Personal Injury, Workers’ Compensation,
Health Psychology and Pain Psychology

The four basic scales that are the most involved in these areas are:

 

The following is a discussion of some of the potential contributions of these scales regarding health, injury, and suffering when viewed from an adaptational and learning perspective. For an expanded discussion of the eight basic clinical scales see Caldwell, 2001, or contact Caldwell Report for a copy of that paper. The included sample report is from a 13/31 coded profile, a pattern which is both frequent and often problematic in each of the above contexts.

 

Scale 1-Hs I believe that scale 1-Hs should basically be interpreted as the extent and intensity of attention that is focused on the person’s physical symptoms and the security of one’s health status. Those with scores that are relatively elevated, e.g., over T-70 to T-80, and high in the code, typically are strongly preoccupied with their bodily problems and anything that is perceived to identify a threat or risk of increasing decline and greater vulnerability of the person’s intact survival. It is correct, of course, that the scale was based on contrasting the responses of patients without any identifiable medical causes for their health distresses versus normal subjects. But an elevation does not demonstrate that a person’s physical complaints are without medical cause: one person can be seriously ill and markedly illness preoccupied, while another person can be equally seriously ill and only intermittently or even insufficiently attentive to their illness. High to very high scores do mark a serious potential for developing symptomatic concerns primarily on a fear-generated basis, but a high score on 1-Hs is still not a proof that any given symptom does not have a partly or even primarily physiologic origin.

 

The diagnoses of somatization (lower K) and hypochondriasis (similar MMPI-2 patterns but higher K) are clinical judgments as to whether the extent of concern is or is not disproportionate to the person’s medical status. If substantially elevated, then the interpretation of the scale is of a heightened level of fear of (1) physical disablement and (2) progressive decline, perhaps resulting from prior experiences of imminently disabling or especially death-frightening moments. The resulting adaptive self-protections can range from a mild cautiousness or inhibition of physical activities with scattered repetitive health concerns when under emotional stress (e.g., T-score 55 to 65) to an immobilization of most activities and unending illness concerns (e.g., T-score over 85 and first or second in the code). Thus, this extent of preoccupation is what scale 1-Hs is assessing; whether particular symptoms are more strongly due to medical vs. psychologic contributions is a secondary implication depending in part on the person’s actual health status.

 

Data from the Mayo clinic (Swenson, Pearson, & Osborne, 1973) indicated a close to 10 point T-score increase in medical patients in general; that is broadly an average one standard deviation increase in health concerns as a function of being sick and in a hospital. Obviously some disorders are more threatening than others, so this baseline is naturally variable among patients of diverse diagnoses. But a 20 or 30 point or larger upward T-score shift (from T 50) on 1-Hs tells us that the person’s mental attention and psychic energy have become strongly focused on health and illness issues.

 

Scale 2-D The common theme among those with scale 2-D depression patterns is some element of loss. Loss is broadly defined; it is not limited to someone’s death or a singular tragedy. There can be a decline in one’s health, aging beyond the capacity to ever have a much-wanted child, a major decline of social supports, the ending of a career (even if expected, more personally tragic if not), a loss of one’s life expectations from a happy marriage, giving up one’s hopes of future travel, and so forth. A chronic deprivation of positively rewarding experiences in childhood seems to have a substantially overlapping and predisposing impact, perhaps understandable in part by the inhibition of the will as an adaptation to a marked reduction or generalized absence of positive inputs and rewards (e.g., a self-preoccupied or depressed mother).

 

The impact of a loss is maximized by (1) how vital the loss is to the person and (2) how permanent and irretrievable it is seen to be. If what was lost can be regained, and it did not matter that much anyhow, the impact, of course, is limited. But if what was lost was vital and can never be regained, it becomes - or may need to become - a focus of active grieving. Note that these are perceived losses. One person’s tragedy can be another’s minor setback. People can be self-deceiving as to how much something matters until they lose it. In the end the issue is, how much did it matter to the individual?

 

Scale 3-Hy The nature of Hysteria is a two-millennium plus enigma. The notion of uterine causation persisted for well over two thousand years until about the beginning of the 20th Century: the uterus could wander about in the body, and where it re-attached it became the source of distressing symptoms (Freud was once scolded by a medical colleague that men could not have hysteria because they did not have a uterus). Demon possession was identified by, e.g., a failure to respond to the tapping of a hammer on a particular place on the woman’s body. Charcot, Freud and others wrote about the conversion of psychic energy into anatomic energy and inhibition, but the "defense mechanism of conversion" has always seemed to me to be less a linear, stepwise mechanism and more nearly a metaphor.

 

Elevations on scale 3-Hy are associated with protective behaviors that avoid (1) interpersonal sources of emotional pain and anguish as well as (2) internal sources of distress, i.e., increased bodily pain and threats of increasing physical misery. The external sensitivities are marked by the scales with which 3-Hy is paired: for example, 34/43 patterns indicate a sensitivity to rejection, often as the person was painfully rejected as a child; 36/63 patterns appear to be associated with fears of deliberately hurtful humiliation, and 39/93 anticipates past occasions of deeply cutting criticism against which protective or over-compensatory reactions such as perfectionism become persistent adaptations. Internal sensitivities are marked by the scales more directly associated with somatic pain: for example, 13/31 is strongly focused on protecting against physical pain and associated emotional suffering, especially as a condition is seen as becoming progressively more anguishing; 23/32 adaptations appear centrally to minimize the pain of unresolved grief; and 37/73 adaptations are to mitigate the painful alarm of emotional shocks and startling misfortunes that were not or cannot be anticipated. Across these patterns, occasions of acute fear and desperate needs to reduce it may perhaps be perceived as "hysterical moments." In sum, I see the "Conversion Hysteria" scale as assessing the urgency of avoiding or adapting to occasions of acute physical pain and/or of great emotional distress that is suffered in one’s body.

 

Scale 7-Pt My hypothesis regarding Scale 7-Pt (Caldwell, 2001) is that unpredictable and frightening moments of startle shape the orienting response. The effect is a heightened frequency of low amplitude orienting responses. One alerts to seemingly endless minor distractions, which makes it hard to concentrate and to perform as well as one previously did. This is obviously a potential effect of an automobile crash or any such terrifying accidents in personal injury and workers’ compensation situations. Unfortunately, this effect usually takes time and patience to reduce.

 

 

 

References

 

Caldwell, 2001, What do the MMPI scales fundamentally measure? Some hypotheses. Journal of Personality Assessment, 76 (1), 1-17.

 

Marks, P. A., & Seeman, W. (1963). The actuarial description of abnormal personality.
Baltimore: Williams & Wilkins.

 

Swenson, W. M., Pears on, J. D., & Osborne, D. (1973). An MMPI source book: Basic item, scale, and pattern data on 50,000 medical patients. Minneapolis: University of Minnesota Press.