Common and specific correlates of preadolescent internalizing and externalizing psychopathology

The specificity of various child characteristics and environmental correlates of childhood internalizing and externalizing problems was examined using both cross-sectional and longitudinal analyses (from ages 2-3 and 4-5 years) in a general population sample of 10-11-year-olds. Specificity was defined according to a between-subjects and a within-subjects method, using parent and teacher reports of psychopathology. Temperamental withdrawal, parental internalizing psychopathology, and early single parenthood (for girls) were identified as correlates that are specific for internalizing problems, whereas temperamental high general activity level was identified as externalizing-specific. Further, parenting stress, poor school results (only for boys), and stressful life events (only for girls) were found to be common correlates of psychopathology. Research implications regarding the findings and the use of a within-subjects method are discussed.     

Recovery and replication of internalizing and externalizing dimensions within the personality assessment inventory

In this study, we examined the internal structure of 13 Personality Assessment Inventory (PAI; Morey, 1991, 2007) scales in a corrections sample (N = 1,099). Previous findings regarding the PAI internal structure have been somewhat inconsistent. We investigated the utility of a 2-dimensional model comprised of internalization and externalization to organize the 11 PAI clinical scales and 2 additional scales, Suicidal Ideation and Aggression. We randomly divided the sample, and a factor analysis revealed a 2-dimensional model representing internalization and externalization. Confirmatory factor analyses conducted with an independent subsample revealed acceptable fit when the model was revised to include correlated error terms between mood and anxiety disorder scales. The revised model exhibited acceptable fit when cross-validated, had better fit than a 1-dimension model, and demonstrated preliminary construct validity in relation to extratest variables.     

Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions

The term and concept of lcomorbidity has been mired in controversy, although there is little question that the existence of covariation among psychiatric diagnoses poses significant challenges to current models of psychiatric classification and diagnosis. The papers in this Special Section underscore a number of important issues relevant to the comorbidity between and within childhood externalizing and internalizing disorders, and illustrate both methodological and substantive reasons for such comorbidity. Weiss, Susser, and Catron's distinction among common, broad-band specific, and narrow-band specific features provides a helpful framework for understanding the comorbidity of childhood externalizing and internalizing disorders (B, Weiss, K. Susser, & T. Catron, 1998). Hierarchical models of psychopathology help to dissolve the distinction between splitters and lumpers and point to variables that may elucidate the etiology of externalizing and internalizing disorders.     

Judgments of impairment and distress associated with symptoms of internalizing and externalizing disorders

The pattern of dysfunction (i.e. impairment vs. distress) judged to be associated with disorders empirically identified by Krueger, Caspi, Moffitt and Silva (1998) as internalizing (e.g. major depressive episode; agoraphobia) was compared to the pattern characterizing disorders classified as externalizing (e.g. antisocial personality disorder; alcohol dependence). In Study 1, lay raters (N=270) judged the social impairment, occupational impairment, and personal distress associated with symptoms of seven internalizing and four externalizing disorders. As predicted, symptoms composing internalizing disorders were perceived as involving a greater degree of distress, and a lesser degree of impairment, relative to symptoms composing externalizing disorders. In Study 2, conducted with a small sample of clinician judges (N=21), symptoms composing internalizing disorders were again judged as involving a greater degree of distress (but, in this case, not a lesser degree of impairment) relative to symptoms composing externalizing disorders. This research provides a novel means of validating the distinction between internalizing and externalizing groups of disorders.     

Aging and the structure and long-term stability of the internalizing spectrum of personality and psychopathology

Structural psychopathology research has identified two broad factors--internalizing and externalizing--that account for comorbidity among many common mental disorders. Evaluating the utility of these factors for nosology, research, and treatment entails expanding beyond a cross-sectional understanding to how these factors evolve over time. We tested factorial invariance of internalizing in three age cohort groups--35 years and under (n = 1,729), 36-50 years (n = 2,719), and over 50 years (n = 2,601)--as well as the long-term stability of internalizing within individuals. Internalizing showed a notable degree of invariance between cohorts and within cohorts over time; long-term internalizing stability was equivalently moderate-to-high in each cohort.     

Five-factor model and internalizing and externalizing syndromes: A 5-year prospective study

The main aim of the present research was to study the prospective relationships of the five-factor model of personality and the internalizing and externalizing suprafactors of psychopathology. A sample of 323 young adults completed the NEO-FFI at Time 1 and different scales of symptoms 5 years later. Neuroticism prospectively predicted the internalizing factor, while extraversion, low agreeableness and low conscientiousness predicted the externalizing factor. We found additional paths between introversion and social phobia symptoms, and between low agreeableness and psychopathy symptoms. These relationships remained significant, even when controlling for previous symptoms, except for extraversion. Gender had no moderation effect on the interrelationship between personality and psychopathology factors. The present study extends previous research about personality and psychopathology, and suggests different ways in which they can be related.     

The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: a meta-analysis

In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition).     

Progress and innovation: personality disorders and the vanguard of psychopathology research

Important progress in our understanding of the natural course of personality disorders (PDs) is documented in the articles for this special section. This progress could set the stage for ideas developed in the study of PDs to play a central role in research on psychopathology more broadly conceived. The Collaborative Longitudinal Personality Disorders Study (Skodol et al., this issue), the Children in the Community Study (Cohen, Crawford, Johnson, & Kasen, this issue), and the McLean Study of Adult Development (Zanarini, Frankenburg, Hennen, Reich, & Silk, this issue) reveal the importance of personality in understanding psychopathology, and point toward a dimensional approach to conceptualizing psychopathology that could also frame categorical clinical decision making processes.     

Temperament, personality, and developmental psychopathology as childhood antecedents of personality disorders

To contribute to the case for a dimensional conceptualization of psychopathology in general and maladaptive personality or personality disorders in particular, the present paper reviews the evidence for a dimensional representation of childhood temperament and personality. The review of temperament and variable-centered as well as person-centered approaches to childhood personality leads us to propose five broadband dimensions that capture individual differences in children and adolescents: extraversion, emotional stability, agreeableness, conscientiousness, and openness/intellect. Our analysis of the CBCL (Achenbach, 1991) and the DIPSI (currently under development at Ghent University), two dimensional models for childhood psychopathology, suggests two common broadband factors, internalizing and externalizing. The relations between the dimensional representation of childhood temperament/personality and psychopathology are documented with data from general population and clinical samples of children and adolescents. The article concludes with a proposal on how the higher-order dimensions emerging from studies of adaptive and maladaptive individual differences in childhood could be integrated in a common dimensional model.     

A multivariate model of gender differences in adolescents' internalizing and externalizing problems.

Gender differences observed in interpersonal and self-critical vulnerabilities, reactivity to stressful life events, quality of relationships, and self-concepts inform a multivariate theoretical model of the moderating effects of gender on internalizing and externalizing problems in adolescence. To test this model, data were collected in a 1-year prospective study from an ethnically diverse sample of 460 middle school students. Increases in girls' internalizing symptoms, compared with boys', were partly explained by greater stability in girls' interpersonal vulnerabilities and greater magnitude in coefficients linking girls' relationships with parents and peers and internalizing problems. Boys' risks for externalizing problems, compared with girls', were partly explained by the greater stability in boys' vulnerability to self-criticism. Coefficients for most pathways in the model are similar for boys and girls.     

Effortful control: factor structure and relation to externalizing and internalizing behaviors

Effortful control, a temperamentally based ability to inhibit a dominant response and activate a subdominant response, was assessed on 3 occasions using a comprehensive, age-appropriate behavioral battery in this 4-year longitudinal study of children (N = 103) from toddlerhood to early school age. The focus was twofold: to explore the structure of effortful control in a normally developing sample and to examine the relations between effortful control and adaptive functioning. Exploratory factor analyses supported the contention that effortful control is a complex, multidimensional construct with longitudinally stable factors. Effortful control was also significantly associated with mother-reported total behavior problems in a nonlinear fashion, with lower and higher levels of effortful control contributing to higher total problem scores. These findings have implications for the assessment of temperament in children and, most importantly, for the study of nonlinear contributions of temperament to early childhood behaviors.     

DSM-III-R personality disorders and the five-factor model of personality: an empirical comparison.

The relationship between the five-factor model (FFM) of personality and the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; DSM-III-R) personality disorders was examined in a sample of 54 psychiatric outpatients. Correlations between raw scores on the NEO-Personality Inventory (NEO-PI) and the number of DSM-III-R personality disorder symptoms rated present using a semistructured interview were computed. In addition, correlations between NEO-PI scores and scores on two self-report personality disorder inventories were also examined to determine which results replicated across instruments. Results indicated that the FFM personality dimensions of Neuroticism, Extraversion, and Agreeableness were most apparent in the DSM-III-R conceptualizations of the personality disorders.     

Depressive personality disorder: rates of comorbidity with personality disorders and relations to the five-factor model of personality

Depressive personality disorder (DPD) is listed in the DSM-IV as one of the "Disorders for Further Study." In this investigation we examined (1) the rates of comorbidity of DPD with the 10 personality disorders (PDs) in the main text of DSM-IV, and (2) the convergent and discriminant validity of DPD in its relation to the 30 facet traits of the Five-Factor Model of personality (FFM). One hundred and sixty-nine participants with psychiatric diagnoses were interviewed with the Structured Clinical Interview for DSM-IV Personality Disorders Questionnaire (SCID-II) and completed the Revised NEO Personality Inventory (NEO PI-R). A total of 26 (15%) of the participants met diagnostic criteria for at least one of the 10 main text PDs, and 15 (9%) met criteria for DPD. Of those who met criteria for DPD, 10 (59%) of the participants also met criteria for one or more of the 10 main text PDs. Regression analyses indicated a four-facet trait set derived from the NEO PI-R thought to be uniquely associated with DPD accounted for a significant amount of variance in DPD SCID-II PD scores and was significantly larger for DPD than it was for the 9 of the 10 main text PDs; the sole exception was for avoidant PD. Diagnostically, DPD overlaps significantly with other PDs but is distinguishable in its unique relation with traits from the FFM.     

Developmental cascades: linking academic achievement and externalizing and internalizing symptoms over 20 years

A developmental cascade model linking competence and symptoms was tested in a study of a normative, urban school sample of 205 children (initially 8 to 12 years old). Internalizing and externalizing symptoms and academic competence were assessed by multiple methods at the study outset and after 7, 10, and 20 years. A series of nested cascade models was tested through structural equation modeling. The final model indicated 2 hypothesized cascade effects: Externalizing problems evident in childhood appeared to undermine academic competence by adolescence, which subsequently showed a negative effect on internalizing problems in young adulthood. A significant exploratory effect was consistent with internalizing symptoms containing or lowering the net risk for externalizing problems under some conditions. These 3 cascade effects did not differ by gender and were not attributable to effects of IQ, parenting quality, or socioeconomic differences. Implications are discussed for developmental models of cascades, progressions, and preventive interventions.     

Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: externalizing and internalizing subtypes

This study used the Multidimensional Personality Questionnaire (MPQ; A. Tellegen, in press) to identify personality-based subtypes of posttraumatic response. Cluster analyses of MPQs completed by combat veterans revealed subgroups that differed on measures relating to the externalization versus internalization of distress. The MPQ profile of the externalizing cluster was defined by low Constraint and Harmavoidance coupled with high Alienation and Aggression. Individuals in this cluster also had histories of delinquency and high rates of substance-related disorder. In comparison, the MPQ profile of the internalizing cluster was characterized by lower Positive Emotionality, Alienation, and Aggression and higher Constraint, and individuals in this cluster showed high rates of depressive disorder. These findings suggest that dispositions toward externalizing versus internalizing psychopathology may account for heterogeneity in the expression of posttraumatic responses, including patterns of comorbidity.     

Integrating psychopathology and personality disorders conceptualized by the MMPI-2-RF and the MCMI-III: a structural validity study

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008 ) Restructured Clinical scales and Higher Order scales were linked to the Millon Clinical Multiaxial Inventory-III (Millon, Millon, Davis, & Grossman, 2009 ) personality disorder scales and clinical syndrome scales in a Flemish/Dutch sample of psychiatric inpatients and outpatients, substance abuse patients, correctional inmates, and forensic psychiatric patients (N = 968). Structural validity of psychopathology and personality disorders as conceptualized by both instruments was investigated by means of principal component analysis. Results reveal a higher order structure with 4 dimensions (internalizing disorders, externalizing disorders, paranoid ideation/thought disturbance, and pathological introversion) that parallels earlier research on pathological personality dimensions as well as research linking pathological personality traits with mental disorders. Theoretical and clinical implications are considered.     

Continuity of axes I and II: toward a unified model of personality, personality disorders, and clinical disorders

In the current standard psychiatric nomenclature, the DSM-IV-TR (APA, 2000), mental disorders are divided into two groups: Clinical Disorders (CDs) and Personality Disorders (PDs), and CD and PD diagnoses are recorded on two separate axes (Axes I and II, respectively). This article considers evidence regarding putative bases for distinguishing between CDs and PDs, and finds that these constructs are more similar than distinct. Links between the domains may be better understood by focusing on how personality connects CDs and PDs. This perspective underlines the need to work toward a more unified model of personality, PDs, and CDs in research and in future editions of the DSM.