clinical disorders of the DSM-5. Similar to the personality scales, the 10 clinical syndrome scales are broken down into 7 clinical syndrome scales (A-R) and 3 severe clinical syndrome scales (SS-PP). When interpreting the clinical scales, the authors recommend that qualified professionals interpret the Severe Clinical Syndrome scales before the Clinical Syndrome scales as the pattern of responding indicated by the Severe Clinical Syndrome scale scores may also affect the scores on the Clinical Syndrome scales (e.g. if an individual scores high on the Severe P scale Clinical Syndrome scale score (e.g. Thought Disorder), this may also explain the pattern of scores on the other Clinical Syndrome scales). Summary table of clinical syndrome scales Validity scales Modifying indices The modifying indices consist of 3 scales: the Disclosure Scale (X), the Desirability Scale (Y) and the Debasement Scale (Z). These scales are used to provide information about a patient's response style, including whether they presented themselves in a positive light (elevated Desirability scale) or negative light (elevated Debasement scale). The Disclosure scale measures whether the person was open in the assessment, or if they were unwilling to share details about his/her history. Random response indicators These two scales assist in detecting random responding. In general, the Validity Scale (V) contains a number of improbable items which may indicate questionable results if endorsed. The Inconsistency Scale (W) detects differences in responses to pairs of items that should be endorsed similarly. The more inconsistent responding on pairs of items, the more confident the examiner can be that the person is responding randomly, as opposed to carefully considering their response to items. Validity The MCMI-IV was updated in 2015, with revised items and a new normative sample of 1,547 clinical patients. The process of updating the MCMI-IV was an iterative process from item generation, through item tryout, to standardization and the selection of final items to be included in the full scale. Test construction underwent three stages of validation, more commonly known as the tripartite model of test construction (theoretical-substantive validity, internal-structural validity, and external-criterion validity). As development was an iterative process, each step was reanalyzed each time items were added or eliminated. Theoretical-substantive validity The first stage was a deductive approach and involved developing a large pool of items. 245 new items were generated by the authors in accordance with relevant personality research, reference materials, and the current diagnostic criteria. These items were