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Article Excerpt
The Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) is the most widely used and extensively investigated objective personality inventory. It is designed to assess psychopathology and emotional functioning in persons with many different types of mental and physical illnesses, including neurological diseases and injuries. The MMPI-2 provides extensive information about personality characteristics and emotional states, and it is used in a wide variety of settings with many different types of clients. However, there is a growing body of research that questions the use of the MMPI-2 with persons with neurological diseases and injuries without appropriate adjustments to the instrument's scoring and interpretation. Counselors who use and interpret the MMPI-2 with this population must be aware of this research in order to refrain from overpathologizing persons with neurological disorders.
Persons with multiple sclerosis, a neurological disease in which the immune system attacks the myelin sheath surrounding the neurons of the central nervous system, present a challenging case for psychological assessment. The characteristics of multiple sclerosis may lead medical doctors and neurologists to request formal assessments to determine psychological and cognitive functioning. The characteristics of multiple sclerosis may also lead those diagnosed to seek counseling because of psychological difficulties that either are a symptom of the disease or are a result of adjusting to and/or coping with the disease. In one study, 58% of persons with multiple sclerosis believed that they needed professional help for their emotional problems, although nearly half of those reported that they were not receiving such assistance (Eklund & MacDonald, 1991). A more recent study found that persons with multiple sclerosis have a need for mental health interventions at more than 2.6 times the rate of those in the general population (Patten, Beck, Williams, Barbui, & Metz, 2003). Because of the great need for psychological assistance among this population, it is not unlikely that counselors will encounter persons with multiple sclerosis on their caseloads. Clearly, a greater understanding of the illness, its psychological correlates, and the effects of the illness on psychological testing, would be of clinical utility for these practitioners.
* Multiple Sclerosis
Multiple sclerosis (MS) is a disease that affects the central nervous system. Myelin, the substance that surrounds nerve fibers, is damaged leaving scar tissue, typically called lesions. These lesions can be in the brain, on the spinal cord, or on the optic nerves. These lesions cause interference in the conduction of electrical impulses in the nerves that are affected (National MS Society, 2005). This interference can affect the sensory and motor function of the person diagnosed with MS. An estimated 400,000 Americans live with MS, and about 10,400 new cases are diagnosed each year (National MS Society, 2005).
The course of this disease is unknown and unpredictable. Functions that are lost because of the interference in the nerves are sometimes lost forever, sometimes only mild interruption in functioning is experienced, and sometimes they are lost for a time and then return to normal. Symptoms of MS can be experienced in a relapsing-remitting pattern, in a steadily progressive pattern, or in a combination of the two patterns. Relapsing-remitting MS is characterized by periods of experiencing symptoms and periods of fewer or no symptoms. Progressive MS is a steady, almost continuous increase of symptoms without remission (National MS Society, 2005).
Common Symptoms
Symptoms experienced by people with MS vary greatly. Some of the most common symptoms are (a) walking, balance, or coordination problems; (b) numbness or other abnormal sensations; (c) fatigue or MS lassitude; (d) bladder and bowel dysfunction; (e) dizziness and vertigo; (f) pain; (g) sexual dysfunction; (h) feelings of stiffness and involuntary muscle spasms; and (i) vision problems. Some less common symptoms include (a) headache, (b) hearing loss, (c) itching, (d) seizures, (e) speech and swallowing disorders, and (f) tremor (National MS Society, 2005). Up to 25% of persons with MS also report significant sleep difficulties (Clark et al., 1992).
In addition to the physiological symptoms, there are common cognitive and affective symptoms. These include problems with memory, problems with attention, difficulty with problem solving, emotional problems, and depression (National MS Society, 2005).
In general, quality of life in persons diagnosed with MS has been shown to be significantly poorer than that in healthy populations and significantly poorer than the quality of life in individuals diagnosed with other chronic illnesses, such as diabetes, epilepsy, rheumatoid arthritis, and inflammatory bowel disease. It is argued that the complexity of the illness and psychological reactions to it lead to poorer quality of life in this population (Hart, Fonareva, Merluzzi, & Mohr, 2005).
Four major difficulties arise when assessing and understanding the functioning of persons with MS. First, the disease is highly idiosyncratic. Persons with MS can exhibit none, some, or all of the symptoms of the disease at any given time. Second, the course of the disease is highly unpredictable. The physical, cognitive, and affective symptoms experienced by any one person can vary greatly over the course of the disease. Third, the disease is very hard to diagnose and undergoing years of uncertainty and misdiagnosis is common. Fourth, very little is known about the disease,...
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