The Defense Abuses Depression

Cripe continued at page 300 of The Evaluation and Treatment of Mild Traumatic Brain Injury:

Because of the problems with item content, the discrimination of patient groups, the lack of validation of maladjustment, the meaning of scale elevations, and many other psychometric issues (Helmes & Reddon, 1993) the use of the MMPI with neurologic patients is precarious. Frankly, it will not do all the things that neuropsychologists hope it can do.

Cripe continued at page 300 of The Evaluation and Treatment of Mild Traumatic Brain Injury:

It is very common in mild head injury cases with prolonged problems to observe the following: The patient has complaints of problems with low energy, concentration, forgetfulness, pain headaches, emotional reactiveness, and mild depression. With appropriate testing and careful analysis, neuropsychological test results often indicate subtle to mild problems with rate of information processing, complex attention processing, and short term memory. The MMPI often indicates significant elevations on Scales 1, 2, 3, and possibly 7 and 8. The typical interpretations of the findings is that the person is doing quite well neuropsychologically, but has significant emotional reactions and problems that account for the complaints and the mild findings on the neuropsychological tests. If the MMPI profile is highly elevated, the tendency is to raise the question of somatization and possible conscious or unconscious motivation problems. Of course, if the examiner has a priori beliefs that mild head injured person cannot and should not have prolonged problems, any mild problems found on neuropsychological tests will be attributed to personality issues, psychiatric disturbance, or manipulation for financial gain. These conclusions about the test results are misguided by the erroneous test and patient assumptions held by the examiners prior to conducting the individual or group study.

If you are in a forensic battle, make sure that your attorney and your neuropsychologist understand the areas in which the MMPI is being misapplied with brain injured persons. Force them to take the time to look at why scales are elevated, not just a computer generated analysis of what the scores show. I cannot say it strongly enough: read all of what Cripe has to say about the MMPI in The Evaluation and Treatment of Mild Traumatic Brain Injury.

It is not necessary to have a loss of consciousness to suffer permanent brain injury.

Source: Definition of Mild Traumatic Brain Injury Developed by the Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993:8(3):86-87

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