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Thought disorder in the meta-structure of psychopathology

Published online by Cambridge University Press:  21 November 2012

K. M. Keyes ,
N. R. Eaton ,
R. F. Krueger ,
A. E. Skodol ,
M. M. Wall ,
B. Grant ,
L. J. Siever  and
D. S. Hasin
K. M. Keyes*
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
N. R. Eaton
Affiliation:
Department of Psychology, Stony Brook University, Stony Brook, NY, USA
R. F. Krueger
Affiliation:
Department of Psychology, University of Minnesota, Minneapolis, MN, USA
A. E. Skodol
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA University of Arizona College of Medicine, Tucson, AZ, USA
M. M. Wall
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
B. Grant
Affiliation:
Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
L. J. Siever
Affiliation:
Department of Psychiatry, Mount Sinai School of Medicine, Bronx, NY, USA
D. S. Hasin
Affiliation:
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
*
*Address for ccorrespondence: K. M. Keyes, Ph.D., Department of Epidemiology, Columbia University, 722 West 168th Street, #503, New York, NY 10032, USA. (Email: kmk2104@columbia.edu)
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Abstract

Background

Dimensional models of co-morbidity have the potential to improve the conceptualization of mental disorders in research and clinical work, yet little is known about how relatively uncommon disorders may fit with more common disorders. The present study estimated the meta-structure of psychopathology in the US general population focusing on the placement of five under-studied disorders sharing features of thought disorder: paranoid, schizoid, avoidant and schizotypal personality disorders, and manic episodes as well as bipolar disorder.

Method

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a face-to-face interview of 34 653 non-institutionalized adults in the US general population. The meta-structure of 16 DSM-IV Axis I and Axis II psychiatric disorders, as assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version (AUDADIS-IV), was examined using exploratory and confirmatory factor analysis.

Results

We document an empirically derived thought disorder factor that is a subdomain of the internalizing dimension, characterized by schizoid, paranoid, schizotypal and avoidant personality disorders as well as manic episodes. Manic episodes exhibit notable associations with both the distress subdomain of the internalizing dimension as well as the thought disorder subdomain. The structure was replicated for bipolar disorder (I or II) in place of manic episodes.

Conclusions

As our understanding of psychopathological meta-structure expands, incorporation of disorders characterized by detachment and psychoticism grows increasingly important. Disorders characterized by detachment and psychoticism may be well conceptualized, organized and measured as a subdimension of the internalizing spectrum of disorders. Manic episodes and bipolar disorder exhibit substantial co-morbidity across both distress and thought disorder domains of the internalizing dimension. Clinically, these results underscore the potential utility of conceptualizing patient treatment needs using an approach targeting psychopathological systems underlying meta-structural classification rubrics.

Keywords

Dimensionalexternalizinginternalizingmetastructurepsychosisthought disorders
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 8 , August 2013 , pp. 1673 - 1683
Copyright
Copyright © Cambridge University Press 2012 

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References

Barlow, D, Farchione, T, Fairholme, C, Ellard, K, Boisseau, C, Allen, L, Ehrenreich-May, J (2011). Unified Protcol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford University Press: New York.Google Scholar
Batel, P (2000). Addiction and schizophrenia. European Psychiatry 15, 115–122.CrossRefGoogle ScholarPubMed
Carpenter, WT, Bustillo, JR, Thaker, GK, van Os, J, Krueger, RF, Green, MJ (2009). The psychoses: cluster 3 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2025–2042.CrossRefGoogle ScholarPubMed
Cohen, AS, Emmerson, LC, Mann, MC, Forbes, CB, Blanchard, JJ (2010). Schizotypal, schizoid and paranoid characteristics in the biological parents of social anhedonics. Psychiatry Research 178, 79–83.CrossRefGoogle ScholarPubMed
Cox, BJ, Clara, IP, Enns, MW (2002). Posttraumatic stress disorder and the structure of common mental disorders. Depression and Anxiety 15, 168–171.CrossRefGoogle ScholarPubMed
Eaton, NR, Keyes, KM, Krueger, RF, Balsis, S, Skodol, AE, Markon, KE, Grant, BF, Hasin, DS (2012). An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample. Journal of Abnormal Psychology 121, 282–288.CrossRefGoogle ScholarPubMed
Eaton, NR, Krueger, RF, Keyes, KM, Skodol, AE, Markon, KE, Grant, BF, Hasin, DS (2011). Borderline personality disorder co-morbidity: relationship to the internalizing–externalizing structure of common mental disorders. Psychological Medicine 41, 1041–1050.CrossRefGoogle Scholar
Forbush, KT, Watson, D (2012). The structure of common and uncommon mental disorders. Psychological Medicine. Published online 21 05 2012. doi:10.1017/S0033291712001092.Google ScholarPubMed
Goldberg, DP, Andrews, G, Hobbs, MJ (2009). Where should bipolar disorder appear in the meta-structure? Psychological Medicine 39, 2071–2081.CrossRefGoogle ScholarPubMed
Grant, BF, Dawson, DA, Hasin, DS (2001). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD.Google Scholar
Grant, BF, Dawson, DA, Stinson, FS, Chou, PS, Kay, W, Pickering, R (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence 71, 7–16.CrossRefGoogle Scholar
Grant, BF, Goldstein, RB, Chou, SP, Huang, B, Stinson, FS, Dawson, DA, Saha, TD, Smith, SM, Pulay, AJ, Pickering, RP, Ruan, WJ, Compton, WM (2009). Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Molecular Psychiatry 14, 1051–1066.CrossRefGoogle ScholarPubMed
Hasin, D, Fenton, MC, Skodol, A, Krueger, R, Keyes, K, Geier, T, Greenstein, E, Blanco, C, Grant, B (2011). Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Archives of General Psychiatry 68, 1158–1167.CrossRefGoogle ScholarPubMed
Hasin, DS, Stinson, FS, Ogburn, E, Grant, BF (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 64, 830–842.CrossRefGoogle ScholarPubMed
Hicks, BM, Blonigen, DM, Kramer, MD, Krueger, RF, Patrick, CJ, Iacono, WG, McGue, M (2007). Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: a longitudinal twin study. Journal of Abnormal Psychology 116, 433–447.CrossRefGoogle ScholarPubMed
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 1–55.CrossRefGoogle Scholar
Insel, T, Cuthbert, B, Garvey, M, Heinssen, R, Pine, DS, Quinn, K, Sanislow, C, Wang, P (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748–751.CrossRefGoogle Scholar
Kendler, KS, Gardner, CO (1997). The risk for psychiatric disorders in relatives of schizophrenic and control probands: a comparison of three independent studies. Psychological Medicine 27, 411–419.CrossRefGoogle ScholarPubMed
Kendler, KS, McGuire, M, Gruenberg, AM, O'Hare, A, Spellman, M, Walsh, D (1993). The Roscommon Family Study. III. Schizophrenia-related personality disorders in relatives. Archives of General Psychiatry 50, 781–788.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Walsh, D (1995). Evaluating the spectrum concept of schizophrenia in the Roscommon Family Study. American Journal of Psychiatry 152, 749–754.Google 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
Kessler, RC, Ormel, J, Petukhova, M, McLaughlin, KA, Green, JG, Russo, LJ, Stein, DJ, Zaslavsky, AM, Aguilar-Gaxiola, S, Alonso, J, Andrade, L, Benjet, C, de Girolamo, G, de Graaf, R, Demyttenaere, K, Fayyad, J, Haro, JM, Hu, C, Karam, A, Lee, S, Lepine, JP, Matchsinger, H, Mihaescu-Pintia, C, Posada-Villa, J, Sagar, R, Ustun, TB (2011). Development of lifetime comorbidity in the World Health Organization world mental health surveys. Archives of General Psychiatry 68, 90–100.CrossRefGoogle ScholarPubMed
Keyes, KM, Eaton, NR, Krueger, RF, McLaughlin, KA, Wall, MM, Grant, BF, Hasin, D (2012). Childhood maltreatment and the structure of common psychiatric disorders. British Journal of Psychiatry 200, 107–115.CrossRefGoogle ScholarPubMed
Kotov, R, Chang, SW, Fochtmann, LJ, Mojtabai, R, Carlson, GA, Sedler, MJ, Bromet, EJ (2011 a). Schizophrenia in the internalizing–externalizing framework: a third dimension? Schizophrenia Bulletin 37, 1168–1178.CrossRefGoogle ScholarPubMed
Kotov, R, Ruggero, CJ, Krueger, RF, Watson, D, Yuan, Q, Zimmerman, M (2011 b). New dimensions in the quantitative classification of mental illness. Archives of General Psychiatry 68, 1003–1011.CrossRefGoogle ScholarPubMed
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.CrossRefGoogle ScholarPubMed
Krueger, RF, Caspi, A, Moffitt, TE, Silva, PA (1998). The structure and stability of common mental disorders (DSM-III-R): a longitudinal–epidemiological study. Journal of Abnormal Psychology 107, 216–227.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, Hicks, BM, Patrick, CJ, Carlson, SR, Iacono, WG, McGue, M (2002). Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. Journal of Abnormal Psychology 111, 411–424.CrossRefGoogle ScholarPubMed
Krueger, RF, Markon, KE (2011). A dimensional-spectrum model of psychopathology: progress and opportunities. Archives of General Psychiatry 68, 10–11.CrossRefGoogle ScholarPubMed
Krueger, RF, Markon, KE (2012). Toward a clinically useful and empirically based dimensional model of psychopathology. World Psychiatry 11, 23–24.CrossRefGoogle Scholar
Lichtenstein, P, Yip, BH, Bjork, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234–239.CrossRefGoogle ScholarPubMed
Markon, KE (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine 40, 273–288.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BL (2010). MPlus User's Guide, 5th Ed. Muthén and Muthén: Los Angeles.Google Scholar
Pulay, AJ, Stinson, FS, Dawson, DA, Goldstein, RB, Chou, SP, Huang, B, Saha, TD, Smith, SM, Pickering, RP, Ruan, WJ, Hasin, DS, Grant, BF (2009). Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 11, 53–67.Google ScholarPubMed
Ruan, WJ, Goldstein, RB, Chou, SP, Smith, SM, Saha, TD, Pickering, RP, Dawson, DA, Huang, B, Stinson, FS, Grant, BF (2008). The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug and Alcohol Dependence 92, 27–36.CrossRefGoogle Scholar
Verona, E, Sachs-Ericsson, N, Joiner, TE Jr (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
Wolf, AW, Schubert, DS, 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
Wolf, EJ, Miller, MW, Krueger, RF, Lyons, MJ, Tsuang, MT, Koenen, KC (2010). Posttraumatic stress disorder and the genetic structure of comorbidity. Journal of Abnormal Psychology 119, 320–330.CrossRefGoogle ScholarPubMed
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