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Typology of common psychiatric syndromes

An empirical study

Published online by Cambridge University Press:  03 January 2018

Patrick F. Sullivan  and
Kenneth S. Kendler
Patrick F. Sullivan*
Affiliation:
Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics
Kenneth S. Kendler
Affiliation:
Virginia Commonwealth University, Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics
*
Dr Sullivan. Department of Psychiatry, Virginia Institute for Psychiatrie and Behavioral Genetics. PO Box 980126. Richmond, VA 23298-0126, USA. Tel: 804-828-8129; Fax: 804-828-1471
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Abstract

Background

Diagnostic comorbidity is prevalent in psychiatry and may be inadequately captured by the DSM-III/III-R nosology.

Methods

The lifetime presence of 11 psychiatric diagnoses was determined by structured personal interviews of a population-based sample of 1898 female twins. We used latent class analysis to derive an empirical typology.

Results

Six classes provided the best fit to the data. Their mnemonics were: minimal disorder (60% of the sample), major depression -generalised anxiety disorder (19%), alcohol–nicotine (7%), highly comorbid major depression (5%) and eating disorders (3%). The validity of this typology was strongly supported by demographic, health, personality and attitudinal validators along with the significant monozygotic twin concordance for class membership. The typology superficially resembled DSM-III-R, but contained many differences. Major depression appeared in three forms (alone, with generalised anxiety disorder and with considerable comorbidity). Alcoholism-nicotine dependence and the various anxiety disorders formed discrete classes, but were also prominent in other classes. Bulimia and anorexia were exceptional in their appearance in a single class.

Conclusions

The DSM-III-R and closely related DSM-IV nosology did not capture the natural tendency of these disorders to co-occur. Fundamental assumptions of the dominant diagnostic schemata may be incorrect.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 4 , October 1998 , pp. 312 - 319
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington. DC: APA.Google Scholar
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington. DC: APA.Google Scholar
Andrews, G., Stewart, G., Allen, R., et al (1990a) The genetics of six neurotic disorders: a twin study. Journal of Affective Disorders, 19, 23–29.CrossRefGoogle ScholarPubMed
Andrews, G., Stewart, G., Morris-Yates, A., et al (1990b) Evidence for a general neurotic syndrome. British Journal of Psychiatry, 157, 6–12.Google ScholarPubMed
Bandecchi, A. (1994) Drug-addiction without drug: a model for treatment of eating disorders. Neuropsychopharmocology, 10 (suppl.).91S.Google Scholar
Boyd, J. E., Burke, J. D., Gruenberg, E., et al (1984) Exclusion criteria of DSM-III: a study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry, 41, 983–989.CrossRefGoogle ScholarPubMed
Brisman, J. & Siegel, M. (1984) Bulimia and alcoholism: two sides of the same coin? Journal of Substance Abuse and Treatment, 1, 113–118.CrossRefGoogle ScholarPubMed
Cantwell, D. P., Stuzenberger, S., Burroughs, J., et al (1977) Anorexia nervosa: an affective disorder? Archives of General Psychiatry, 34, 1087–1093.CrossRefGoogle ScholarPubMed
Cohen, J. (1988) Statistical Power Analysis for the Behavioral Sciences (2nd edn). Hillsdale. NJ: Lawrence Erlbaum.Google Scholar
Davis, M. H. (1980) A multidimensional approach to individual differences in empathy. Catalog of Selected Documents in Psychology, 10, 85.Google Scholar
Eaves, L. J., Silberg, J. L., Hewitt, J. K., et al (1993) Analyzing twin resemblance in multisymptom data: genetic applications of a latent class model for symptoms of conduct disorder in juvenile boys. Behavior Genetics, 23, 5–19.CrossRefGoogle ScholarPubMed
Fagerstrom, K.-O. (1978) Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addictive Behaviors, 3, 235–241.CrossRefGoogle ScholarPubMed
Fagerstrom, K.-O. & Schneider, N. G. (1989) Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine, 12, 159–182.CrossRefGoogle ScholarPubMed
Heath, A. C., Neale, M. C., Kessler, R. C., et al (1992) Evidence for genetic influences on personality from self-reports and from informant ratings. Journal of Personality and Social Psychology, 63, 85–96.CrossRefGoogle ScholarPubMed
Hirschfeld, R. M. (1977) A measure of interpersonal dependency. Journal of Personality Assessment, 41, 610–618.CrossRefGoogle ScholarPubMed
Jimerson, D. C., Lesem, M. D., Kaye, W. H., et al (1990) Eating disorders and depression: is there a serotonin connection? Biological Psychiatry, 28, 443–454.CrossRefGoogle Scholar
Kendell, R. E. (1989) Clinical validity. Psychological Medicine, 19, 45–55.CrossRefGoogle ScholarPubMed
Kendler, K. S. (1990) Toward a scientific psychiatric nosology: strengths and limitations. Archives of General Psychiatry, 47, 969–973.CrossRefGoogle Scholar
Kendler, K. S., Silberg, J. L. Neale, M. C., et al (1990) Genetic and environmental factors in the aetiology of menstrual, premenstrual and neurotic symptoms: a population-based twin study. Psychological Medicine, 22, 85–100.Google Scholar
Kendler, K. S., Maclean, C., Neale, M. C., et al (1991) The genetic epidemiology of bulimia nervosa. American Journal of Psychiatry, 140, 1627–1637.Google Scholar
Kendler, K. S., Heath, A. C., Neale, M. C., et al (1992) A population-based twin study of alcoholism in women. Journal of the American Medical Association, 268, 1877–1882.CrossRefGoogle ScholarPubMed
Kendler, K. S., Neale, M. C., Kessler, R. C., et al (1993) Panic disorder in women: a population-based twin study. Psychological Medicine, 23, 397–406.CrossRefGoogle ScholarPubMed
Kendler, K. S. Walters, E. E., Neale, M. C., et al (1995) The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Archives of General Psychiatry, 52, 374–383.CrossRefGoogle ScholarPubMed
Kessler, R. C. (1997) The prevalence of psychiatric comorbidity. In Treatment Strategies of Patients with Psychiatric Comorbidity (eds Wetzler, S. & Sanderson, W. C.), pp. 23–48. New York: John Wiley and Sons.Google Scholar
Kendler, K. S., McGonagle, K. A., Zhao, S., et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19.Google Scholar
Kraepelin, E. (1907) Clinical Psychiatry (trans Diefendorf, A. R.) (7th edn). London: Macmillan.Google Scholar
Maddi, S. R., Kobasa, S. C. & Hoover, M. (1979) An alienation test. Journal of Humanist Psychology, 19, 73–76.CrossRefGoogle Scholar
McCutcheon, A. L. (1987) Latent Class Analysis. (Vol. 07-064). Beverly Hills. CA: Sage.CrossRefGoogle Scholar
Menninger, K., Mayman, M. & Pruyser, P. (1963) The Vital Balance. New York: Viking Press.Google Scholar
Neale, M. C. & Kendler, K. S. (1995) Models of comorbidity for multifactorial disorders. American Journal of Human Genetics, 57, 935–953.Google ScholarPubMed
Numerical Algorithms Group (1993) NAG FORTRAN Library Manual (mark 16 edn). Oxford: Numerical Algorithms Group.Google Scholar
Peterson, C., Semmel, A., von Vaeyer, C., et al (1982) The attributional style questionnaire. Cognitive Therapy Research, 6, 287–299.CrossRefGoogle Scholar
Regier, D. A., Narrow, W. F., Rae, D. S., et al (1993) The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective one-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85–94.CrossRefGoogle Scholar
Robins, E. & Guze, S. B. (1970) Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry, 126, 107–111.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965) Society and the Adolescent Self-image. Princeton, NJ: Princeton University Press.CrossRefGoogle Scholar
Scheier, M. G. & Carver, C. S. (1985) Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.CrossRefGoogle ScholarPubMed
Tyrer, P. (1989) Classification of Neurosis. New York: John Wiley and Sons.Google Scholar
Walters, E. E. & Kendler, K. S. (1995) Anorexia nervosa and anorexic-like syndrome in a population-based female twin sample. American Journal of Psychiatry, 152, 64–71.Google Scholar
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10). Geneva: WHO.Google Scholar
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