title: The internalizing and externalizing structure of psychiatric comorbidity in combat veterans.
abstract: This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA. mark.miller5@va.gov
authors.forename: Mark W
authors.initials: MW
authors.lastname: Miller
authors.forename: Jason M
authors.initials: JM
authors.lastname: Fogler
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Wolf
authors.forename: Danny G
authors.initials: DG
authors.lastname: Kaloupek
authors.forename: Terence M
authors.initials: TM
authors.lastname: Keane
mesh_terms: D000293:Adolescent; D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear; D006801:Humans; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D047829:Vietnam Conflict