations on DRG
and MAN, respectively.

82. SUBSTANCE ABUSE SCALES:
•A PIM elevation can signify that an individual is
underreporting problems with alcohol or drugs.

83. ALC: ALCOHOL PROBLEMS
•This scale provides an assessment of behavioral and
consequences related to alcohol use, abuse and
dependence.
•DX: Alcohol abuse and/or dependence with
dependence having an average score of 84t.

84. DRG: DRUG PROBLEMS
•This scale provides an assessment of behavioral and
consequences related to drug use, abuse and
dependence.
•DX: Scores that fall within the 70-80t range are more
likely to reflect abuse.

85. AGG: AGGRESSION
•This is a treatment consideration scale and has no direct
correspondence to any DSM diagnostic category.
•Aggressive Attitude (AGG-A)—focuses on hostility, poor
control over anger expression, and a belief in the
instrumental utility of aggression.
•Verbal Aggression (AGG-V)—focuses on verbal
expressions of anger ranging from assertiveness to
abusiveness and on a readiness to express anger to
others.
•Physical Aggression (AGG-P)—focuses on a tendency
to have physical displays of anger, including damage to
property, physical fights and threats of violence.

86. SUI: SUICIDAL IDEATIONS
•This scale is the starting point for evaluating
suicide potential.
•This scale is directly related to thoughtsof suicide
and related behaviors therefore, individuals who wish
to disguise suicidal intents can do so easily.
•This is a scale of suicidal ideations NOT a
prediction scale.
•It is fairly unusual for individuals in clinical settings to
score below 45t.
•Scores from 60t to 69t are typical of clinical patients.

87. ASSESSMENT OF PERCEPTION OF
ENVIRONMENT
•STR: STRESS
•NON: NONSUPPORT
•RXR: TREATMENT REJECTION

88. STR: STRESS
•This is an assessment of life stressors such as family
relationships, financial hardships, employment
issues, or major life changes.
•This scale is helpful for identifying situational
adjustment disorders.

89. NON: NONSUPPORT
•This scale provides a measure of a perceived lack of
social support.

90. RXR: TREATMENT REJECTION
•A score of 50t on RXR in the presence of clinical
difficulties represents a problematic level of treatment
motivation, even though it reflects an average score
in the general population.

91. INTERPERSONAL STYLE
•DOM: DOMINANCE
•WRM: WARMTH

92. DOM: DOMINANCE
•This scale looks at the degree to which a person
desires control in interpersonal relationships.

93. WRM: WARMTH
•This scale indicates the degree to which a person is
interested in and comfortable with attachment
relationships.
•DX: It adds in distinguishing some personality types.

94. WRM: WARMTH (cont)
•Low WRM---Schizotypal, schizoid, paranoid or
obsessive-compulsive personalities, social anxiety or
phobias even schizophrenia.
•Low DOM---avoidant, passive-aggressive
personalities.
•High DOM---narcissistic and antisocial personalities
as well as someone in a manic episode.
•High WRM but Low DOM---dependent personality.

95. This completes the presentation on the PAI scales.
This however, is only the first of a three part
training process that will enable you to provide
appropriate interpretations of PAI profiles.

96. Step 2:
•You will now need to complete a classroom
training or one on one training practicing
interpretations of PAI profiles.
•Sample profiles will be provided for this
phase of the training.

97. Step 3:
•In this phase of the training you will
administer the PAI and write an evaluation
based on these results.
•These reports will be critiqued by someone
qualified to interpret the PAI such as your
MHM or SMHM.

98. After completing the following quiz.
Please get with your MHM or SMHM to
complete this training.

99. References:
•Morey, L.C. (1991). The Personality Assessment
Inventory Professional Manual. Odessa, FL:
Psychological Assessment Resources.
•Morey, L.C. (2003). Essentials of PAI Assessment.
Hoboken, NJ: Wiley.
•Morey, L.C. (1996). An Interpretive Guide to the
Personality Assessment Inventory. Psychological
Assessment Resources, Inc.

100. You have completed this program.
Click on the “Complete Course”
button then continue on to the
evaluation and exam.