Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-23T10:21:36.830Z Has data issue: false hasContentIssue false
  • English
  • Français

Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders

Published online by Cambridge University Press:  11 June 2009

K. E. Markon
K. E. Markon*
Affiliation:
Department of Psychology, University of Iowa, Iowa City, IA, USA
*
*Address for correspondence: K. E. Markon, Ph.D., Department of Psychology, University of Iowa, 11 Seashore Hall E., Iowa City, IA 52242, USA. (Email: kristian-markon@uiowa.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Analyses of co-morbidity patterns among common mental disorders have repeatedly indicated that relationships among disorders can be understood in terms of broad superordinate dimensions. However, these analyses have been based on syndromal-level indicators, which are often heterogeneous, rather than on symptoms, which are presumably more homogeneous.

Method

Symptom-level exploratory and confirmatory analyses were used to explore the joint hierarchical organization of Axis I and II psychopathology, using data on 8405 individuals from the 2000 British Psychiatric Morbidity Survey.

Results

Analyses indicated that 20 identified subordinate dimensions of psychopathology could be organized into four broad superordinate dimensions: Internalizing, Externalizing, Thought Disorder, and Pathological Introversion.

Conclusions

These results extend existing model frameworks ‘downward’ as well as ‘outward’, by analyzing symptoms rather than diagnoses, and by integrating symptoms from Axis I and II disorders in a common framework. This model demonstrates the importance of hierarchy in psychopathology structure, comprises replicable features of psychopathology structure, and has important implications for understanding the nature and organization of mental disorders.

Keywords

Axis IAxis IIfactor analysispsychopathologystructural equation model
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 273 - 288
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Achenbach, TM (1966). The classification of children's psychiatric symptoms: a factor analytic study. Psychological Monographs 80, 1–37.CrossRefGoogle ScholarPubMed
Austin, EJ, Deary, IJ (2000). The ‘four As’: a common framework for normal and abnormal personality? Personality and Individual Differences 28, 977–995.CrossRefGoogle Scholar
Babor, TF, de la Fuente, JR, Saunders, J, Grant, M (1992). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. World Health Organization: Geneva.Google Scholar
Bacon, DR (2001). Evaluation of cluster analytic approaches to initial model specification. Structural Equation Modeling 8, 397–429.CrossRefGoogle Scholar
Bagby, RM, Costa, J, Widiger, TA, Ryder, AG, Marshall, M (2005). DSM-IV personality disorders and the five-factor model of personality: a multi-method examination of domain- and facet-level predictions. European Journal of Personality 19, 307–324.CrossRefGoogle Scholar
Bebbington, P, Nayani, T (1995). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research 5, 11–19.Google Scholar
Bedford, A, Deary, IJ (2006). The British Inventory of Mental Pathology (BIMP): six factored scales. Personality and Individual Differences 40, 1017–1025.CrossRefGoogle Scholar
Bienvenu, OJ, Samuels, JF, Costa, PT, Reti, IM, Eaton, WW, Nestadt, G (2004). Anxiety and depressive disorders and the five-factor model of personality: a higher- and lower-order personality trait investigation in a community sample. Depression and Anxiety 20, 92–97.CrossRefGoogle Scholar
Bickel, PJ, Levina, E (2008). Covariance regularization by thresholding. Annals of Statistics 36, 2577–2604.CrossRefGoogle Scholar
Brown, TA, Barlow, DH (2005). Dimensional versus categorical classification of mental disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and beyond: comment on the special section. Journal of Abnormal Psychology 114, 551–556.CrossRefGoogle ScholarPubMed
Cannon, TD, Keller, MC (2006). Endophenotypes in the genetic analyses of mental disorders. Annual Review of Clinical Psychology 2, 267–290.CrossRefGoogle ScholarPubMed
Chmielewski, M, Watson, D (2008). The heterogeneous structure of schizotypal personality disorder: item-level factors of the schizotypal personality questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality. Journal of Abnormal Psychology 117, 364–376.CrossRefGoogle ScholarPubMed
Chopra, HD, Beatson, JA (1986). Psychotic symptoms in borderline personality disorder. American Journal of Psychiatry 143, 1605–1607.Google ScholarPubMed
Clark, LA (2005). Temperament as a unifying basis for personality and psychopathology. Journal of Abnormal Psychology 114, 505–521.CrossRefGoogle ScholarPubMed
Connell, J, Barkham, M, Stiles, WB, Twigg, E, Singleton, N, Evans, O, Miles, JNV (2007). Distribution of CORE-OM scores in a general population, clinical cut-off points and comparison with the CIS-R. British Journal of Psychiatry 190, 69–74.CrossRefGoogle Scholar
Cooney, NL, Meyer, RE, Kaplan, RF, Baker, LH (1986). A validation study of four scales measuring severity of alcohol dependence. British Journal of Addiction 81, 223–229.CrossRefGoogle ScholarPubMed
Davidson, RJ, Putnam, KM, Larson, CL (2000). Dysfunction in the neural circuitry of emotion regulation: a possible prelude to violence. Science 289, 591–594.CrossRefGoogle ScholarPubMed
Depue, RA, Lenzenweger, MF (2006). A multidimensional neurobehavioral model of personality disturbance. In Personality and Psychopathology (ed. Krueger, R. F. and Tackett, J. L.), pp. 210–261. Guilford Press: New York.Google Scholar
Depue, RA, Morrone-Strupinsky, JV (2005). A neurobehavioral model of affiliative bonding: implications for conceptualizing a human trait of affiliation. Behavioral and Brain Sciences 28, 313–395.CrossRefGoogle ScholarPubMed
Dickinson, D, Ramsey, ME, Gold, JM (2007). Overlooking the obvious: a meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry 64, 532–542.CrossRefGoogle ScholarPubMed
Dikeos, DG, Wickham, H, McDonald, C, Walshe, M, Sigmundsson, T, Bramon, E, Grech, A, Toulopoulou, T, Murray, R, Sham, PC (2006). Distribution of symptom dimensions across Kraepelinian divisions. British Journal of Psychiatry 189, 346–353.CrossRefGoogle ScholarPubMed
Enders, CK, Peugh, JL (2004). Using an EM covariance matrix to estimate structural equation models with missing data: choosing an adjusted sample size to improve the accuracy of inferences. Structural Equation Modeling 11, 1–19.CrossRefGoogle Scholar
First, MB, Gibbon, M, Spitzer, RL, William, JBW, Benjamin, L (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders. American Psychiatric Press: Washington, DC.Google Scholar
Forbush, KT, South, S, Krueger, RF, Iacono, W, Clark, LA, Keel, PK, Watson, D (2007). Where do disordered eating attitudes and behaviors belong in the diagnostic taxonomy? Paper presented at the 21st Annual Meeting of the Society for Research in Psychopathology, Iowa City, IA, October 2001.Google Scholar
Gorsuch, RL (1983). Factor Analysis. Erlbaum: Hillsdale, NJ.Google Scholar
Gorsuch, RL, Nelson, J (1981). CNG scree test: an objective procedure for determining the number of factors. Paper presented at the annual meeting of the Society for Multivariate Experimental Psychology.Google Scholar
Gottesman, II, Shields, J (1973). Genetic theorizing and schizophrenia. British Journal of Psychiatry 122, 15–30.CrossRefGoogle ScholarPubMed
Groom, MJ, Bates, AT, Jackson, GM, Calton, TG, Liddle, PF, Hollis, C (2008). Event-related potentials in adolescents with schizophrenia and their siblings: a comparison with attention-deficit/hyperactivity disorder. Biological Psychiatry 63, 784–792.CrossRefGoogle ScholarPubMed
Harkness, AR, McNulty, JL, Finger, MS, Arbisi, PA, Ben-Porath, YS (1999). The pleiometric nature of psychoticism items, or why the Big-5 does not measure psychoticism. Paper presented at the 34th Annual MMPI-2 Symposium, Huntington Beach, CA, April 1999.Google Scholar
Hong, S, Mitchell, SK, Harshman, RA (2006). Bootstrap scree tests: a Monte Carlo simulation and applications to published data. British Journal of Mathematical and Statistical Psychology 59, 35–57.CrossRefGoogle Scholar
Jenkins, R, Bebbington, P, Brugha, T, Farrell, M, Gill, B, Lewis, G, Meltzer, H, Petticrew, M (1997). The National Psychiatric Morbidity Surveys of Great Britain: strategy and methods. Psychological Medicine 27, 765–774.CrossRefGoogle ScholarPubMed
James, LM, Taylor, J (2008). Revisiting the structure of mental disorders: borderline personality disorder and the internalizing/externalizing spectra. British Journal of Clinical Psychology 47, 361–380.CrossRefGoogle ScholarPubMed
Johns, LC, Cannon, M, Singleton, N, Murray, RM, Farrell, M, Brugha, T, Bebbington, P, Jenkins, R, Meltzer, H (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298–305.CrossRefGoogle ScholarPubMed
Johns, LC, Nazroo, JY, Bebbington, P, Kuipers, E (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. British Journal of Psychiatry 180, 174–178.CrossRefGoogle Scholar
Johnson-Selfridge, M, Zalewski, C (2001). Moderator variables of executive functioning in schizophrenia: meta-analytic findings. Schizophrenia Bulletin 27, 305–316.CrossRefGoogle ScholarPubMed
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937.CrossRefGoogle ScholarPubMed
Kendler, KS, Aggen, SH, Czajkowski, N, Roysamb, E, Tambs, K, Torgersen, S, Neale, MC, Reichborn-Kjennerud, T (2008). The structure of genetic and environmental risk factors for DSM-IV personality disorders. Archives of General Psychiatry 65, 1438–1446.CrossRefGoogle ScholarPubMed
Kessler, RC, Birnbaum, H, Demler, O, Falloon, IRH, Gagnon, E, Guyer, M, Howes, MJ, Kendler, KS, Shi, L, Walters, E, Wu, EQ (2005). The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R). Biological Psychiatry 58, 668–676.CrossRefGoogle ScholarPubMed
Krabbendam, L, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Nolen, WA, Iedema, J, Van Os, J (2004). Dimensions of depression, mania and psychosis in the general population. Psychological Medicine 34, 1177–1186.CrossRefGoogle ScholarPubMed
Krueger, RF, Chentsova-Dutton, YE, Markon, KE, Goldberg, D, Ormel, J (2003). A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting. Journal of Abnormal Psychology 112, 437–447.CrossRefGoogle ScholarPubMed
Krueger, RF, Markon, KE (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111–133.CrossRefGoogle ScholarPubMed
Krueger, RF, Markon, KE, Patrick, CJ, Benning, SD, Kramer, MD (2007). Linking antisocial behavior, substance use, and personality: an integrative quantitative model of the adult externalizing spectrum. Journal of Abnormal Psychology 116, 645–666.CrossRefGoogle ScholarPubMed
Krueger, RF, McGue, M, Iacono, WG (2001). The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Personality and Individual Differences 30, 1245–1259.CrossRefGoogle Scholar
Ledoit, O, Wolf, M (2004). A well-conditioned estimator for large-dimensional covariance matrices. Journal of Multivariate Analysis 88, 365–411.CrossRefGoogle Scholar
Lahey, BB, Applegate, B, Waldman, ID, Loft, JD, Hankin, BL, Rick, J (2004). The structure of child and adolescent psychopathology: generating new hypotheses. Journal of Abnormal Psychology 113, 358–385.CrossRefGoogle ScholarPubMed
Lee, J, Park, S (2005). Working memory impairments in schizophrenia: a meta-analysis. Journal of Abnormal Psychology 114, 599–611.CrossRefGoogle ScholarPubMed
Lenzenweger, MF, Clarkin, JF, Fertuck, EA, Kernberg, OF (2004). Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study. Journal of Personality Disorders 18, 421–438.CrossRefGoogle ScholarPubMed
Lewis, G, Pelosi, AJ (1990). Manual of the Revised Clinical Interview Schedule. Institute of Psychiatry: London.Google Scholar
Lewis, G, Pelosi, AJ, Araya, RC, Dunne, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465–486.CrossRefGoogle ScholarPubMed
Livesley, WJ, Jang, KL, Vernon, PA (1998). Phenotypic and genetic structure of traits delineating personality disorder. Archives of General Psychiatry 55, 941–948.CrossRefGoogle ScholarPubMed
Loeber, R, Schmaling, KB (1985). Empirical evidence for overt and covert patterns of antisocial conduct problems: a meta-analysis. Journal of Abnormal Child Psychology 13, 337–352.CrossRefGoogle Scholar
Lorr, M (1957). The Wittenborn psychiatric syndromes: an oblique rotation. Journal of Consulting Psychology 21, 439–444.CrossRefGoogle ScholarPubMed
Lorr, M, Klett, CJ, McNair, DM (1963). Syndromes of Psychosis. Pergamon Press: Oxford.Google Scholar
MacDonald, AW, Carter, CS (2003). Event-related fMRI study of context processing in dorsolateral prefrontal cortex of patients with schizophrenia. Journal of Abnormal Psychology 112, 689–697.CrossRefGoogle ScholarPubMed
Maisto, SA, Conigliaro, J, McNeil, M, Kraemer, K, Kelley, ME (2000). An empirical investigation of the factor structure of the AUDIT. Psychological Assessment 12, 346–353.CrossRefGoogle ScholarPubMed
Markon, KE, Krueger, RF, Watson, D (2005). Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. Journal of Personality and Social Psychology 88, 139–157.CrossRefGoogle ScholarPubMed
Meehl, PE (1962). Schizotaxia, schizotypy, schizophrenia. American Psychologist 17, 827–838.CrossRefGoogle Scholar
Miller, JD, Pilkonis, PA (2006). Neuroticism and affective instability: the same or different? American Journal of Psychiatry 163, 839–845.CrossRefGoogle ScholarPubMed
Muthen, LK, Muthen, BO (2007). Mplus User's Guide, 5th edn. Muthen & Muthen: Los Angeles.Google Scholar
Naragon, K, Watson, D (2007). Differential relations of depression and social anxiety to the facets of extraversion/positive emotionality. Paper presented at the 21st Annual Meeting of the Society for Research in Psychopathology, Iowa City, IA, October 2007.Google Scholar
Nestadt, G, Hsu, F, Samuels, J, Bienvenu, OJ, Reti, I, Costa, Jr. PT, Eaton, WW (2006). Latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder criteria. Comprehensive Psychiatry 47, 54–62.CrossRefGoogle ScholarPubMed
O'Connell, M, Cooper, SH, Perry, JC, Hoke, L (1989). The relationship between thought disorder and psychotic symptoms in borderline personality disorder. Journal of Nervous and Mental Disease 177, 273–278.CrossRefGoogle ScholarPubMed
O'Connor, BP, Dyce, JA (1998). A test of models of personality disorder configuration. Journal of Abnormal Psychology 107, 3–16.CrossRefGoogle ScholarPubMed
R Development Core Team (2008). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna.Google Scholar
Revelle, W (1979). Hierarchical cluster analysis and the internal structure of tests. Multivariate Behavioral Research 14, 57–74.CrossRefGoogle ScholarPubMed
Revelle, W (2007). psych-package: a package for personality, psychometric and psychological research (http://personality-project.org/r). Accessed 17 July 2008.Google Scholar
Robins, LN, Regier, DA (1991). Psychiatric Disorders in America: The Epidemiological Catchment Area Study. The Free Press: New York.Google Scholar
Sanislow, CA, Grilo, CM, Morey, LC, Bender, DS, Skodol, AE, Gunderson, JG, Shea, MT, Stout, RL, Zanarini, MC, McGlashan, TH (2002). Confirmatory factor analysis of DSM-IV criteria for borderline personality disorder: findings from the Collaborative Longitudinal Personality Disorders Study. American Journal of Psychiatry 159, 284–290.CrossRefGoogle Scholar
Saulsman, LM, Page, AC (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review 23, 1055–1085.CrossRefGoogle ScholarPubMed
Sbrana, A, Dell'Osso, L, Benvenuti, A, Rucci, P, Cassano, P, Banti, S, Gonnelli, C, Doria, MR, Ravani, L, Spagnolli, S, Rossi, L, Raimondi, F, Catena, M, Endicott, J, Frank, E, Kupfer, DJ, Cassano, GB (2005). The psychotic spectrum: validity and reliability of the Structured Clinical Interview for the Psychotic Spectrum. Schizophrenia Research 75, 375–387.CrossRefGoogle ScholarPubMed
Shafer, A (2005). Meta-analysis of the Brief Psychiatric Rating Scale factor structure. Psychological Assessment 17, 324–335.CrossRefGoogle ScholarPubMed
Shafer, AB (2006). Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology 62, 123–146.CrossRefGoogle ScholarPubMed
Sheeran, T, Zimmerman, M (2004). Factor structure of the Psychiatric Diagnostic Screening Questionnaire (PDSQ), a screening questionnaire for DSM-IV Axis I disorders. Journal of Behavior Therapy and Experimental Psychiatry 35, 49–55.CrossRefGoogle ScholarPubMed
Simms, LJ, Gros, DF, Watson, D, O'Hara, M (2008). Parsing the general and specific components of depression and anxiety with bifactor modeling. Depression and Anxiety 25, E34–E46.CrossRefGoogle ScholarPubMed
Singleton, N, Lee, A, Meltzer, H (2002). Psychiatric Morbidity Among Adults Living in Private Households, 2000: Technical Report. Office for National Statistics: London.Google Scholar
Slade, T, Watson, D (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine 36, 1593–1600.CrossRefGoogle ScholarPubMed
Spitzer, RL, Fleiss, JL, Endicott, J, Cohen, J (1967). Mental status schedule: properties of factor-analytically derived scales. Archives of General Psychiatry 16, 479–493.CrossRefGoogle ScholarPubMed
Stockwell, T, Murphy, D, Hogson, R (1983). The Severity of Alcohol Dependence Questionnaire: its use, reliability and validity. British Journal of Addiction 78, 145–155.CrossRefGoogle ScholarPubMed
Tackett, JL, Krueger, RF, Iacono, WG, McGue, M (2005). Symptom-based subfactors of DSM-defined conduct disorder: evidence for etiologic distinctions. Journal of Abnormal Psychology 114, 483–487.CrossRefGoogle ScholarPubMed
Tackett, JL, Krueger, RF, Sawyer, MG, Graetz, BW (2003). Subfactors of DSM-IV conduct disorder: evidence and connections with syndromes from the Child Behavior Checklist. Journal of Abnormal Child Psychology 31, 647–654.CrossRefGoogle ScholarPubMed
Tackett, JL, Silberschmidt, AL, Krueger, RF, Sponheim, SR (2008). A dimensional model of personality disorder: incorporating DSM Cluster A characteristics. Journal of Abnormal Psychology 117, 454–459.CrossRefGoogle Scholar
Tate, R (2003). A comparison of selected empirical methods for assessing the structure of responses to test items. Applied Psychological Measurement 27, 159–203.CrossRefGoogle Scholar
van Abswoude, AAH, Vermunt, JK, Hemker, BT, van der Ark, LA (2004). Mokken scale analysis using hierarchical clustering procedures. Applied Psychological Measurement 28, 332–354.CrossRefGoogle Scholar
Verona, E, Sachs-Ericsson, N, Joiner, Jr. TE (2004). Suicide attempts associated with externalizing psychopathology in an epidemiological sample. American Journal of Psychiatry 161, 444–451.CrossRefGoogle Scholar
Watson, D (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522–536.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Carey, G (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology 97, 346–353.CrossRefGoogle ScholarPubMed
Watson, D, Clark, LA, Chmielewski, M (2008). Structures of personality and their relevance to psychopathology: II. Further articulation of a comprehensive unified trait structure. Journal of Personality 76, 1545–1586.CrossRefGoogle ScholarPubMed
Watson, D, O'Hara, MW, Simms, LJ, Kotov, R, Chmielewski, M, McDade-Montez, EA, Gamez, W, Stuart, S (2007). Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS). Psychological Assessment 19, 253–268.CrossRefGoogle ScholarPubMed
Widiger, TA, Samuel, DB (2005). Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Journal of Abnormal Psychology 114, 494–504.CrossRefGoogle ScholarPubMed
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519–526.CrossRefGoogle ScholarPubMed
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablensky, A, Regier, D, Sartorius, N (1990). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 586–593.CrossRefGoogle ScholarPubMed
Wittenborn, JR (1951). Symptom patterns in a group of mental hospital patients. Journal of Consulting Psychology 15, 290–302.CrossRefGoogle Scholar
Wittenborn, JR, Holzberg, JD (1951). The generality of psychiatric syndromes. Journal of Consulting Psychology 15, 372–380.CrossRefGoogle ScholarPubMed
Wolf, AW, Schubert, DSP, Patterson, MB, Grande, TP, Brocco, KJ, Pendleton, L (1988). Associations among major psychiatric diagnoses. Journal of Consulting and Clinical Psychology 56, 292–294.CrossRefGoogle ScholarPubMed
Yuan, K, Chan, W (2008). Structural equation modeling with near singular covariance matrices. Computational Statistics and Data Analysis 52, 4842–4858.CrossRefGoogle Scholar
Zinbarg, RE, Barlow, DH (1996). Structure of anxiety and the anxiety disorders: a hierarchical model. Journal of Abnormal Psychology 105, 181–193.CrossRefGoogle ScholarPubMed
Supplementary material: File

Markon supplementary material

Tables.doc

Download Markon supplementary material(File)
File 331.3 KB