Schizophrenia in the internalizing-externalizing framework: A third dimension?

Roman Kotov, Su Wei Chang, Laura J. Fochtmann, Ramin Mojtabai, Gabrielle A. Carlson, Mark J. Sedler, Evelyn J. Bromet

Research output: Contribution to journalArticle

Abstract

Background: Prior studies of common disorders in community-dwelling adults identified internalizing and externalizing spectra of mental illness. We investigated the placement of schizophrenia and schizotypal personality disorder in this framework and tested the validity of the resulting organization in a clinical population. Methods: The data came from the Suffolk County Mental Health Project cohort (N = 628), which consists of first-admission patients with psychosis recruited from inpatient units throughout Suffolk County, NY (72% response rate). The sample was reassessed multiple times over the following 10 years. Complete diagnostic data were available for 469 participants. Mental health professionals diagnosed 11 target conditions based on semistructured clinical interviews, review of medical records, and reports of significant others. Two validators were included: family history of schizophrenia and 10-year illness course. Results: Confirmatory factor analysis revealed that the The Diagnostic and Statistical Manual of Mental Disorders-IV grouping of conditions fit the data poorly. The best alternative classification consisted of three clusters: internalizing, externalizing, and schizophrenic. Both validators supported the coherence and distinctiveness of the schizophrenic cluster. Conclusions: We replicated internalizing and externalizing spectra in a clinical population, identified a schizophrenic spectrum, and provided initial evidence of its validity. These findings suggest that schizotypal personality disorder may be better placed with schizophrenia, antisocial conditions with substance use disorders, and major depression with anxiety disorders.

Original languageEnglish (US)
Pages (from-to)1168-1178
Number of pages11
JournalSchizophrenia Bulletin
Volume37
Issue number6
DOIs
StatePublished - Nov 2011

Fingerprint

Schizotypal Personality Disorder
Schizophrenia
Mental Health
Independent Living
Patient Admission
Anxiety Disorders
Diagnostic and Statistical Manual of Mental Disorders
Psychotic Disorders
Population
Statistical Factor Analysis
Substance-Related Disorders
Medical Records
Inpatients
Organizations
Interviews
Depression

Keywords

  • classification
  • confirmatory factor analysis
  • DSM
  • nosology
  • validation

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Kotov, R., Chang, S. W., Fochtmann, L. J., Mojtabai, R., Carlson, G. A., Sedler, M. J., & Bromet, E. J. (2011). Schizophrenia in the internalizing-externalizing framework: A third dimension? Schizophrenia Bulletin, 37(6), 1168-1178. https://doi.org/10.1093/schbul/sbq024

Schizophrenia in the internalizing-externalizing framework : A third dimension? / Kotov, Roman; Chang, Su Wei; Fochtmann, Laura J.; Mojtabai, Ramin; Carlson, Gabrielle A.; Sedler, Mark J.; Bromet, Evelyn J.

In: Schizophrenia Bulletin, Vol. 37, No. 6, 11.2011, p. 1168-1178.

Research output: Contribution to journalArticle

Kotov, R, Chang, SW, Fochtmann, LJ, Mojtabai, R, Carlson, GA, Sedler, MJ & Bromet, EJ 2011, 'Schizophrenia in the internalizing-externalizing framework: A third dimension?', Schizophrenia Bulletin, vol. 37, no. 6, pp. 1168-1178. https://doi.org/10.1093/schbul/sbq024
Kotov, Roman ; Chang, Su Wei ; Fochtmann, Laura J. ; Mojtabai, Ramin ; Carlson, Gabrielle A. ; Sedler, Mark J. ; Bromet, Evelyn J. / Schizophrenia in the internalizing-externalizing framework : A third dimension?. In: Schizophrenia Bulletin. 2011 ; Vol. 37, No. 6. pp. 1168-1178.
@article{03690b8a64c44a6d8f5daddc914d6c35,
title = "Schizophrenia in the internalizing-externalizing framework: A third dimension?",
abstract = "Background: Prior studies of common disorders in community-dwelling adults identified internalizing and externalizing spectra of mental illness. We investigated the placement of schizophrenia and schizotypal personality disorder in this framework and tested the validity of the resulting organization in a clinical population. Methods: The data came from the Suffolk County Mental Health Project cohort (N = 628), which consists of first-admission patients with psychosis recruited from inpatient units throughout Suffolk County, NY (72{\%} response rate). The sample was reassessed multiple times over the following 10 years. Complete diagnostic data were available for 469 participants. Mental health professionals diagnosed 11 target conditions based on semistructured clinical interviews, review of medical records, and reports of significant others. Two validators were included: family history of schizophrenia and 10-year illness course. Results: Confirmatory factor analysis revealed that the The Diagnostic and Statistical Manual of Mental Disorders-IV grouping of conditions fit the data poorly. The best alternative classification consisted of three clusters: internalizing, externalizing, and schizophrenic. Both validators supported the coherence and distinctiveness of the schizophrenic cluster. Conclusions: We replicated internalizing and externalizing spectra in a clinical population, identified a schizophrenic spectrum, and provided initial evidence of its validity. These findings suggest that schizotypal personality disorder may be better placed with schizophrenia, antisocial conditions with substance use disorders, and major depression with anxiety disorders.",
keywords = "classification, confirmatory factor analysis, DSM, nosology, validation",
author = "Roman Kotov and Chang, {Su Wei} and Fochtmann, {Laura J.} and Ramin Mojtabai and Carlson, {Gabrielle A.} and Sedler, {Mark J.} and Bromet, {Evelyn J.}",
year = "2011",
month = "11",
doi = "10.1093/schbul/sbq024",
language = "English (US)",
volume = "37",
pages = "1168--1178",
journal = "Schizophrenia Bulletin",
issn = "0586-7614",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Schizophrenia in the internalizing-externalizing framework

T2 - A third dimension?

AU - Kotov, Roman

AU - Chang, Su Wei

AU - Fochtmann, Laura J.

AU - Mojtabai, Ramin

AU - Carlson, Gabrielle A.

AU - Sedler, Mark J.

AU - Bromet, Evelyn J.

PY - 2011/11

Y1 - 2011/11

N2 - Background: Prior studies of common disorders in community-dwelling adults identified internalizing and externalizing spectra of mental illness. We investigated the placement of schizophrenia and schizotypal personality disorder in this framework and tested the validity of the resulting organization in a clinical population. Methods: The data came from the Suffolk County Mental Health Project cohort (N = 628), which consists of first-admission patients with psychosis recruited from inpatient units throughout Suffolk County, NY (72% response rate). The sample was reassessed multiple times over the following 10 years. Complete diagnostic data were available for 469 participants. Mental health professionals diagnosed 11 target conditions based on semistructured clinical interviews, review of medical records, and reports of significant others. Two validators were included: family history of schizophrenia and 10-year illness course. Results: Confirmatory factor analysis revealed that the The Diagnostic and Statistical Manual of Mental Disorders-IV grouping of conditions fit the data poorly. The best alternative classification consisted of three clusters: internalizing, externalizing, and schizophrenic. Both validators supported the coherence and distinctiveness of the schizophrenic cluster. Conclusions: We replicated internalizing and externalizing spectra in a clinical population, identified a schizophrenic spectrum, and provided initial evidence of its validity. These findings suggest that schizotypal personality disorder may be better placed with schizophrenia, antisocial conditions with substance use disorders, and major depression with anxiety disorders.

AB - Background: Prior studies of common disorders in community-dwelling adults identified internalizing and externalizing spectra of mental illness. We investigated the placement of schizophrenia and schizotypal personality disorder in this framework and tested the validity of the resulting organization in a clinical population. Methods: The data came from the Suffolk County Mental Health Project cohort (N = 628), which consists of first-admission patients with psychosis recruited from inpatient units throughout Suffolk County, NY (72% response rate). The sample was reassessed multiple times over the following 10 years. Complete diagnostic data were available for 469 participants. Mental health professionals diagnosed 11 target conditions based on semistructured clinical interviews, review of medical records, and reports of significant others. Two validators were included: family history of schizophrenia and 10-year illness course. Results: Confirmatory factor analysis revealed that the The Diagnostic and Statistical Manual of Mental Disorders-IV grouping of conditions fit the data poorly. The best alternative classification consisted of three clusters: internalizing, externalizing, and schizophrenic. Both validators supported the coherence and distinctiveness of the schizophrenic cluster. Conclusions: We replicated internalizing and externalizing spectra in a clinical population, identified a schizophrenic spectrum, and provided initial evidence of its validity. These findings suggest that schizotypal personality disorder may be better placed with schizophrenia, antisocial conditions with substance use disorders, and major depression with anxiety disorders.

KW - classification

KW - confirmatory factor analysis

KW - DSM

KW - nosology

KW - validation

UR - http://www.scopus.com/inward/record.url?scp=80053484967&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053484967&partnerID=8YFLogxK

U2 - 10.1093/schbul/sbq024

DO - 10.1093/schbul/sbq024

M3 - Article

C2 - 20357134

AN - SCOPUS:80053484967

VL - 37

SP - 1168

EP - 1178

JO - Schizophrenia Bulletin

JF - Schizophrenia Bulletin

SN - 0586-7614

IS - 6

ER -