Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-13T02:03:52.651Z Has data issue: false hasContentIssue false
  • English
  • Français

The structure and short-term stability of the emotional disorders: a dimensional approach

Published online by Cambridge University Press:  12 December 2014

R. Kotov ,
G. Perlman ,
W. Gámez  and
D. Watson
R. Kotov*
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
G. Perlman
Affiliation:
Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
W. Gámez
Affiliation:
Department of Psychology, University of Iowa, Iowa City, IA, USA
D. Watson
Affiliation:
Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
*
*Address for correspondence: R. Kotov, Department of Psychiatry, Stony Brook University, Putnam Hall-South Campus, Stony Brook, New York 11794-8790, USA. (Email: roman.kotov@stonybrook.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Factor-analytic studies have found that depressive, bipolar, post-traumatic, obsessive–compulsive, and anxiety disorders – jointly referred to as the emotional disorders – form an internalizing spectrum that includes distress and fear subfactors. However, placement of some disorders is uncertain. Also, prior research analysed dichotomous interview-based diagnoses or dimensional self-report measures. We investigated this structure using a third-generation measure – the Interview for Mood and Anxiety Symptoms (IMAS) – that combines strengths of a clinical interview with dimensional assessment.

Method

The interview was administered to 385 students and 288 psychiatric out-patients. Participants were reinterviewed 2 months later.

Results

Exploratory and confirmatory factor analyses identified three factors: distress (depression, generalized anxiety, post-traumatic stress, irritability, and panic syndrome); fear (social anxiety, agoraphobia, specific phobia, and obsessive–compulsive); and bipolar (mania and obsessive–compulsive). The structure was consistent over time and across samples, except that panic and agoraphobia had higher factor loadings in patients. Longitudinal analyses revealed high temporal stability of the factors (test–retest r = 0.72 to 0.87), but also substantial disorder-specific stability.

Conclusions

This investigation – which bridges diagnostic and self-report studies – found three subfactors of internalizing psychopathology. It provided support for a new subfactor, clarified the placement of obsessive–compulsive and bipolar disorders, and demonstrated that this model generalizes across populations. The accumulating research suggests the need to recognize formally the close links among the emotional disorders, as well as empirical clusters within this spectrum. The IMAS demonstrated strong psychometric properties and can be useful for various research and clinical applications by providing dimensional, interview-based assessment of the emotional disorders.

Keywords

Anxiety disordersdiagnosisDSMmood disordersnosology
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 8 , June 2015 , pp. 1687 - 1698
Copyright
Copyright © Cambridge University Press 2014 

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.Google Scholar
Achenbach, TM, Rescorla, LA (2001). Manual for the ASEBA School-Age Forms & Profiles. University of Vermont, Research Center for Children, Youth and Families: Burlington, VT.Google Scholar
Andrews, G, Goldberg, DP, Krueger, RF, Carpenter, WT, Hyman, SE, Sachdev, P, Pine, DS (2009). Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychological Medicine 39, 1993–2000.CrossRefGoogle ScholarPubMed
Arbuckle, J (2005). Amos 6.0 User's Guide. Marketing Department, SPSS Incorporated: Chicago, IL.Google Scholar
Barlow, DH (1991). Disorders of emotion. Psychological Inquiry 2, 58–71.CrossRefGoogle Scholar
Blanco, C, Okuda, M, Wright, C, Hasin, DS, Grant, BF, Liu, SM, Olfson, M (2008). Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions. Archives of General Psychiatry 65, 1429–1437.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.Google Scholar
Chmielewski, M, Watson, D (2009). What is being assessed and why it matters: the impact of transient error on trait research. Journal of Personality and Social Psychology 87, 186–202.Google Scholar
Craske, MG (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety 29, 749–753.Google Scholar
Eaton, NR, Krueger, RF, Markon, KE, Keyes, KM, Skodol, AE, Wall, M, Hasin, DS, Grant, BF (2013). The structure and predictive validity of the internalizing disorders. Journal of Abnormal Psychology 122, 86–92.Google Scholar
Eaton, NR, Krueger, RF, Oltmanns, TF (2011). Aging and the structure and long-term stability of the internalizing spectrum of personality and psychopathology. Psychology and Aging 26, 987–993.CrossRefGoogle ScholarPubMed
Enders, CK (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods 6, 352–370.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Boden, JM (2006). Structure of internalising symptoms in early adulthood. British Journal of Psychiatry: Journal of Mental Science 189, 540–546.Google Scholar
Fervaha, G, Remington, G (2013). Invalid responding in questionnaire-based research: implications for the study of schizotypy. Psychological Assessment 25, 1355–1360.CrossRefGoogle Scholar
Forbes, MK, Schniering, CA (2013). Are sexual problems a form of internalizing psychopathology? A structural equation modeling analysis. Archives of Sexual Behavior 42, 23–34.Google Scholar
Forbush, KT, Watson, D (2013). The structure of common and uncommon mental disorders. Psychological Medicine 43, 97–108.Google Scholar
Goldberg, DP, Andrews, G, Hobbs, MJ (2009 a). Where should bipolar disorder appear in the meta-structure? Psychological Medicine 39, 2071–2081.Google Scholar
Goldberg, DP, Krueger, RF, Andrews, G, Hobbs, MJ (2009 b). Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2043–2059.Google Scholar
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.Google Scholar
Kessler, RC, Cox, BJ, Green, JG, Ormel, J, McLaughlin, KA, Merikangas, KR, Petukhova, M, Pine, DS, Russo, LJ, Swendsen, J, Wittchen, H, Zaslavsky, AM (2011). The effects of latent variables in the development of comorbidity among common mental disorders. Depression and Anxiety 28, 29–39.Google Scholar
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Keyes, KM, Eaton, NR, Krueger, RF, Skodol, AE, Wall, MM, Grant, B, Siever, LJ, Hasin, DS (2012). Thought disorder in the meta-structure of psychopathology. Psychological Medicine 43, 1673–1683.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.Google Scholar
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
Kramer, MD, Krueger, RF, Hicks, BM (2008). The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes. Psychological Medicine 38, 51–61.Google Scholar
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.Google Scholar
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.Google Scholar
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.Google Scholar
Kushner, MG, Krueger, RF, Wall, MM, Maurer, EW, Menk, JS, Menary, KR (2013). Modeling and treating internalizing psychopathology in a clinical trial: a latent variable structural equation modeling approach. Psychological Medicine 43, 1611–1623.Google 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.Google Scholar
Lahey, BB, Rathouz, PJ, Van Hulle, C, Urbano, RC, Krueger, RF, Applegate, B, Garriock, HA, Chapman, DA, Waldman, ID (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of Abnormal Child Psychology 36, 187–206.CrossRefGoogle ScholarPubMed
Lanyon, RI, Wershba, RE (2013). The effect of underreporting response bias on the assessment of psychopathology. Psychological Assessment 25, 331–338.Google Scholar
Markon, KE (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine 40, 273–288.Google Scholar
Meade, AW, Craig, SB (2012). Identifying careless responses in survey data. Psychological Methods 17, 437–455.Google Scholar
Miller, MW, Fogler, JM, Wolf, EJ, Kaloupek, DG, Keane, TM (2008). The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress 21, 58–65.Google Scholar
Miller, MW, Wolf, EJ, Reardon, A, Greene, A, Ofrat, S, McInerney, S (2012). Personality and the latent structure of PTSD comorbidity. Journal of Anxiety Disorders 26, 599–607.Google Scholar
Prenoveau, JM, Zinbarg, RE, Craske, MG, Mineka, S, Griffith, JW, Epstein, AM (2010). Testing a hierarchical model of anxiety and depression in adolescents: a tri-level model. Journal of Anxiety Disorders 24, 334–344.Google Scholar
Rammstedt, B, Farmer, RF (2013). The impact of acquiescence on the evaluation of personality structure. Psychological Assessment 25, 1137–1145.Google Scholar
Reinholt, N, Krogh, J (2014). Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cognitive Behaviour Therapy 43, 171–184.Google Scholar
Roysamb, E, Kendler, KS, Tambs, K, Orstavik, RE, Neale, MC, Aggen, SH, Torgersen, S, Reichborn-Kjennerud, T (2011). The joint structure of DSM-IV Axis I and Axis II disorders. Journal of Abnormal Psychology 120, 198–209.Google Scholar
Ruggero, CJ, Kotov, R, Watson, D, Kilmer, J, Perlman, G, Liu, K (2014). Beyond a single index of mania symptoms: structure and validity of subdimensions. Journal of Affective Disorders 161, 8–15.Google Scholar
Sellbom, M, Ben-Porath, YS, Bagby, RM (2008). Personality and psychopathology: mapping the MMPI-2 Restructured Clinical (RC) Scales onto the five factor model of personality. Journal of Personality Disorders 22, 291–312.Google Scholar
Simms, LJ, Prisciandaro, JJ, Krueger, RF, Goldberg, DP (2012). The structure of depression, anxiety and somatic symptoms in primary care. Psychological Medicine 42, 15–28.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.Google Scholar
Spitzer, RL, Williams, JBW, Gibbon, M, First, MB (1992). The Structured Clinical Interview for DSM-III-R (SCID). I: history, rationale, and description. Archives of General Psychiatry 49, 624–629.Google Scholar
Vollebergh, WA, Iedema, J, Bijl, RV, de Graaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: the NEMESIS study. Archives of General Psychiatry 58, 597–603.Google Scholar
Watson, D (2005). Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. Journal of Abnormal Psychology 114, 522–536.Google Scholar
Watson, D (2009). Differentiating the mood and anxiety disorders: a quadripartite model. Annual Review of Clinical Psychology 5, 221–247.Google Scholar
Watson, D, O'Hara, MW, Naragon-Gainey, K, Koffel, E, Chmielewski, M, Kotov, R, Stasik, SM, Ruggero, CJ (2012). Development and validation of new anxiety and bipolar symptom scales for an expanded version of the IDAS (the IDAS-II). Assessment 19, 399–420.Google Scholar
Watson, D, O'Hara, MW, Simms, LJ, Kotov, R, Chmielewski, M, MclityDade-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
Watson, D, Wu, KD, Cutshall, C (2004). Symptom subtypes of obsessive–compulsive disorder and their relation to dissociation. Journal of Anxiety Disorders 18, 435–458.Google Scholar
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.Google Scholar
Wright, AG, Krueger, RF, Hobbs, MJ, Markon, KE, Eaton, NR, Slade, T (2013). The structure of psychopathology: toward an expanded quantitative empirical model. Journal of Abnormal Psychology 122, 281–294.Google Scholar
Zinbarg, RE, Barlow, DH (1996). Structure of anxiety and the anxiety disorders: a hierarchical model. Journal of Abnormal Psychology 105, 181–193.Google Scholar
Supplementary material: File

Kotov Supplementary Material

Supplementary Material

Download Kotov Supplementary Material(File)
File 132.6 KB