Psychologizing Customers with Critical Items

*Editor’s Notes: 

— Critical items also have uses in non-clinical, business ventures where they serve as psychological markers for likely buyer behavior. 

— Specific critical items are not mentioned to protect the integrity of the tests. 

Critical items were born in the field of psychology to detect the presence of behavioral or mental instability (i.e., psychopathology) and serve as an indicator for intervention. Staying true to the definition of the term critical, these items represent a point of crisis that is uncommon to “normal individuals" (Fiske and Adkins, 2017). Critical items rely on the establishment of social norms and are indicated through psychological testing such as personality tests. If a person reports experiencing a critical item, that could tip off the clinician to the presence of psychopathology (Domino, 2006). 

Standardized Psychological Testing 

Psychologists use historical records, interviews, and behavioral observations in addition to tests to get a complete picture of psychological assessment. This information often supports the production of an item set. 

Upon establishing an item set, psychologists identify a group of subjects that the test is intended to measure, formally known as a designated population (Fiske and Adkins, 2017). Identifying the proper population for an inventory—as well as ensuring that anyone from that population has an equal chance of being included in the standard sample—is extremely important because the normative data becomes the benchmark for comparing and contrasting an individual’s performance (Committee on Psychological Testing, 2015). Additionally, normative data allows for the interpretation of data and prediction based on verification of the data. 

The Committee on Psychological Testing emphasizes the importance of standardized administration because any supplementary information provided by the examiner can alter the individual’s scores. This initial process also serves to iron out the administrative process and adjust any questions that are unclear. 

Woodworth Psychoneurotic Inventory

In 1920 psychologist Robert Woodworth created his Psychoneurotic Inventory of 116 yes or no questions that measured emotional instability. The inventory is often referred to as the “first structured test of psychopathology” (Koss and Butcher, 1973, p. 225). The inventory contained 10 questions (i.e., the first true set of critical items) that—if even one was answered yes to—indicated a neurotic tendency (Koss et. al., 1976). 

However, as Koss noted, single items are higher risk than multiple items with scales because an error in the patient’s judgment—whether they accidently choose the wrong option, misread the question, or incorrectly interpret the context—can “invalidate the item as a correct sample of behavior” (Koss, et. al., 1976, p. 923). Still, Woodworth’s method for developing a personality test paved the way for diagnostic techniques, as Grayson and Caldwell respectively added 38 and 69 critical items to the MMPI (Grayson 1951, Caldwell 1969). However, Koss noted that such methods were “derived intuitively” necessitating the development of empirically verifiable items (Koss, et. al., 1976, p. 921).

Crisis Situation 

The Koss-Butcher (1973, 1976) crisis situations—which are still used in the MMPI-2—were used to test critical items and their efficacy to delineate across situations. The results produced 67 critical items that differentiated psychiatric patients admitted in categories of crisis from general psychiatric patients. 

• Acute Anxiety State: The anxiety category represents a person who deals with intense stress that hinders performance. Other experiences may include restlessness, tension, and poor diet. 

• Depressed-Suicidal Ideation: The depressive category represents a person who has been experiencing elevated or lowered mood for several months and perhaps has voiced the urge to commit suicide. 

• Situational Stress Due To Alcoholism: The alcohol/drug category represents a person who struggles with drugs or alcohol, to the point that they cannot maintain their everyday lives (e.g., they were recently fired for drug use or their drug use has strained personal relationships). Denial—a Freudian psychological defense mechanism—of usage and its perceived effects are common. 

• Threatened Assault: The marital crisis category represents a person with wild temper and disorderly, forcefully violent behavior. This person would not abide by the societal convention that you should never “place your hands” on another person. 

• Mental Confusion: The psychotic category represents a person who is disconnected from reality. In other words, they see the world in a drastically different way than most others. They may hallucinate or be generally disoriented. 

• Persecutory Ideas: The paranoid category represents a person who is suspicious and uneasy, or highly strung. They might think that someone or something is out to get them. 

Validating Hunches

The Lachar-Wrobel critical items (1979)—some of which are still used in the MMPI-2—were developed as “face-valid descriptors of psychological concern” (Lachar and Wrobel, 1979, p. 284). The results totaled 111 items across 14 content categories that aimed to align MMPI critical items with accurate patient behavior and history. 

• Anxiety and Tension: This category is indicated by experiences of dread, fear, panic, and stress. These are not your typical Sunday Scaries, however. They are forces that drive people to seek treatment. 

• Depression and Worry: This category is indicated by episodes of depression, depression onset from an adverse life experience (e.g., loss of job or family member), as well as attempted suicide or the desire to do so. 

• Sleep Disturbance: This category is indicated by sleep troubles, including erratic sleep patterns and sleep deprivation. Sleep is essential for physical and psychological health, so its disturbance can be critical. 

• Deviant Beliefs: This category is indicated by strange thoughts and ideas of the paranoid, overambitious, or out of touch with reality type. However, deviant beliefs are culture specific, as norms vary from culture to culture. 

• Deviant Thinking and Experience: This category is indicated by odd associations, hallucinations, and delusional thinking. There’s a fine line between deviant thought and true artistry. Given the right platform, deviant thoughts can become art. Consider Dali’s clock paintings. 

• Deviant Behavior: This category is indicated by ill-suited, ritualistic, and even manic behavior. Again, societal differences play a huge role in determining what is and is not deviant. Today, cannibalism would be conventionally considered deviant, however it has been reported that the practice is still in ritualistic use in far reaching parts of the world. 

• Substance Abuse: This category is indicated by the usage of drugs and alcohol to the point of issue, such that the person cannot maintain their current affairs in an orderly or acceptable manner. 

• Antisocial Attitude: This category is indicated by disdain and disrespect for authority and general societal conventions. Green Day is the most vivid example of an antisocial attitude in music. By modern standards, war—and not peace—is the convention. Green Day actively promotes anti-war messages in their music. 

• Family Conflict: This category is indicated by deep seated dissent and hostility towards non-spousal family members. We all have family troubles, but the conflicts of this variety are aggressive. 

• Problematic Anger: This category is indicated by a similar definition of the prior Family Conflict category, with the distinction that the hostility is generally interpersonal, rather than family specific. 

• Sexual Concern: This category is indicated by issues with or unbridled worries about everyday sexual performance. This can relate to an inability to experience arousal or pleasure. 

• Sexual Deviation: This category is indicated by fetishism of uncommon objects or people (i.e., paraphilia) as well as gender-role conflicts, which can create strains in relationships. 

• Somatic Symptoms: This category is indicated by self-reported physical pains that are clinically determined to be exaggerated or even psychological by nature. With respect to amplified cognitions, this is sometimes referred to as pain catastrophizing.  

• Neurological Screening: This category is indicated by problems that necessitate neurological screening of the nervous system, or assessments of balance, coordination, hearing, speech, and mental status. 

Critical Buying Items

Critical items traditionally alert clinical psychologists that a likely behavior will occur. However, critical items can be conceptualized within the context of the workplace or marketing outcomes (e.g., likelihood to buy product X). Psychologize allows marketers to easily test consumer’s on sets of critical buying items. Try it out today to discover what our psych tech can do for your marketing strategy. 

References: 

Caldwell, A. B. (1969). MMPI critical items. Unpublished manuscript (Available from Clinical Psychological Services, 3122 Santa Monica Blvd., Santa Monica, CA 90404). 

Committee on Psychological Testing, Including Validity Testing, for Social Security Administration Disability Determination. (2015). Overview of Psychological Testing. Board on the Health of Select Populations; Institute of Medicine. Psychological Testing in the Service of Disability Determination. Washington (DC): National Academies Press (US). 

Domino, G., & Domino, M. L. (Eds). (2006). Psychological testing: An introduction. Cambridge University Press.

Fiske, D., & Adkins, D. (2017). Psychological testing. Encyclopædia Britannica.

Grayson, H. M. (1951). PsychologicalAdmissionsTestingProgram and Manual. Los Angeles: Veterans Administration Center, Neuropsychiatric Hospital.

Koss, M. P., & Butcher, J. N. (1973). A comparison of psychiatric patients' self-report with other sources of clinical information. Journal of Research in Personality, 7, 225-236.

Koss, M. P., Butcher, J. N., & Hoffmann, N. G. (1976). The MMPI critical items: How well do they work? Journal of Consulting and Clinical Psychology, 44(6), 921–928. 

Lachar, D., & Wrobel, T. A. (1979). Validating clinicians' hunches: Construction of a new MMPI critical item set. Journal of Consulting and Clinical Psychology, 47(2), 277–284.

Woodworth, R. S. (1920). Personal Data Sheet. Chicago: Stoelting.