Posttraumatic stress disorder and the structure of common mental disorders
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Krueger [1999: Arch Gen Psychiatry 56:921-926] identified a three-factor structure of psychopathology that explained the covariation or grouping of common mental disorders found in the U.S. National Comorbidity Survey (NCS) [Kessler et al., 1994: Arch Gen Psychiatry 51:8-19]. These three fundamental groupings included an externalizing disorders factor and two internalizing disorders factors (anxious-misery and fear). We extended this research through the examination of additional data from a large subsample of the NCS (n=5,877) that contained diagnostic information on posttraumatic stress disorder (PTSD). Factor analytic findings revealed that PTSD showed no affinity with the fear factor defined by panic and phobic disorders, and instead loaded on the anxious-misery factor defined primarily by mood disorders. An identical pattern of results emerged for both lifetime PTSD and 12-month PTSD prevalence figures. Implications of these findings for the classification of PTSD and research on its etiology are briefly discussed.
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Population-based factor analyses of psychiatric comorbidity find two sub-dimensions within internalizing disorders: one for fear diagnoses and one for anxiety-misery diagnoses.
“These studies have reported that internalizing disorders are made up of two sub-dimensions, one representing ‘fear’ diagnoses (eg, simple phobia, social phobia, agoraphobia, panic disorder) and the other ‘anxiety–misery’ diagnoses (depression, dysthymia, GAD, PTSD).”
From Phasic vs Sustained Fear in Rats and Humans: Role of the Extended Amygdala in Fear vs Anxiety (2010) · cites this paper as Cox et al, 2002
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Roest, A. M., de Jonge, P., Lim, C. W. W., Stein, D. J., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Bunting, B., Caldas-de-Almeida, J. M., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.03.015 · Cited by 22 · see citing works
Cox, B. J., Clara, I. P., Hills, A., & Sareen, J. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.08.003 · Cited by 23 · see citing works
Self-citationPsychopathy and internalizing psychopathology
Willemsen, J., & Verhaeghe, P. (2012) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2012.04.004 · Cited by 23 · see citing works
Contractor, A. A., Mehta, P., Tiamiyu, M. F., Hovey, J. D., Geers, A. L., Charak, R., Tamburrino, M., & Elhai, J. D. (2014) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-013-9846-5 · Cited by 22 · see citing works
Sunderland, M., Carragher, N., Chapman, C., Mills, K. L., Teesson, M., Lockwood, E., Forbes, D., & Slade, T. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.001 · Cited by 21 · see citing works
The structure of posttraumatic psychopathology in veterans attending primary care
Forbes, D., Elhai, J. D., Lockwood, E., Creamer, M. C., Frueh, B. C., & Magruder, K. M. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.09.004 · Cited by 20 · see citing works
- Authors
- Cox, B. J., Clara, I. P., & Enns, M. W.
- Affiliations
- University of Manitoba (CA)
- Corresponding author
- Cox, Brian J.
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2002
- Volume
- 15
- Issue
- 4
- Pages
- 168-171
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2116388723
- Cited by
- 147
- References
- 8
- Citations by year
- 2026: 1 · 2025: 3 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 2 · 2018: 3 · 2017: 5 · 2016: 9 · 2015: 9 · 2014: 16 · 2013: 10 · 2012: 11
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Manitoba Health Research Council
- Canada Research Chairs
- Canadian Institutes of Health Research
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- post-traumatic stress disorder, common mental disorders, three-factor model, fear factors, externalizing disorders, internalizing disorders, panic disorder, phobia, mood disorders, PTSD etiology, National Comorbidity Survey
- MeSH terms
- Adolescent, Adult, Mental Disorders, Diagnosis, Differential, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Stress Disorders, Post-Traumatic
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