The joint structure of DSM-IV Axis I and Axis II disorders.

Abstract

The Diagnostic and Statistical Manual (4th ed. [DSM–IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM–IV Personality (SIDP–IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM–IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.

An Examination of the Higher-Order Structure of Psychopathology and Its Relationship to Personality

“…In this model, antisocial and borderline personality disorders comprise a single factor representing externalizing behavior, while histrionic and narcissistic personality disorders represent another factor representing attention-seeking grandiosity. This is in concordance with some studies that have found narcissistic and histrionic personality disorder to load onto a different factor than antisocial personality disorder (e.g., Røysamb et al, 2011). Also, some studies have found that traits characterizing narcissistic and histrionic personality disorders (i.e., grandiosity, attention-seeking) and antisocial personality (i.e., impulsivity, irresponsibility) load onto separate factors at the lowest level of the hierarchy (e.g., Wright & Simms, 2014).…”

“…As mentioned above, studies of personality pathology often split the internalizing factor into negative affect and detachment factors, with the latter factor describing interpersonal difficulty. Similar factors labeled pathological introversion (Markon, 2010) and anhedonic introversion (Røysamb et al, 2011) have been supported in other studies. Based on these findings, the third factor includes dependent and avoidant personality disorders and social anxiety disorder; this factor was labeled interpersonal sensitivity (see Figure 2).…”

“…Across all studies, regardless of the number of factors supported, depressive and anxiety disorders were found to load on an internalizing factor. Almost no studies have examined eating disorders; one study did find anorexia to load onto the internalizing factor as well (Røysamb et al, 2011). In accordance with the research on personality pathology, all Cluster C personality disorders were included on the internalizing factor and all Cluster B the externalizing factor (see Figure 1).…”

Genetic and Environmental Contributions to the Relationship Between Internalizing Disorders and Sick Leave Granted for Mental and Somatic Disorders

“…In order to investigate the broad construct of internalizing disorders, the following lifetime disorders were selected for the present study: major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, panic disorder, and agoraphobia. As these disorders are strongly interrelated (Hettema et al, 2006;Krueger & Markon, 2006;Røysamb et al, 2011), a dichotomized index (no lifetime internalizing disorder vs. any lifetime internalizing disorder) was generated based on the specific diagnostic data.…”

The Relationship between Personality Disorders and Quality of Life in Adolescent Outpatients

“…The SIDP-IV is a comprehensive semi-structured diagnostic interview for DSM-IV personality disorder (Axis II) diagnoses. The SIDP-IV has been used in numerous studies in different countries, including Norway (3,11,33). It covers 14 DSM-IV Axis II diagnoses as well as conduct disorder as a separate Axis I disorder.…”