Slade T, Watson D. The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychol Med 36: 1593-1600

School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
Psychological Medicine (Impact Factor: 5.94). 12/2006; 36(11):1593-600. DOI: 10.1017/S0033291706008452
Source: PubMed


Patterns of co-occurrence among the common mental disorders may provide information about underlying dimensions of psychopathology. The aim of the current study was to determine which of four models best fits the pattern of co-occurrence between 10 common DSM-IV and 11 common ICD-10 mental disorders.
Data were from the Australian National Survey of Mental Health and Well-Being (NSMHWB), a large-scale community epidemiological survey of mental disorders. Participants consisted of a random population-based sample of 10641 community volunteers, representing a response rate of 78%. DSM-IV and ICD-10 mental disorder diagnoses were obtained using the Composite International Diagnostic Interview (CIDI), version 2.0. Confirmatory factor analysis (CFA) was used to assess the relative fit of competing models.
A hierarchical three-factor variation of a two-factor model demonstrated the best fit to the correlations among the mental disorders. This model included a distress factor with high loadings on major depression, dysthymia, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and neurasthenia (ICD-10 only); a fear factor with high loadings on social phobia, panic disorder, agoraphobia and obsessive-compulsive disorder (OCD); and an externalizing factor with high loadings on alcohol and drug dependence. The distress and fear factors were best conceptualized as subfactors of a higher order internalizing factor.
A greater focus on underlying dimensions of distress, fear and externalization is warranted.

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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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    • "A seminal paper by Krueger et al. (1998) – partly inspired by Achenbach & Edelbrock (1984) – suggested that relationships between disorders reflect two underlying dimensions – internalizing and externalizing – that are subject to genetic and environmental influences. This grouping of mental disorders, or meta-structure, has received robust support from community and clinical samples worldwide, demonstrating invariance across cultures (Krueger et al. 1998, 2003; Vollebergh et al. 2001; Slade & Watson, 2006; Røysamb et al. 2011), gender (Eaton et al. 2012), ethnicity (Eaton et al. 2013), age (Eaton et al. 2011), and time (Krueger et al. 1998; Vollebergh et al. 2001; Measelle et al. 2006; Eaton et al. 2011). However, important gaps remain. "
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    ABSTRACT: Background: Most empirical studies into the covariance structure of psychopathology have been confined to adults. This work is not developmentally informed as the meaning, age-of-onset, persistence and expression of disorders differ across the lifespan. This study investigates the underlying structure of adolescent psychopathology and associations between the psychopathological dimensions and sex and personality risk profiles for substance misuse and mental health problems. Method: This study analyzed data from 2175 adolescents aged 13.3 years. Five dimensional models were tested using confirmatory factor analysis and the external validity was examined using a multiple-indicators multiple-causes model. Results: A modified bifactor model, with three correlated specific factors (internalizing, externalizing, thought disorder) and one general psychopathology factor, provided the best fit to the data. Females reported higher mean levels of internalizing, and males reported higher mean levels of externalizing. No significant sex differences emerged in liability to thought disorder or general psychopathology. Liability to internalizing, externalizing, thought disorder and general psychopathology was characterized by a number of differences in personality profiles. Conclusions: This study is the first to identify a bifactor model including a specific thought disorder factor. The findings highlight the utility of transdiagnostic treatment approaches and the importance of restructuring psychopathology in an empirically based manner.
    Full-text · Article · Dec 2015 · Psychological Medicine
    • "The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) and the International Classification of Diseases—Eleventh Edition Beta Draft (ICD-11) now incorporate dimensional spectra of psychopathology (e.g., the internalizing spectrum and the externalizing spectrum ) to account for the body of research that documents the systematic patterns of co-occurrence between larger groups of disorders . The internalizing–externalizing framework has been researched extensively; it interprets comorbidity between disorders as an indicator of stable, underlying core psychological processes (Krueger, 1999), and has been expanded to include many types of psychopathology, including depressive and anxiety disorders , posttraumatic stress disorder, obsessive–compulsive disorder , bipolar disorder, eating disorders, schizophrenia, and personality disorders (Kotov et al., 2011; Krueger, 2005; Krueger, Caspi, Moffit, & Silva, 1998; Markon, Krueger, & Watson, 2005; Slade & Watson, 2006; Watson, 2005). Sexual dysfunctions also have strong and multifaceted relationships with depressive and anxiety disorders that are consistent with a shared underlying factor of internalizing psychopathology (see Laurent & Simons, 2009 for a review), and preliminary research has shown that a dimensional model that includes sexual problems in the internalizing spectrum fits better than a categorical model that separates the disorders (Forbes, Baillie, & Schniering , 2014a; Forbes & Schniering, 2013). "
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    ABSTRACT: Sexual dysfunctions have not been included in research on the broad structure of psychopathology to date, despite their high prevalence and impact on quality of life. Preliminary research has shown that they may fit well in an internalizing spectrum, alongside depressive and anxiety disorders. This study compared dimensional and categorical models of the relationships between depression, anxiety, and sexual problems with "hybrid" models (i.e., factor mixture analyses), which combine dimensional and categorical components simultaneously. Participants (n = 1000) were selectively recruited to include a range of symptom levels, and completed a series of self-report measures online. A hybrid model that combined dimensional and categorical components fit best for men and women. Taken together, the results are consistent with a nosology that explicitly recognizes the relationships between the diagnostic chapters of depressive and anxiety disorders and sexual dysfunctions, but still maintains discrete diagnoses, which is compatible with the structure of the DSM-5 and upcoming ICD-11.
    No preview · Article · Nov 2015 · Archives of Sexual Behavior
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