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Seth D. Grossman

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Quickly acquire the knowledge and skills you need to administer, score, and interpret the MCMI ¯®-IV Essentials of MCMI ¯®-IV Assessment is the definitive source of up-to-date, practical information for clinicians and students using the MCMI¯®-IV inventory. Step-by-step guidelines walk you through the process of administering the assessment, with a profile and demonstration of the clinical process from administration to treatment. Expert discussion helps inform higher-quality therapeutic interventions. The link between assessment and intervention is emphasized throughout, as well as coverage of relevant populations and clinical applications, to provide a well-rounded understanding while illuminating the uses of the MCMI ¯®-IV. This book provides instruction and clarification from the foremost experts to help you achieve better outcomes for your clients. * Follow step-by-step guidelines for administering the MCMI ¯®-IV * Recognize the connection between data and intervention * Improve quality and accuracy of therapeutic applications * Gain a more practical understanding of the MCMI ¯®-IV assessment process The MCMI ¯®-IV assesses a wide range of information related to a client's personality, emotional adjustment, test-taking approach, and other critical information. Interpretation and reporting serve as a basis from which therapeutic interventions are designed, so quality and accuracy is of utmost importance every step of the way. Essentials of MCMI ¯®-IV Assessment is the most authoritative, up-to-date resource in the field, and a must-have reference for anyone who uses the test.

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Essentials of MCMI®‐IV Assessment



Seth Grossman

Blaise Amendolace





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Library of Congress Cataloging-in-Publication Data

Names: Grossman, Seth, 1968- author. | Amendolace, Blaise, 1982- author.

Title: Essentials of MCMI®-IV assessment / Seth Grossman, Psy.D., Blaise Amendolace, Psy.D.

Other titles: Essentials of psychological assessment series.

Description: Hoboken, New Jersey : John Wiley & Sons, 2017. | Series: Essentials of psychological assessment series | Includes bibliographical references and index.

Identifiers: LCCN 2016035910 (print) | LCCN 2016052631 (ebook) | ISBN 9781119236429 (pbk.) | ISBN 9781119236436 (pdf ) | ISBN 9781119236443 (epub)

Subjects: LCSH: Millon Clinical Multiaxial Inventory—Handbooks, manuals, etc.

Classification: LCC RC473.M47 G76 2017 (print) | LCC RC473.M47 (ebook) | DDC 616.89/075076—dc23

LC record available at

Cover design: Wiley

Cover image: ©Greg Kuchik/Getty Images


To our sons, Aiden and Lucca,

Both of you provide the fire and light that allow us to push forward, always providing a why for any how.

With all of our love,

SG and BA

Table of Contents


Essentials of Psychological Assessment Series

Title Page


List of Figures

List of Tables

Series Preface

Chapter One: History and Development of the MCMI® Through MCMI®-IV

Construction of the Legacy MCMI Tests (MCMI, MCMI-II, MCMI-III)

Development of the MCMI-IV

Test Yourself

Chapter Two: MCMI®-IV and Millon Evolutionary Theory

Personality as Focal Point in Clinical Assessment and Intervention

An Evolutionary Model of Personality

Motivating Aims

Problematic Patterns in Motivating Aims

Levels of Adaptiveness

Structural and Functional Domains

Applying Millon’s Evolutionary Theory to the MCMI-IV

Test Yourself

Chapter Three: Administration and Scoring



Test Yourself

Chapter Four: Sections and Scales

Validity and Modifying Indices

Noteworthy Responses

Clinical Personality Patterns

Severe Personality Pathology

Clinical Syndromes

Severe Clinical Syndromes

Grossman Facet Scales

Test Yourself

Chapter Five: Interpretive Principles

Role of Personality in Assessment: A Recapitulation

Building an Integrative MCMI-IV Interpretation

Integrating the Overall Clinical Picture

Test Yourself

Chapter Six: Therapeutic Alliance Building

Introducing the MCMI-IV to the Examinee

Preparing the Examinee for Feedback

The Examiner’s Initial Preparation for Feedback

Moving Away From Labels

Understanding the Examinee’s Test-Taking Style (Modifying Indices)

Language of the Theory = Language of Alliance 1: Individual Personality Scales

Language of the Theory = Language of Alliance 2: Multiple Personality Scales

Language of the Theory = Language of Alliance 3: Facet Scales

Language of the Theory = Language of Alliance 4: Clinical Symptomology

Test Yourself

Chapter Seven: Strengths and Weaknesses of the MCMI®-IV



Final Comment

Test Yourself

Chapter Eight: Clinical Applications of the Millon Inventories

Key MCMI-IV Augmentation: Personality Spectra and Clinical Populations

The MCMI-IV in Clinical Assessment

Specific Assessment Applications With the MCMI

Other Millon Inventories

Test Yourself

Chapter Nine: Illustrative Case Reports

Case Example 1

Case Example 2


About the Authors


End User License Agreement



Table of Contents

Begin Reading

List of Illustrations

Chapter 2

Figure 2.1 Motivating Aims of the Evolutionary Model

Chapter 4

Figure 4.1 Schizoid Motivating Aims

Figure 4.2 Schizoid Domains

Figure 4.3 Avoidant Motivating Aims

Figure 4.4 Avoidant Domains

Figure 4.5 Melancholic Motivating Aims

Figure 4.6 Melancholic Domains

Figure 4.7 Dependent Motivating Aims

Figure 4.8 Dependent Domains

Figure 4.9 Histrionic Motivating Aims

Figure 4.10 Histrionic Domains

Figure 4.11 Turbulent Motivating Aims

Figure 4.12 Turbulent Domains

Figure 4.13 Narcissistic Motivating Aims

Figure 4.14 Narcissistic Domains

Figure 4.15 Antisocial Motivating Aims

Figure 4.16 Antisocial Domains

Figure 4.17 Sadistic Motivating Aims

Figure 4.18 Sadistic Domains

Figure 4.19 Compulsive Motivating Aims

Figure 4.20 Compulsive Domains

Figure 4.21 Negativistic Motivating Aims

Figure 4.22 Negativistic Domains

Figure 4.23 Masochistic Motivating Aims

Figure 4.24 Masochistic Domains

Figure 4.25 Schizotypal Motivating Aims

Figure 4.26 Schizotypal Domains

Figure 4.27 Borderline Motivating Aims

Figure 4.28 Borderline Domains

Figure 4.29 Paranoid Motivating Aims

Figure 4.30 Paranoid Domains

Chapter 6

Figure 6.1 Motivating Aims of Scales 5 and 2A

Chapter 9

Figure 9.1 MCMI-IV Profile Page, Case Example 1 (Mitch)

Figure 9.2 MCMI-IV Facet Page for Case Example 1 (Mitch)

Figure 9.3 Profile Page for Case Example 2 (Valerie)

Figure 9.4 Facet Page for Case Example 2 (Valerie)

List of Tables

Chapter 1

Table 1.1 Millon’s Original Eight Personality Prototypes

Table 1.2 Reliability of MCMI-IV Personality Scaless

Table 1.3 Reliability of MCMI-IV Syndrome Scales

Table 1.4 Sensitivity and Specificity of MCMI-IV Personality Scales

Table 1.5 Sensitivity and Specificity of MCMI-IV Clinical Syndrome Scales

Chapter 2

Table 2.1 Personality Levels Across Evolutionary Spectra

Table 2.2 Expression of Domains by Prototype

Chapter 4

Table 4.1 Grossman Facet Scales

Chapter 5

Table 5.1 Base Rate Anchor Points

Chapter 8

Table 8.1 Objective and Projective Assessment Integration Guidelines


































































































































































































Figure 2.1

Motivating Aims of the Evolutionary Model

Figure 4.1

Schizoid Motivating Aims

Figure 4.2

Schizoid Domains

Figure 4.3

Avoidant Motivating Aims

Figure 4.4

Avoidant Domains

Figure 4.5

Melancholic Motivating Aims

Figure 4.6

Melancholic Domains

Figure 4.7

Dependent Motivating Aims

Figure 4.8

Dependent Domains

Figure 4.9

Histrionic Motivating Aims

Figure 4.10

Histrionic Domains

Figure 4.11

Turbulent Motivating Aims

Figure 4.12

Turbulent Domains

Figure 4.13

Narcissistic Motivating Aims

Figure 4.14

Narcissistic Domains

Figure 4.15

Antisocial Motivating Aims

Figure 4.16

Antisocial Domains

Figure 4.17

Sadistic Motivating Aims

Figure 4.18

Sadistic Domains

Figure 4.19

Compulsive Motivating Aims

Figure 4.20

Compulsive Domains

Figure 4.21

Negativistic Motivating Aims

Figure 4.22

Negativistic Domains

Figure 4.23

Masochistic Motivating Aims

Figure 4.24

Masochistic Domains

Figure 4.25

Schizotypal Motivating Aims

Figure 4.26

Schizotypal Domains

Figure 4.27

Borderline Motivating Aims

Figure 4.28

Borderline Domains

Figure 4.29

Paranoid Motivating Aims

Figure 4.30

Paranoid Domains

Figure 6.1

Motivating Aims of Scales 5 and 2A

Figure 9.1

MCMI-IV Profile Page, Case Example 1 (Mitch)

Figure 9.2

MCMI-IV Facet Page for Case Example 1 (Mitch)

Figure 9.3

Profile Page for Case Example 2 (Valerie)

Figure 9.4

Facet Page for Case Example 2 (Valerie)


Table 1.1

Millon’s Original Eight Personality Prototypes

Table 1.2

Reliability of MCMI-IV Personality Scales

Table 1.3

Reliability of MCMI-IV Syndrome Scales

Table 1.4

Sensitivity and Specificity of MCMI-IV Personality Scales

Table 1.5

Sensitivity and Specificity of MCMI-IV Clinical Syndrome Scales

Table 2.1

Personality Levels Across Evolutionary Spectra

Table 2.2

Expression of Domains by Prototype

Table 4.1

Grossman Facet Scales

Table 5.1

Base Rate Anchor Points

Table 8.1

Objective and Projective Assessment Integration Guidelines


In the Essentials of Psychological Assessment series, we have attempted to provide the reader with books that will deliver key practical information in the most efficient and accessible style. Many books in the series feature specific instruments in a variety of domains, such as cognition, personality, education, and neuropsychology. Other books, like Essentials of KTEA-3 and WIAT®-III Assessment focus on crucial topics for professionals who are involved in anyway with assessment—topics such as specific reading disabilities, evidence-based interventions, or ADHD assessment. For the experienced professional, books in the series offer a concise yet thorough review of a test instrument or a specific area of expertise, including numerous tips for best practices. Students can turn to series books for a clear and concise overview of the important assessment tools, and key topics, in which they must become proficient to practice skillfully, efficiently, and ethically in their chosen fields.

Wherever feasible, visual cues highlighting key points are utilized alongside systematic, step-by-step guidelines. Chapters are focused and succinct. Topics are organized for an easy understanding of the essential material related to a particular test or topic. Theory and research are continually woven into the fabric of each book, but always to enhance the practical application of the material, rather than to sidetrack or overwhelm readers. With this series, we aim to challenge and assist readers interested in psychological assessment to aspire to the highest level of competency by arming them with the tools they need for knowledgeable, informed practice. We have long been advocates of “intelligent” testing—the notion that numbers are meaningless unless they are brought to life by the clinical acumen and expertise of examiners. Assessment must be used to make a difference in the child’s or adult’s life, or why bother to test? All books in the series—whether devoted to specific tests or general topics—are consistent with this credo. We want this series to help our readers, novice and veteran alike, to benefit from the intelligent assessment approaches of the authors of each book.

We are delighted to include Essentials of MCMI®-IV Assessment in our series. This book articulates the considerable depth of Theodore Millon’s overarching theory of personality in a concise, accessible, and clinician-friendly form that is then directly applicable to MCMI-IV assessment and therapeutic applications. Going beyond the instrument’s traditional supportive role in providing incremental validity of personality and psychopathology diagnoses, the authors provide a historical view of our modern personality conceptualizations, and illustrate how the MCMI-IV can, through an integration of its theory and empirical qualities, inform the clinician about key personality variables that influence the onset, course, and resolution of psychological distress. They also provide insight into using the instrument’s findings therapeutically, from both traditional and collaborative modes of assessment and intervention. Further, the authors illustrate these methods both through a stepwise examination of theory and clinical practice, as well as MCMI-IV case examples. Finally, they cover the use of the instrument in different settings and applications, and describe the other Millon inventories that are specialized for use with child/adolescent, college, medical, and adaptive counseling populations.

Alan S. Kaufman, PhD, and Nadeen L. Kaufman, EdD, Series Editors

Yale Child Study Center, Yale University School of Medicine


To fully understand and operationalize the application and range of the Millon Clinical Multiaxial Inventory, Fourth Edition (MCMI-IV; Millon, Grossman, & Millon, 2015), it is useful to gain a working knowledge of its original intent and development in context with the time and challenges in the field of psychological assessment. This chapter will focus not only on the development of this most recent iteration of the instrument but also will highlight its evolution from its original form in context with advances in personality diagnosis, assessment, and intervention throughout the latter half of the 20th century.

The MCMI-IV is a 195-item self-report inventory designed to articulate complex personality patterns in context with clinical symptomology, noteworthy concerns, and test-taking attitude in order to maximize therapeutic plans. The current, fourth generation of the instrument traces its roots back to the early 1960s, when Theodore Millon, then an associate professor at Lehigh University, a private university in the northeast United States, began contextualizing the personality study and research he had conducted throughout the early years of his career (Millon, 2002). Examining the characterologic prototypes described in the classic psychoanalytic literature, Millon noted the superbly articulated characterizations of personality styles, but he lamented the lack of comprehensiveness and consistency across these different patterns. A self-described “inclusive behaviorist” in his early career (Millon, 1990), Millon began blending his empirical background with his interest in integrative theory to attempt to construct an explanatory framework for basic personality constellations. He felt that this could, at once, describe core motivations of individuals and also provide a system for classification of personality variables. The driving force of this exercise was to make the case for personality as the central concern for clinical psychology, owing to its influence on, and ability to modulate, clinical symptomology. The fruits of this labor, manifest in Millon’s (1969) Modern Psychopathology, set the stage not only for the first Millon Clinical Multiaxial Inventory (MCMI; Millon, 1977) but also for the designation of personality on its own separate axis in the multiaxial systems of DSM-III through DSM-IV.

Millon’s (1969) original template, described as a “biosocial-learning theory,” mapped a continuum from adaptive to maladaptive personality patterns and specified several distinct motivating forces when, combined with one another, gave rise to a series of personality prototypes evident among adaptive and maladaptive individuals. These motivational orientations emphasized social engagement and adaptation to the environment, drawn as opposing ends of a continuum. Social engagement was seen as engaged versus disengaged, whereas the adaptation continuum was described as active versus passive (that is, whether to act on an environment in order to suit the individual or to accept what the environment provides and change aspects of the self to fit in). This schema, when examined for different possible combinations, manifested eight prototypal personalities which largely coincided with identified problematic personality trends as seen in the literature and in the official psychiatric diagnostic system (see Table 1.1). Millon’s framework garnered the attention of key figures from the DSM leadership in the 1970s, and he was recruited to its personality disorders work group in which many of his conceptualizations were ultimately translated to its empirically based diagnostic criteria of the DSM-III (American Psychiatric Association [APA], 1980).

Table 1.1Millon’s Original Eight Personality Prototypes

Relational Mode

Adaptive Mode


Passive: Schizoid

Active: Avoidant


Passive: Dependent

Active: Histrionic


Passive: Narcissistic

Active: Antisocial


Passive: Compulsive

Active: Negativistic

Because Millon had specified a measurable framework for understanding personalities, he and his colleagues began exploring methods for doing this. Several attempts were made to map data points of existing instruments, such as the original MMPI (Hathaway & McKinley, 1940) and the Rorschach (Rorschach, 1921), to Millon’s personality constructs, but these efforts yielded inconsistent or incomplete results. Ultimately, Millon decided to formulate a new research-oriented instrument—the Millon-Illinois Self-Report Inventory (MISRI)—which would be constructed with the explicit intent of measuring these personality prototypes. As his explorations expanded from academic and research settings to clinical use, measures for the major psychiatric disorders were added as a means to contextualize personality with major psychiatric disturbance. These additions were integrated into the original Millon Clinical Multiaxial Inventory (Millon, 1977).


Envisioned as a theoretically derived, empirically supported instrument, Millon chose to construct the original MCMI (as well as its predecessor, the MISRI) employing Loevinger’s (1957) classic three-stage model for objective test construction. In the first, Theoretical-Substantive stage, Millon and his colleagues developed more than 1,000 items written as either operational definitions of the theoretical constructs comprising the personality patterns or self-statements reflective of psychiatric symptomology. This initial stage was then followed by the Internal-Structural stage, in which this large item pool was administered to a developmental sample drawn from psychological and psychiatric clinics, inpatient and outpatient, across the United States. Classic psychometric measures were then applied to this sample to determine the adequacy of the items in terms of reliability (e.g., Cronbach’s alpha, repeated measures). Those items retained through the second phase were subsequently assessed in a third phase, the External-Criterion validation stage, wherein the surviving items were assessed for agreement with clinicians’ ratings of subjects and how they corresponded with scales on the new assessment, as well as concordance with other instruments measuring similar constructs.


Theodore Millon designed his assessment instruments to be theoretically derived and empirically validated measures.

The original MCMI featured eight primary personality scales corresponding to Millon’s eight personality styles, as well as three “severe” personality scales (Schizotypal, Cycloid [Borderline], and Paranoid) measuring personality prototypes conceived as more structurally compromised variants of the Basic Personality Patterns. Additionally, nine Clinical Syndrome scales measured classic psychopathology (e.g., depression, anxiety, alcohol abuse), and one validity scale was developed to detect random response patterns. In addition, the new instrument used Base Rate (BR) scores as an alternative to the commonly used T-score. The BR system, Millon argued, offered greater idiographic accuracy by rejecting the assumption that the prevalence rate for any given disorder is the same as the prevalence rate for any other disorder. The BR system, instead, referred to the prevalence rate (or base rate) of the disorder, setting a cutting point at a specified percentile of examinees for any of the disorders under consideration and using an iterative process to determine key scores and all score conversions (Wetzler, 1990).

The MCMI rapidly became one of the most popular instruments used by clinical psychologists (Piotrowski & Keller, 1989; Piotrowski & Lubin, 1989, 1990). This was, in large part, because of its overlap with the personality disorders of the diagnostic system, offering clinicians a system in which they could further contextualize official diagnostic criteria via the explanatory principles embedded in Millon’s theory (Choca & Grossman, 2015). By the time of the original MCMI’s release in 1977, revisions to be introduced in DSM-III were imminent. There was much discussion about the possibility of adding the sadistic and the masochistic personality disorders to the DSM. Millon, who championed these additions, also added these two patterns to his theory and to the plans for the MCMI’s first major revision. The political landscape of the era was not in favor of these additions, because women and LGBT groups, in particular, opposed these inclusions because of concern regarding social and legal ramifications (Millon, 1981). Although the American Psychiatric Association ultimately voted against the additions and the prototypes were relegated to the DSM-III appendix for further consideration, Millon felt strongly about the importance and validity of these patterns for clinical applications, and they were incorporated into the MCMI-II (Millon, 1987).

The MCMI-II also introduced a system of differential weights for items, reflective of their use as prototypal or supportive items for given scales. An item written specifically for a given scale was weighted; that is, it was given more than 1 raw score point (either 2 or 3) when endorsed for that scale. The same item, then, may have been used on another scale to measure a similar or contextually modified concept for that scale, but it was limited to a raw weight of 1. This system provided an economical means to explain similarities between different prototypes using minimal test content, but much like the sadistic and masochistic prototypes, it was not without its own controversy. Although these differential raw score weights made sense from a theoretical point of view, it added significantly to the complexity of scoring and gave rise to difficulties with discriminant validity (Retzlaff, 1991; Retzlaff, Sheehan, & Lorr, 1990; Streiner, Goldberg, & Miller, 1993; Streiner, & Miller, 1989; Widiger, Williams, Spitzer, & Frances, 1985).

Less controversial, and arguably more beneficial, the MCMI-II also introduced three Modifying Indices, similar in scope to the MMPI validity scales. These three scales, Disclosure, Desirability, and Debasement, based on extant content, measured the examinee’s test-taking approach and added a dimension that further contextualized the person’s response to the challenges of self-reflection inherent in personality assessment.

The end of the 1980s saw the most major theoretical revision in Millon’s career, culminating in a publication that tied core personality motivations to evolutionary theory (Millon, 1990). The new MCMI-II prototypes had already added a discordant element to the theory that, similar to the other relational factors, featured a passive variant (the self-defeating, masochistic personality) as well as an active variant (the forceful-aggressive, sadistic personality). This new dimension, along with the classic biosocial-learning schema of the eight basic prototypes, showed considerable overlap with Millon’s evolutionary proposals, and the existing personality patterns were reconceptualized as expressions of nature analogous to evolutionary phenomena of the natural world (e.g., Wilson, 1978). Subsequent publications based on the evolutionary theory included the second edition of Millon’s primary theory text, Disorders of Personality (Millon & Davis, 1996), as well as the next version of the instrument, the MCMI-III (Millon, 1994; Millon, Millon, & Davis, 1997). Chapter 2 details Millon’s evolutionary theory and its clinical application.


Millon’s theory was originally designed as a biosocial-learning theory. In 1990, he reconceptualized it as a more inclusive evolutionary theory. Most of the original theory was incorporated into this new version, which provides the guiding framework for all modern Millon inventories, including the MCMI-IV.

Among other more nuanced changes incorporated into the revised theory and the MCMI-III (e.g., the impulsivity of the cycloid pattern being more fully fleshed out for its emotionality into the Borderline prototype), a new pattern, the depressive personality, was introduced and discussed as a possible addition to the upcoming DSM-IV (APA, 1994). Although the pattern was ultimately relegated to the appendix for future consideration, it has enjoyed recognition as an entity that is qualitatively distinct from both major depression and persistent depression/dysthymic disorder (e.g., Maddux & Johansson, 2014). Finally, in an effort to improve discriminant validity and parsimony, the weighting system for the MCMI-III was simplified. All items included on the MCMI-III, whether legacy or newly introduced, were designated as prototypal on only one scale and given a weight of 2 raw score points. They were then considered, based on theoretical consideration and intercorrelations, for inclusion as supplementary items for other scales (Jankowski, 2002; Millon, Millon, Davis, & Grossman, 2009). The mid-2000s also saw the first set of official facet scales published as part of the MCMI-III (Craig, 2005), an expansion of factorial ideas previously considered for the Millon inventories (e.g., Davis, 1993). Designed to reflect aspects of the evolutionary theory geared toward specific structural and functional domains, the Grossman Facet Scales provided a further breakdown of each of the primary personality scales along theoretical demarcations (Grossman, 2004; Millon, Millon, Davis, & Grossman, 2006a, 2006b). A final revision to the MCMI-III (Millon et al., 2009) updated the norms to the contemporary, mixed-gender standard, and introduced the Inconsistency scale to partner with and improve on the instrument’s validity measures.

Millon’s final theoretical revision (2011) set the stage for the development of the current instrument, the MCMI-IV. Although the revision contained numerous enhancements and clarifications, two additions are most salient. First, this edition of the theory introduced another personality pattern, the Turbulent prototype, based on early psychoanalytic descriptions (e.g., Kraepelin, 1921; see also Boudry, 1983, and Carlson & Maniacci, 2012, for further discussion) as well as more current references in popular culture (e.g., Jamison, 2005). Second, the theory more fully articulated a wider bandwidth from adaptive to maladaptive levels of personality functioning. Although the evolutionary theory always specified a continuum, the revision sought to highlight characteristics at mild, moderate, and severe personologic pathology levels, designated as Style, Type, and Disorder, respectively.

Rapid Reference 1.1

Millon Clinical Multiaxial Inventory-IV (MCMI-IV)


: Theodore Millon, PhD, DSc; Seth Grossman, PsyD; and Carrie Millon, PhD

Publication date

: 2015


: Pearson Clinical Assessments; 5601 Green Valley Drive, Bloomington, MN 55437

Copyright holder

: Dicandrien, Inc.

What the test measures

: Personality patterns and domains (adaptive styles, abnormal traits, clinical disorders) in context with clinical psychopathology with individuals seeking clinical services

Age range

: 18 years and older

Reading level

: Fifth grade

Average administration time

: 30 to 40 minutes or less


: The instrument is normed on 1,547 clinical subjects (individuals seeking mental health services). Detailed normative information is available in the MCMI-IV examiner’s manual (Millon et al., 2015).

Qualification of examiners

: Purchase of MCMI-IV materials requires a C-level qualification as elaborated at


Products and services

: Examiner’s manual (digital and paper), paper-pencil test materials (for mail-in scoring), and administration and scoring services via digital platforms Q-Global (web-based) and Q-Local (local PC-based) are available through Pearson Clinical Assessments.


The decision to develop a new version of the MCMI followed the historic precedent to keep the instrument aligned not only with the official diagnostic system, but with contemporary clinical needs as reflected by sociological changes. The manual for the last update to the MCMI-III (Millon et al., 2009) noted several of these trends, such as different concentrations of disorders and diagnoses, as well as a new standard for a combined-gender normative sample in several other instruments (prompting a renorming of the MCMI-III in its 4th edition). However, the authors agreed that there were substantive societal changes that could not be addressed by the MCMI-III renorming project alone, and Millon’s theory had been recently significantly updated (Millon, 2011). Therefore, the decision was made for the development of the next generation of the instrument, the MCMI-IV.

Theoretical-Substantive Stage