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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: [email protected])
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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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