Personality-based latent classes of posttraumatic psychopathology: personality disorders and the internalizing/externalizing model

Prior research using the Brief Form of the Multidimensional Personality Questionnaire (MPQ-BF; Patrick, Curtin, & Tellegen, 2002) has shown evidence of 3 temperament-based subtypes--termed internalizing, externalizing, and simple PTSD--among individuals with symptoms of posttraumatic stress disorder (PTSD; Miller, Greif, & Smith, 2003). This study sought to replicate and extend research in this area by conducting a latent profile analysis of higher order temperament scales from the MPQ-BF using a new sample of 208 veterans with symptoms of PTSD. Results suggest that a 3-class solution reflecting internalizing, externalizing, and simple subtypes of posttraumatic psychopathology provided the best fit to the data. The externalizing subtype was characterized by features of antisocial, borderline, histrionic, and narcissistic personality disorders on the International Personality Disorder Examination (Loranger, 1999) as well as low levels of constraint and high levels of negative emotionality on the MPQ-BF. In contrast, individuals in the internalizing class exhibited features of schizoid and avoidant personality disorders, low levels of positive emotionality, and high levels of negative emotionality. The simple subtype was defined by low levels of comorbid personality disorder features and relatively normal personality profiles. Findings support the reliability of this typology and support the relevance of the internalizing and externalizing model to the structure of personality disorders.     

Associations between respiratory sinus arrhythmia reactivity and internalizing and externalizing symptoms are emotion specific

Internalizing and externalizing disorders are often, though inconsistently in studies of young children, associated with low baseline levels of respiratory sinus arrhythmia (RSA). RSA is thus considered to reflect the capacity for flexible and regulated affective reactivity and a general propensity for psychopathology. However, studies assessing RSA reactivity to emotional challenges tend to report more consistent associations with internalizing than with externalizing disorders, although it is unclear whether this is a function of the type of emotion challenges used. In the present study, we examined whether baseline RSA was associated with internalizing and/or externalizing severity in a sample of 273 young children (ages 5–6) with elevated symptoms of psychopathology. Following motivation-based models of emotion, we also tested whether RSA reactivity during withdrawal-based (fear, sadness) and approach-based (happiness, anger) emotion inductions was differentially associated with internalizing and externalizing symptoms, respectively. Baseline RSA was not associated with externalizing or internalizing symptom severity. However, RSA reactivity to specific emotional challenges was associated differentially with each symptom domain. As expected, internalizing symptom severity was associated with greater RSA withdrawal (increased arousal) during fearful and sad film segments. Conversely, externalizing symptom severity was related to blunted RSA withdrawal during a happy film segment. The use of theoretically derived stimuli may be important in characterizing the nature of the deficits in emotion processing that differentiate the internalizing and externalizing domains of psychopathology.     

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).     

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β = 0.082, SE = 0.032, p = 0.012) and internalizing behaviors (β = 0.111, SE = 0.037, p = 0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β = 0.051, SE = 0.034, p = 0.138) and internalizing behaviors (β = 0.077, SE = 0.040, p = 0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p < 0.0001) for externalizing behaviors and 10.5% (p < 0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β = −0.074, SE = 0.030, p = 0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β = −1.33, SE = 0.378, p = 0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.     

Within-child associations between family income and externalizing and internalizing problems

Within-child associations between family income and child externalizing and internalizing problems were examined using longitudinal data from the NICHD Study of Early Child Care and Youth Development (2004a, 2004b; N=1,132). Variations in income effects were estimated as a function of whether families were poor, whether mothers were partnered, and the number of hours mothers and their partners were employed. On average, children had fewer externalizing problems during times when their families' incomes were relatively high than during times when their families' incomes were relatively low; the estimated benefits of increased income were greatest for children who were chronically poor. For both externalizing and internalizing problems, income was most strongly associated with problems when chronically poor children's mothers were partnered and employed.     

Parenting practices and internalizing and externalizing problems in Spanish adolescents

The goal of this study was to analyze the relationship between parenting practices and internalizing and externalizing problems presented by a group of adolescents according to their gender. Four hundred and sixty-nine secondary school students (aged between 12 and 18) participated in this study. The adolescents presented differences in perception of the educational practices of both parents as a function of their gender. Negative parenting practices were positively related to adolescents' internalizing and externalizing problems, whereas positive practices were negatively related to externalizing problems. Moreover, differences between boys and girls were found in predictor variables of problems, and the predictive power of the variables was higher for externalizing problems.     

Cross-informant consistency in externalizing and internalizing problems in early adolescence

The concept of cross-informant consistency has long been a topic of interest for those involved in assessment of behavior problems in adolescence. The purpose of the present study was to replicate and expand the existing literature by including four informants (mother, father, teacher, and adolescent self-report) and examining correlations among them as well as differences between reporters on an absolute level of both internalizing and externalizing problems. Fifty-two young adolescents (ranging in age from 11 to 15 years) and their mothers, fathers, and social studies teachers participated in the study. The Conduct Disorder subscale, Socialized Aggression subscale, and Anxiety/Withdrawal subscale of the Revised Behavior Problem Checklist were used. Results indicated that teachers showed little agreement with other informants on conduct problems (teachers reporting fewer problems), while parents and adolescents showed significant agreement. Informants showed no agreement on the measure of covert problems (socialized aggression), and all reports showed agreement on internalizing problems (although teachers continued to report fewer problems). Implications for assessment of young adolescents are discussed.This research was supported, in part, by the William T. Grant Foundation and the University of Georgia's Institute for Behavior Research.     

Personality profile for adolescents at risk for internalizing and externalizing problems

To estimate the personality profile for adolescents at psychopathological risk, a community sample of 762 adolescents, ages 12 to 16 years (M = 13.8, SD = 1.3), 53% boys and 47% girls, from the city of Barcelona, Spain, were tested with the Youth Self-Report and the High School Personality Questionnaire. Among this group, 140 adolescents were identified as showing symptoms of psychopathological risk for internalizing or externalizing syndromes as defined by Achenbach's theory. Analysis indicated that adolescents who scored high for internalizing and externalizing symptoms showed differing personality profiles, which also differed by sex. Boys scoring high on internalizing tended to adopt an inhibited, shy, and apprehensive behavior, while girls showed a tendency to display a more distant and cold affect and changeable emotionality. The personality pattern of boys and girls who scored high on externalizing symptoms showed both similar and different aspects. Both sexes displayed characteristics such as dominance, poor rule conformity, and low self-discipline. However, girls who scored high on externalizing symptoms also tended to show impulsiveness, social boldness, and low sensitivity.     

Reciprocal influences between parents' marital problems and adolescent internalizing and externalizing behavior

The present study examines reciprocal associations between marital functioning and adolescent maladjustment using cross-lagged autoregressive models. The research involved 451 early adolescents and their families and used a prospective, longitudinal research design with multi-informant methods. Results indicate that parental conflicts over child rearing predicted adolescent depressive symptoms and delinquency. In turn, these adolescent problems exacerbated parental conflicts over child rearing. Furthermore, conflict over child rearing served as the nexus through which more generalized marital dissatisfaction and adolescent adjustment problems were reciprocally interrelated. This research replicates earlier observations that marital problems intensify adolescent maladjustment and extends the literature by demonstrating that adolescent problems also predict marital conflict and ultimately marital dissatisfaction. In sum, the present study demonstrates that marital dissatisfaction, conflict over child rearing, and early adolescent adjustment difficulties are interwoven in a dynamic family system marked by reciprocity along these dimensions.     

Cognitive specificity in internalizing and externalizing problems in community and clinic-referred children

Examined whether cognitive features in Beck's (1967) model of depression and his cognitive content-specificity hypothesis (Beck, Brown, Steer, Eidelson, & Riskind, 1987) are broadband specific features that distinguish internalizing problems from externalizing problems. From a community (n = 389; 196 boys, 193 girls; age M = 9.98, SD = 1.52) and clinic (n = 82; 55 boys, 27 girls; age M = 10.42, SD = 2.91) sample, 4 groups were defined on behavioral measures and then examined on cognitive measures: externalizing only (n = 33), internalizing only (n = 41), comorbid externalizing and internalizing (n = 53), and control (neither externalizing nor internalizing; n = 35). Both the internalizing only and comorbid groups reported significantly more cognitive disturbances (negative cognitive triad, cognitive processing distortions, and "depressive" and "anxious" thought content) than both of the externalizing only and control groups in both the community and clinic samples. The results were not related to either overall level of psychopathology (as reported by mothers) or social desirability in children's reporting. These findings suggest that the cognitive features in Beck's model distinguish internalizing from externalizing problems and add to a growing literature that calls for further conceptual refinement of cognitive models for understanding both narrow-band and broadband syndromes.     

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.     

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.     

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.     

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.     

The relation between dimensions of attachment and internalizing or externalizing problems during adolescence

The authors examined the relation between dimensions of attachment and internalizing and externalizing problems in 15- to 16-year-old adolescents (n = 62) who completed the Attachment Style Questionnaire (ASQ; J. Feeney, P. Noller, & M. Hanrahan, 1994) and the Youth Self-Report (YSR; T. M. Achenbach, 1991). In total, the ASQ dimensions accounted for 48% of the variance in scores on the broad YSR internalizing problem scale. Three ASQ dimensions (confidence, discomfort with closeness, preoccupation with relationships) accounted for unique variance. Girls exhibited higher problem scores than did boys even when the authors considered ASQ scores. The authors observed comparable results for the anxious/depressed subscales. The confidence, discomfort, and preoccupation dimensions predicted scores on the withdrawn subscale. The authors observed weak relations or no relations between results on the ASQ and the externalizing problems scale. In conclusion, dimensions of attachment are powerful predictors of internalizing problems in adolescents. The authors discussed the potential cause and effect relationship between attachment variables and self-reported problems.     

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.     

Parent-to-child physical aggression,neighborhood cohesion,and development of children's internalizing and externalizing

Taking a risk and resilience approach, this study examined (1) whether child age moderates the association between exposure to parent–child physical aggression (PCPA) and initial levels and growth in internalizing and externalizing problems, and (2) whether neighborhood social cohesion is a protective factor for children who experience PCPA. Data came from 2810 caregivers of children aged 3–15 who participated in the Project on Human Development in Chicago Neighborhoods (PHDCN). Multilevel growth models showed that age moderated PCPA's association with internalizing problems, such that the association was stronger in older children than in younger children. Age also moderated PCPA's association with externalizing problems, such that the association was stronger in younger children than in older children. Neighborhood cohesion partially attenuated the association between PCPA and internalizing but only for older children; living in a neighborhood characterized by high cohesion mitigated levels of internalizing for maltreated children aged 11 years and older.