The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress, 21, 58-65

National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 02/2008; 21(1):58-65. DOI: 10.1002/jts.20303
Source: PubMed


This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.

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Available from: Terence M Keane, Jun 16, 2015
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    • "However, the absence of disorders such as PTSD in earlier studies regarding the structure of psychopathology most likely reflects a methodological characteristic of earlier large epidemiological datasets where PTSD was excluded, rather than theoretical or substantive considerations. Investigations using more recent epidemiological and clinical samples have since located PTSD under the broad internalizing latent dimension (Cox et al., 2002; Miller et al., 2008; Seeley et al., 2011). Additionally, using alternative methods and discrete-time survival analysis, Kessler et al., (2011) demonstrated that the development of comorbidity among anxiety (including PTSD), mood, and substance disorders over time could be accounted for by two common pathways representing internalizing and externalizing disorders. "
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    ABSTRACT: The experience of traumatic events has been linked to the development of psychopathology. Changing perspectives on psychopathology have resulted in the hypothesis that broad dimensional constructs account for the majority of variance across putatively distinct disorders. As such, traumatic events may be associated with several disorders due to their relationship with these broad dimensions rather than any direct disorder-specific relationship. The current study used data from 8,871 Australians to test this hypothesis. Two broad dimensions accounted for the majority of relationships between traumatic events and mental and substance use disorders. Direct relationships remained between post-traumatic stress disorder and six categories of traumatic events in the total population and between drug dependence and accidents/disasters for males only. These results have strong implications for how psychopathology is conceptualized and offer some evidence that traumatic events are associated with an increased likelihood of experiencing psychopathology in general.
    Full-text · Article · Feb 2016
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    • "mood and anxiety disorders) and externalizing (e.g. substance use disorder, antisocial personality disorder) (Krueger, 1999; Krueger et al. 2001; Vollebergh et al. 2001; Kendler et al. 2003b; Watson, 2005; Slade & Watson, 2006; Miller et al. 2008; Markon, 2010; Miller et al. 2012). Most of this work is conducted within the context of the Big Five traits of neuroticism, extraversion , agreeableness, conscientiousness, and openness (Watson et al. 1994; Markon et al. 2005; Watson et al. 2008). "
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    ABSTRACT: Background. Research suggests that personality traits have both direct and indirect effects on the development of psychological symptoms, with indirect effects mediated by stressful or traumatic events. This study models the direct influence of personality traits on residualized changes in internalizing and externalizing symptoms following a stressful and potentially traumatic deployment, as well as the indirect influence of personality on symptom levels mediated by combat exposure. Method. We utilized structural equation modeling with a longitudinal prospective study of 522 US National Guard soldiers deployed to Iraq. Analyses were based on self-report measures of personality, combat exposure, and internalizing and externalizing symptoms. Results. Both pre-deployment Disconstraint and externalizing symptoms predicted combat exposure, which in turn predicted internalizing and externalizing symptoms. There was a significant indirect effect for pre-deployment externalizing symptoms on post-deployment externalizing via combat exposure (p < .01). Negative Emotionality and pre-deployment internalizing symptoms directly predicted post-deployment internalizing symptoms, but both were unrelated to combat exposure. No direct effects of personality on residualized changes in externalizing symptoms were found. Conclusions. Baseline symptom dimensions had significant direct and indirect effects on post-deployment symptoms. Controlling for both pre-exposure personality and symptoms, combat experiences remained positively related to both internalizing and externalizing symptoms. Implications for diagnostic classification are discussed.
    Full-text · Article · Jan 2016 · Psychological Medicine
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    • "Breslau et al., 2000; Brewin et al., 2000; Kendler et al., 2002; Koenen et al., 2008; O'Donnell et al., 2004). In addition, by using factor analysis, some studies have found that PTSD and depression load onto the same higher-order factor (Anxious Misery/ Distress; Cox et al., 2002; Miller et al., 2008; Slade and Watson, 2006). And in the quantitative hierarchical model of mood and anxiety disorders proposed by Watson (2005), PTSD is grouped into the subclass of distress disorders along with MDD, suggesting that PTSD and depression share identical elements of one form of psychopathology. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. A sample exposed to specific traumatic events was assessed by self-report measures. The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations. Copyright © 2015 Elsevier B.V. All rights reserved.
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