The Structure and Stability of Common Mental Disorders

Abstract

EPIDEMIOLOGICAL studies on DSM-III-R diagnoses in the general population have often revealed strikingly high levels of comorbidity; substantial proportions of respondents meet the criteria for more than 1 psychiatric disorder.%^1-6 This comorbidity represents a serious challenge to those seeking to understand the specificity of distinguished DSM-III-R disorders.%^7-11 A recent analysis of comorbidity in the ARCHIVES identified latent dimensions underlying the different diagnoses in the National Comorbidity Survey.%¹⁰ Results of this study suggest that a 2-dimensional (D) structure of internalizing and externalizing disorders is suited to explain the comorbidity between common mental disorders in the general population. Thereby, the internalizing dimension appeared to distinguish 2 subdimensions—one referring to the combination of anxious-depressive diagnoses (depression, dysthymia, and generalized anxiety disorder [GAD]) and one referring to diagnoses of more specific anxiety disorders (simple phobia, social phobia, agoraphobia, and panic disorder). It was concluded that these latent dimensions should be interpreted in terms of core psychopathological processes underlying the different diagnoses of common mental disorders.