Transgender and the Use of MMPI-2
The Minnesota Multiphasic Personality Inventory (MMPI) test is a self-report measure of psychopathology and the personality structures in adults. As opposed to other similar tests, it is difficult for those subjected to it to give a false impression or deny` the existence of a problem. It is also possible to conduct empirical research using the MMPI-2 tests, as it gives an opportunity to give quantitative evidence. Therefore, it is more practical when evaluating psychological issues. It is especially the case in addressing the psychological issues of the diverse transgender population (Tellegen, et al., 2003).
Interventions such as hormonal treatment and reconstructive surgery are often used to enable transgender individuals transition into an authentic gender. The effects and risks associated with these interventions, especially the psychological effects are not well known. The MMPI-2 test seeks to assist psychologists, clinicians, and the societies understand these effects on transgender people. Before discussing the efficacy of using MMPI-2 on the transgender population, it is important to have a background of the transgender phenomenon and the psychological issues that arise therein.
Transgender individuals are those that have gender identity problems in that their assigned sex does not conform to their biological and psychological structures. As such, they do not fit the societal conceptions of the gender roles that they have been assigned (Sellbom, Ben-Porath, Lilienfeld, Patrick, & Graham, 2005).
Transgender individuals experience a barrage of issues that predispose them to psychological problems. The period of gender identity development often results in psychological distress, which is made worse by societal stereotypes and non-acceptance of transgender individuals in the wider society (Elkins, 2006). As a consequence of these internal conflicts, psychological therapy is usually recommended for the concerned individuals. That occurs if the transgender individual intends to transition to from their assigned gender to their preferred gender.
The issues of the transgender community are well articulated even in the purview of professional medicine as they are only considered to be in dire need of help if they are diagnosed with a gender identity disorder. Furthermore, a diagnosis of gender identity disorder for a transgender may not necessarily be the only trigger for help, but they may also be required to prove that it causes distress in the individual, which is often manifested in the form of depression and anti-social behavior.
However, the society has harbored a wrong perception of the transgender community in which it has become synonymous with gender identity disorders which is not the case for all transgender individuals. In fact, there are those transgender individuals that do not have a problem with their assigned gender. Most medical practitioners are of the view that gender identity disorders can only be rectified by hormone treatments or reconstructive surgery. While this might be the case, societal pressures against the transgender demographic have led to the push to treat all transgender individuals (even those that do not suffer from gender identity disorders).
The misinformation and stigma have served to disadvantage the transgender population, therefore, increasing further the distress that they encounter. That is especially the case for the gender queer category of transgender populations that do not have a unique gender identity but have nevertheless been forced to undergo hormone treatments or reconstructive surgery. Just as is the case with the general population seeking mental health services, a transgender seeking the same does not necessarily mean that they have a gender identity problem.
The MMPI-2 has been used to evaluate psychological functioning, and acute post treatments follow up, which is often three months after the onset of hormone treatment or reconstructive surgery (Tellegen, et al., 2003). However, there has been no harmonized body of research using MMPI-2 concerning transgender. In fact, most research outcomes differ in their interpretation of the psychopathology in the transgender demography. The test contains five hundred and sixty-seven items. It works by generating a score report that provides a scale.
In the case of transgender tests, control is required, which is usually a cisgender man or woman. It has four validity scales that include the lie (L) scale, the F scale, the BackF scale and the K scale all which are meant to assess a subject's approach to the test. The test seeks to determine if sexually dimorphic brain structures that affect an individual's psychology are similar to the preferred gender as opposed to the assigned gender. It also measures the psychological response to treatment and other corrective measures taken by transgender individuals.
Under the MMPI-2 test, the masculinity versus the femininity measures is the most instrumental concerning studies on transgender. It contains fifty-six items that are queried. The mf measures hobbies and vocational interests, as well as other preferences with the intention of determining how an individual subjected to the test fits into the societal perceptions of masculine or feminine roles.
It is against the background of research studies that have shown people with a gender identity disorder are at a greater risk of developing psychiatric problems when compared to the general population. MMPI-2 test seeks to help clinicians understand whether psychological dysfunction resulting from hormonal treatment in transgender individuals is the cause rather than the consequence of gender identity disorders.
The tests have shown that with hormonal treatment, there is usually a higher rate of associated psychological problems in male to female gender reassignments as opposed to the case in female to male reassignments. It also shows that the probability of psychological disorders increases with the late onset of gender identity disorder (post-pubertal) when compared to the early onset (pre-pubertal) of the gender disorders, especially when put on the spectrum of Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of assessment. The DSM system of evaluation makes use of a layer of axes models to offer a comprehensive diagnostic approach for individuals that suffer from mental health.
Studies were using the MMPI-2 in the past indicated transgender individuals have an increased probability of acquiring an Axis I disorder. However, current studies using the same tests seek to suggest a different perspective in evaluating the correlation between gender disposition and gender psychopathology. In these studies, 25% of the transgender individuals that have undergone hormone treatment had issues to do with substance abuse before the treatment (Sellbom et al., 2005).
However, only 10% of them showed any evidence of Axis I disorders symptoms (Sellbom et al., 2005). These symptoms include but are not limited to mental illness, genital mutilations, and suicidal behavior. For that reason, the use of MMPI-2 in transgender populations that have undergone hormone treatment or reconstruction surgery indicates reduced incidents of psychopathology. That is especially the case under the mf scale of the MMPI-2.
The study was conducted using the MMPI-2 test. It should be a significant reduction in psychopathology from the baseline in transgender men that had received the treatment as opposed to those that had not though the psychopathological levels were still quite high when compared to those of non-transgender men. Of importance is that the study illustrated that the various spheres of axes of disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), transgender individuals exhibit significant improvements in psychological functioning at a much faster rate than in non-transgender men (Sellbom at al., 2005).
However, the studies paint an entirely different picture when the comparison is between transgender individuals and cisgender individuals. That is opposed to the previous case where the comparison was between transgender individuals that had received some form of treatment against those transgender individuals that had not received any therapy. When compared to the general population, the transgender community performs poorly, especially concerning effective and anxiety disorders. The rates of these disorders, when compared to the general population, were significantly higher for both divisions of transgender (male to female and female to male).
The incompatibility between gender identity and other spheres of social life that people with gender identity disorders undergo can ultimately be the cause of the significantly varied results when compared to the general population (Nordin, Eisemann & Richter, 2005). Follow-up tests using MMIP-2 show an increase in depressive and anxiety symptoms during the treatment process. Consequently, stigma results, and that reduces the quality of life for transgender individuals especially regarding their mental health.
Some studies using the MMPI-2 indicate an increase in the prevalence rates of suicides among the transgender demographic, especially those that suffer from gender identity disorders. However, it was not directly attributed to psychological co-morbidity. For that reason, gender identity disorder may not necessarily be a contributing factor to the suicide attempts, but acts as a coping mechanism used by these individuals. The major conclusion from such studies is that psychiatric conditions such as suicidal behavior, depression and anxiety should not be considered as the effects of hormonal treatment and reconstructive surgery as is the case currently.
The use of MMPI-2 has increased over the years, and it is among the most frequently used psychological tests when evaluating the mental state and diagnostic measures in transgender individuals. While it is important in addressing individual cases, it also shows a wide misconception and mismatch in information as regards transgender people. The validity of the MMPI-2 is not in doubt not only in dealing with transgender individuals, but also in other spheres of life (Sellbom, Fischler, Ben-Porath, 2007). However, the interpretation of the test scores is not harmonized and is often open to the discretion of the clinician administering the test.
Therefore, the decisions are often biased as there is no sufficient body of research to inform the clinicians at the same. Furthermore, these clinicians often find themselves entangled in the web of stereotyping of the transgender community just as is the case with the rest of the society (Gregory, 2007). In fact, many transgender individuals have been subjected to hormonal treatments and reconstructive surgeries, even in instances when the mf scale of the MMPI-2 showed they are quite stable and comfortable in their assigned gender. It is important that people realize that just as is the case with cisgender individuals that have mental issues, the same applies to transgender individuals and are not merely restricted to gender identity disorders.
All in all, in conclusion, MMPI-2 tests indicate that transgender individuals (especially those that have gender identity disorders) are more predisposed to psychopathology when compared to the general population (Sellbom et al., 2005). The use of hormonal treatment and reconstructive surgery shows marked improvements in the psychological functioning of transgender individuals. While this may paint a bright picture regarding the ability of corrective measures to alleviate the burden faced by transgender populations, it is evidently not enough.
It is especially the case when comparisons on the psychological functioning are made between transgender populations and the general population, which is evidenced by the huge disparities in the results of the MMPI-2 tests. Furthermore, there is a downside to the use of MMPI-2 tests. It is strictly controlled and only licensed clinicians, who are inadequate compared to the population of transgender individuals, can administer the test. As such, it has the effect of increasing the cost of the test, hence a barrier to many transgender individuals that would want to be examined (Nordin, Eisemann & Richter, 2005).
It is, therefore, evident that more needs to be done by the entire society and more so by the medical and research fraternities in a bid to come up with corrective measures that would bridge the gap in the psychological stability between transgender individuals and cisgender individuals. Efforts to reduce the barriers to undertaking the test would also be instrumental. While the MMPI-2 test provides psychologists with an overview of the individual’s mental status, it would be critical that these practitioners make extra commitments to assist their patients in coping with the adjustments following treatment (Sellbom, Fischler, Ben-Porath, 2007). Such measures may include linking them to support groups and offering counseling services.
There is also need to conduct more research to find out the disparities that are evidenced by the MMPI-2 test results even among the transgender communities themselves. For example, it would be important to find out why transgender individuals that transition from female to male portray better psychological functioning as opposed to those that transition from male to female. It is more so the case for those that would wish to transition. The use of MMPI-2 tests to determine the psychological standing of transgender individuals is not a means to an end. It is a tool that enables us to understand the issues that this demography faces and the task for the entire society is then to determine how best to address these matters (Elkins, 2006).
Ultimately, improvements in the psychological functioning that treated transgender individuals experience albeit small are an important pointer that it is better for these individuals and other minorities to come out and seek help rather than confining themselves (Paap, Kreukels, Cohen-Kettenis, Richter-Appelt, & De Cuypere, 2011). Individuals that fail to seek treatment end up paying a heavy price in terms of the psychological burden that they have to bear.
References
Butcher, J. N., & Williams, C. L. (2009). "Personality assessment with the mmpi-2: historical roots, international adaptations, and current challenges." Applied Psychology: Health and Well-Being 1 (1): 105–135
Colton, L., Herman, L., Reisner, S., Seth, T & Julia C. (2015). Testosterone treatment and MMPI–2 improvement in transgender men: A prospective controlled study.
Elkins, R. (2006). The Transgender Phenomenon. New York: Sage Press
Gregory, R. (2007). Psychological Testing: History, Principles, and Applications. Boston: Pearson.
Kreukels, B & Haraldsen, I. (2012). A European network for the investigation of gender incongruence: the ENIGI initiative. Journal of European Psychiatry, 27: 445–50
Nordin H, Eisemann M, Richter J (2005). MMPI-2 subgroups in a sample of chronic pain patients. Scandinavian Journal of Psychology. 46:209-216.
Paap, S., Kreukels B., Cohen-Kettenis, T., Richter-Appelt, H., & De Cuypere, G. (2011). Assessing the utility of diagnostic criteria: a multisite study on gender identity disorder. J Sex Med, 8: 180–90
Sellbom, M., Ben-Porath, Y. S., Lilienfeld, S. O., Patrick, C. J., & Graham, J. R. (2005). Assessing psychopathic personality traits with the MMPI-2. Journal of Personality Assessment, 85, 334-343.
Sellbom, M., Fischler, L., Ben-Porath, S., (2007). Identifying MMPI-2 predictors of police officer integrity and misconduct. Journal of Criminal Justice Behavior. 34:985-1004.
Tellegen, A., Ben-Porath, Y.S., McNulty, J.L., Arbisi, P.A., Graham, J.R., & Kaemmer, B. (2003). The MMPI-2 Restructured Clinical Scales: Development, validation, and interpretation: Minneapolis, MN2. An MMPI handbook: Vol. I. Clinical interpretation. Minneapolis, University of Minnesota Press
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