title: Evidence for a multi-dimensional latent structural model of externalizing disorders.
abstract: Strong associations between conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (SUD) seem to reflect a general vulnerability to externalizing behaviors. Recent studies have characterized this vulnerability on a continuous scale, rather than as distinct categories, suggesting that the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) take into account the underlying continuum of externalizing behaviors. However, most of this research has not included measures of disorders that appear in childhood [e.g., attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD)], nor has it considered the full range of possibilities for the latent structure of externalizing behaviors, particularly factor mixture models, which allow for a latent factor to have both continuous and categorical dimensions. Finally, the majority of prior studies have not tested multidimensional models. Using lifetime diagnoses of externalizing disorders from participants in the Fast Track Project (n = 715), we analyzed a series of latent variable models ranging from fully continuous factor models to fully categorical mixture models. Continuous models provided the best fit to the observed data and also suggested that a two-factor model of externalizing behavior, defined as (1) ODD+ADHD+CD and (2) SUD with adult antisocial behavior sharing common variance with both factors, was necessary to explain the covariation in externalizing disorders. The two-factor model of externalizing behavior was then replicated using a nationally representative sample drawn from the National Comorbidity Survey-Replication data (n = 5,692). These results have important implications for the conceptualization of externalizing disorders in DSM-5.
authors.affiliation: Department of Psychology, Washington State University, 14204 NE Salmon Creek Ave, Vancouver, WA 98686, USA. katie.witkiewitz@wsu.edu
authors.forename: Katie
authors.initials: K
authors.lastname: Witkiewitz
authors.forename: Kevin
authors.initials: K
authors.lastname: King
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McMahon
authors.forename: Johnny
authors.initials: J
authors.lastname: Wu
authors.forename: Jeremy
authors.initials: J
authors.lastname: Luk
authors.forename: Karen L
authors.initials: KL
authors.lastname: Bierman
authors.forename: John D
authors.initials: JD
authors.lastname: Coie
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Dodge
authors.forename: Mark T
authors.initials: MT
authors.lastname: Greenberg
authors.forename: John E
authors.initials: JE
authors.lastname: Lochman
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Pinderhughes
mesh_terms: D000293:Adolescent; D000328:Adult; D000987:Antisocial Personality Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D019955:Conduct Disorder / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D035061:Control Groups; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004198:Disease Susceptibility; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D011599:Psychopathology; D016032:Randomized Controlled Trials as Topic; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult