The joint structure of DSM-IV and Axis I and II disorders

Norwegian Institute of Public Health and University of Oslo, Norway.
Journal of Abnormal Psychology (Impact Factor: 4.86). 02/2011; 120(1):198-209. DOI: 10.1037/a0021660
Source: PubMed


The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.

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    • "Relatedly, additional validation work in relation to treatment course and outcomes could help facilitate the development of tailored prevention and intervention programs. From a structural perspective, the close relationship between PTSD and internalizing disorders adds to a nascent literature suggesting that PTSD should be located within the internalizing dimension (e.g., Cox et al., 2002; Eaton et al., 2011; Keyes et al., 2013; Røysamb, et al., 2011). "
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    ABSTRACT: Background: The posttraumatic stress disorder (PTSD) literature is replete with investigations of factor structure, however, few empirical studies have examined discriminant validity and the moderating role of gender on factor structure and symptom expression. This study aimed to address these gaps. Methods: An online, population-based study of 3175 Australian adults was conducted. This study analyzed data from 642 participants who reported a traumatic event. Overall, 10.2% (13.4% females, 7.6% males) met diagnostic criteria for current PTSD. Results: Confirmatory factor analyses indicated that eight factor models provided excellent fit to the data. The DSM-5 model, anhedonia and hybrid models provided strong fit to the data, based on statistical fit indices and parsimony. The models' factors were significantly associated with a number of external correlates. Factor structure was gender invariant for the three models, albeit significant latent mean-level differences were apparent in relation to the intrusion/re-experiencing and alterations in arousal and reactivity factors. Bonferroni-adjusted Wald chi-square tests indicated significant gender differences in four DSM-5 PTSD symptoms: females reported significantly higher rates of negative beliefs, diminished interest, restricted affect and sleep disturbance symptoms compared to men. Limitations: Response rate to the survey was low. However, the number of respondents who completed the survey was high and population weights were employed to account for self-selection biases and aid generalizability. Conclusions: The findings provide support for the DSM-5, anhedonia and hybrid models compared to alternative models based on DSM-5 symptoms. Discriminant validity analyses indicated similar patterns of significant associations with the transdiagnostic factors, potentially suggesting that all the PTSD factors are related to non-specific distress. Further research investigating how gender influences PTSD symptom expression is warranted, including possible gender differences in symptom item interpretation.
    Journal of Affective Disorders 10/2015; 190:56-67. DOI:10.1016/j.jad.2015.09.071 · 3.38 Impact Factor
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    • " biologi - cal predispositions , the CAPS model emphasizes the substantial influence that biogenetic factors can have at all lev - els of analysis . Indeed , there is an empirical basis for evaluat - ing the biogenetic underpinning of personality and related psychopathology , particularly with regard to Axis II disorders ( DeYoung et al . , 2010 ; Røysamb et al . , 2011 ; South & DeYoung , 2013 ) . More specifically , there is growing evidence for the interaction of biological influences on personality with developmental experiences or contexts ( Bornovalova et al . , 2013 ; Cicchetti , Rogosch , Hecht , Crick , & Hetzel , 2014 ; Dis - tel et al . , 2011 ; Krueger et al . , 2002 ) . One such line of re"
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    ABSTRACT: The Cognitive-Affective Processing System (CAPS) is a dynamic and expansive model of personality proposed by Mischel and Shoda (1995) that incorporates dispositional and processing frameworks by considering the interaction of the individual and the situation, and the patterns of variation that result. These patterns of cognition, affect, and behavior are generally defined through the use of if … then statements, and provide a rich understanding of the individual across varying levels of assessment. In this article, we describe the CAPS model and articulate ways in which it can be applied to conceptualizing and assessing personality pathology. We suggest that the CAPS model is an ideal framework that integrates a number of current theories of personality pathology, and simultaneously overcomes a number of limits that have been empirically identified in the past.
    Journal of Personality Assessment 07/2015; 97(5):1-11. DOI:10.1080/00223891.2015.1058806 · 2.01 Impact Factor
    • "This strategy might also be helpful to integrate other domains (e.g., clinical syndromes formerly represented on Axis I in DSM) into a general latent framework of psychopathology (Kotov et al., 2011; Markon, 2010; Røysamb et al., 2011). Indeed, as Markon (2010) demonstrated, many of the individual clinical syndromes and PD symptoms clustered together to form 20 specific factors that loaded on four more general factors. "
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    ABSTRACT: Rigorous science and effective treatment both rest on a foundation of valid and reliable assessment and diagnosis. In the consulting room, assessment and diagnosis should provide useful information for clear communication among professionals and to patients, establishing prognosis and ultimately deciding whether, and if so how, to treat. In the laboratory, assessment and diagnosis are necessary to decide which participants to include and exclude from studies, while also providing data of interest to examine as predictors and outcomes. In turn, assessment and diagnosis are predicated on the understanding of the nature and structure of the target phenomenon, in this case personality disorder (PD). Thoroughly and accurately assessing and diagnosing PD can be a demanding enterprise. Patients with severe PDs often lead chaotic lives and have a fragmented or diffuse sense-of-self that can become embodied in a frenzied assessment process and a muddled clinical picture. In contrast, milder but nevertheless impairing personality pathology often becomes apparent only as a clinician learns the patient’s characteristic manner of perceiving and responding to others, and set ways of regulating self and affect. These difficulties in the assessment process are understandable and to be expected given the nature of the pathology. However, a further challenge to this enterprise is that the current diagnostic framework more often than not serves to obfuscate as opposed to clarify clinical description. For more than 30 years, the modern era of the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2013) has furthered a model of personality pathology in which patients can receive one of ten putatively discrete, categorical PD diagnoses, or a diagnosis of PD not otherwise specified (PD-NOS). Despite a growing body of scientific work that calls its fundamental structure in to question (Widiger & Trull, 2007), this remains the model for the foreseeable future as it has been ported virtually verbatim from DSM-IV to DSM-5. Here we highlight a number of key questions that emerge when the extant PD model is applied in clinical practice, and demonstrate how they are directly amenable to investigation using contemporary quantitative methodology.
    Personality disorders: Toward theoretical and empirical integration in diagnosis and assessment, Edited by Steven K. Huprich, 01/2015: chapter 5: pages 109-144; American Psychological Association., ISBN: 978-1-4338-1845-5
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