Externalizing and Internalizing Subtypes of Combat-Related PTSD: A Replication and Extension Using the PSY-5 Scales.

This study replicated and extended prior findings of internalizing and externalizing subtypes of posttraumatic response (M. W. Miller, J. L. Greif, & A. A. Smith, 2003). Cluster analyses of the Minnesota Multiphasic Personality Inventory-2 Personality Psychopathology-Five (MMPI-2 PSY-5; A. R. Harkness, J. L. McNulty, Y. S. Ben-Porath, 1995) profiles obtained from 736 veterans with posttraumatic stress disorder (PTSD) partitioned the sample into a low pathology cluster defined by personality scores in the normal range, an externalizing cluster characterized by low constraint and high negative emotionality, and an internalizing cluster with high negative emotionality and low positive emotionality. Externalizers showed the highest rates of alcohol-related and antisocial personality disorders; internalizers, the highest rates of panic and major depressive disorder. These findings support the development of a personality-based typology of posttraumatic response designed to account for heterogeneity in the expression of PTSD and associated psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital psychological and physical aggression and children's mental and physical health: Direct, mediated, and moderated effects.

Relations between marital aggression (psychological and physical) and children's health were examined. Children's emotional insecurity was assessed as a mediator of these relations, with distinctions made between marital aggression against mothers and fathers and ethnicity (African American or European American), socioeconomic status, and child gender examined as moderators of effects. Participants were 251 community-recruited families, with multiple reporters of each construct. Aggression against either parent yielded similar effects for children. Children's emotional insecurity mediated the relation between marital aggression and children's internalizing, externalizing, and posttraumatic stress disorder symptoms. No differences were found in these pathways for African American and European American families or as a function of socioeconomic status or child gender. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delineating the construct network of the Personnel Reaction Blank: Associations with externalizing tendencies and normal personality.

Integrity testing has long been utilized in personnel selection to screen for tendencies toward counterproductive workplace behaviors. The construct of externalizing from the psychopathology literature represents a coherent spectrum marked by disinhibitory traits and behaviors. The present study drew on a sample of male and female undergraduates to examine the construct network of the Personnel Reaction Blank (PRB; H. G. Gough, R. D. Arvey, & P. Bradley, 2004), a measure of integrity, in relation to externalizing as well as normal-range personality constructs assessed by the Multidimensional Personality Questionnaire (MPQ; A. Tellegen & N. G. Waller, 2008). Results revealed moderate to strong associations between several PRB scales and externalizing, which were largely accounted for by MPQ traits subsumed by Negative Emotionality and Constraint. After accounting for MPQ traits in the prediction of externalizing, a modest predictive increment was achieved when adding the PRB scales, particularly biographical indicators from the Prosocial Background subscale. The findings highlight externalizing as a focal criterion for scale development in the integrity testing literature and help delineate the construct network of the PRB within the domains of personality and psychopathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cloning and characterization of Rep-8 (D8S2298E) in the human chromosome 8p11.2-p12

Assessed the effect of co-occurring versus not co-occurring internalizing and externalizing behavior problems on the reasons parents reported for clinical referral of their adolescent child. Reasons for referral were coded for 181 inpatient adolescents, and parent ratings of internalizing and externalizing behavior were obtained for a general population sample of 500 adolescents. Parents concurrently reported internalizing and externalizing behavior as reasons for referral less frequently (p < .0001) than would be expected given the correlation between these two domains in the general population sample. This suggests that the presence of externalizing problems may decrease parents' concern or awareness of internalizing problems, the presence of internalizing problems may decrease parents' concern or awareness of externalizing problems, or both. Implications for the clinical referral of adolescents and for informal parental efforts at helping their children with externalizing and internalizing problems are discussed.     

Posttraumatic stress disorder and the genetic structure of comorbidity.

This study used structural equation modeling to examine the genetic and environmental architecture of latent dimensions of internalizing and externalizing psychiatric comorbidity and explored structural associations between posttraumatic stress disorder (PTSD) and these dimensions. Data were drawn from the Vietnam Era Twin Registry and included lifetime diagnoses for PTSD and a range of other psychiatric disorders for 3,372 male–male twin pairs. Examination of the phenotypic structure of these disorders revealed that PTSD cross-loaded on both Internalizing and Externalizing common factors. Biometric analyses suggested largely distinct genetic risk factors for the latent internalizing and externalizing comorbidity dimensions, with the total heritability of the Externalizing factor (69%) estimated to be significantly stronger than that for Internalizing (41%). Nonshared environment explained the majority of the remaining variance in the Internalizing (58%) and Externalizing (20%) factors. Shared genetic variance across the 2 dimensions explained 67% of their phenotypic correlation (r = .52). These findings have implications for conceptualizations of the etiology of PTSD and its location in an empirically based nosology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An internalizing pathway to alcohol use and disorder.

Research emanating from the field of developmental science indicates that initial risk factors for alcohol use and disorder can be evident in early childhood. One dominant developmental pathway connecting these initial risk factors with subsequent alcohol involvement focuses on the central role of disinhibited or externalizing behaviors. In the current paper, we delineate a second pathway that focuses on internalizing symptomatology. Several studies indicate that internalizing symptoms in early and middle childhood predict alcohol involvement in adolescence and young adulthood. We use a developmental psychopathology framework to describe a risk model that traces the potential developmental markers of this internalizing pathway and to consider the relation between the internalizing pathway and the more widely researched externalizing pathway. We outline the markers of risk in this pathway and conclude with a discussion of the implications of this model for prevention efforts and future research. In this manner, we strive for a translational goal, linking our existing understanding of internalizing processes and alcohol use and disorder with our efforts to develop effective prevention programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pretrauma problems, prior stressor exposure, and gender as predictors of change in posttraumatic stress symptoms among physically injured children and adolescents.

Objective: This study addressed predictors of change in posttraumatic stress symptoms (PTSS) among youths who had experienced physical injuries. The influences of pretrauma internalizing and externalizing problems, prior stressor exposure, and gender were investigated. Additionally, gender was examined as a moderator of the associations between internalizing problems and PTSS, externalizing problems and PTSS, and prior stressor exposure and PTSS. Method: Participants were 157 children and adolescents (75% male; age M = 13.30 years, SD = 3.60; 44% Caucasian, 39% African American, 13% Hispanic, and 4% other) admitted to 2 hospitals for physical injuries. Youths and their parents completed measures of PTSS (Child Posttraumatic Stress Reaction Index), internalizing and externalizing problems (Child Behavior Checklist), and prior stressor exposure (Coddington Life Events Scale, Child) during the hospital stay; youths completed up to 3 additional PTSS assessments targeted at 3, 6, and 12 months postinjury. Results: Multilevel regression analyses revealed a significant average decline in PTSS over time (p p p     

Treating paternal alcoholism with learning sobriety together: Effects on adolescents versus preadolescents.

The purpose of this study was to determine whether Learning Sobriety Together, a treatment for substance abuse that combines behavioral couples therapy and individual counseling, had comparable secondary benefits on the internalizing and externalizing behaviors of adolescent versus preadolescent siblings living in homes with their alcoholic fathers (N = 131) and their non-substance-abusing mothers. During a 17-month assessment period, the association between parents' functioning (i.e., fathers' drinking as determined by percentage of days abstinent and parents' dyadic adjustment) and children's adjustment (as rated by mothers, fathers, and children's teachers) was stronger for preadolescents than for their adolescent siblings, particularly in terms of children's externalizing behaviors. Interventions that reduce paternal drinking and improve couple functioning may serve as an important preventative intervention for preadolescents in these homes, whereas adolescents may need more intensive interventions to address internalizing and externalizing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic symptomatology in children and adolescents after an industrial fire

OBJECTIVE: This investigation evaluated the extent and nature of posttraumatic symptomatology (PTS) in children and adolescents 9 months after an industrial fire at the imperial Foods chicken-processing plant in Hamlet, North Carolina, caused extensive loss of life. METHOD: Using a PTS self-report measure plus self- and teacher reports of comorbid symptoms the authors surveyed 1,019 fourth- to ninth-grade students in the community where the fire occurred. RESULTS: Three factors comprising PTS were identified: reexperiencing, avoidance and hyperarousal. Reexperiencing and avoidance were positively correlated; hyperarousal proved weakly correlated with reexperiencing, perhaps because exposure was largely indirect. Using a T score cutoff of 65 on the reexperiencing factor as indicative of PTS 9.7% of subjects met criteria for PTS; 11.9% met criteria for posttraumatic stress disorder (PTSD) using DSM-III-R PTSD criteria. Degree of exposure was the most powerful predictor of PTS. Race (African-American) and gender (female) posed significant risk factors for PTS. Self-reported internalizing symptoms and teacher-reported externalizing symptoms were positively predicted by intercurrent PTS, and independently of PTS, by degree of exposure. Comorbid symptoms showed interesting interactions with exposure, race, and gender. Lack of self-attributed personal efficacy predicted PTS but did not moderate the effects of race or gender on PTS risk. CONCLUSIONS: This study, which used a population-based sampling strategy, strengthens and extends findings from earlier literature on pediatric PTSD in showing that (1) PTS and comorbid internalizing and externalizing symptoms rise in direct proportion to degree of exposure; (2) gender and race show variable effects on risk for PTS and comorbid symptoms; and (3) comorbid symptoms are positively correlated with PTS and may represent primary outcomes of traumatic exposure in their own right.     

The association between psychopathology in fathers versus mothers and children's internalizing and externalizing behavior problems: A meta-analysis.

In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

P300 amplitude, externalizing psychopathology, and earlier- versus later-onset substance-use disorder.

P300 amplitude predicts substance use or disorder by age 21. Earlier- versus later-onset substance disorders may reflect different levels of an externalizing psychopathology dimension. P300 in adolescence may not be as strongly related to later-onset substance problems as it is to earlier-onset ones. In the present study, visual P300 amplitude was measured at age 17 in a community-representative sample of young men. Substance and externalizing disorders were assessed at approximately ages 17, 20, and 24. Earlier-onset (by age 20) substance disorder was associated with higher rates of externalizing disorders than were later-onset problems. P300 amplitude was reduced in subjects with earlier-onset substance disorders, relative to later-onset and disorder-free subjects. Amplitude was also reduced in subjects with an externalizing disorder but no substance disorder. Earlier-onset subjects had reduced P300, even in the absence of an externalizing disorder. The results could not be attributed to a concurrent disorder or to recent substance use at the time of the P300 recording. The findings are consistent with P300 indexing an externalizing spectrum. Earlier-onset substance disorders are more strongly related to P300 and externalizing than are later-onset problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood.

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modeling relations between hassles and internalizing and externalizing symptoms in adolescents: A four-year prospective study.

This study examined the relations between hassles and internalizing and externalizing symptoms across 4 years in adolescents who varied with regard to their risk for psychopathology. The sample comprised 240 adolescents assessed in 6th, 7th, 8th, and 9th grades regarding their level of peer and academic hassles and internalizing and externalizing symptoms. Structural equation modeling was used to construct latent variables of hassles and internalizing and externalizing syndromes. Results varied by informant about the teens' symptoms. For adolescent report, the stress exposure model fit the data best for internalizing syndromes; that is, higher levels of stressors predicted significantly higher levels of self-reported symptoms 1 year later. For mother report of adolescents' symptoms, the stress generation model fit the data best for both internalizing and externalizing syndromes; that is, higher levels of adolescents' internalizing and externalizing symptoms, as reported by their mothers, significantly predicted higher levels of hassles 1 year later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Joint factor structure of the Multidimensional Personality Questionnaire and the MMPI in a psychiatric and high-risk sample.

Assessed aspects of the construct validity of the Multidimensional Personality Questionnaire (MPQ), a measure of normal personality characteristics, in a clinically relevant sample through joint factor analyses of primary and second-order scales of the MPQ and the MMPI. A subsample from the Washington University Twin Study of Psychopathology was analyzed. The MPQ's primary scales and higher order factors were found to have meaningful associations with MMPI scales that served as construct markers. The MPQ taps constructs related to, although not redundant with, those measured by the MMPI. Additionally, the MPQ provides a Constraint measure that is relevant to the study of psychopathy and not represented among the MMPI clinical scales. The potential utility of the MPQ in clinical settings as an adjunct to traditional assessment instruments such as the MMPI is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways of risk for accelerated heavy alcohol use among adolescent children of alcoholic parents

The current study examined two questions. First, do internalizing symptoms and externalizing behavior each mediate the relations between parent psychopathology (alcoholism, antisocial personality disorder, and affective disorder) and growth in adolescent heavy alcohol use? Second, are there gender differences in these mediated pathways? Using latent curve analyses, we examined these questions in a high-risk sample of 439 families (53% children of alcoholic parents; 47% female). Collapsing across gender, adolescent-reported externalizing behavior mediated both the relation between parent alcoholism and growth in heavy alcohol use and the relation between parent antisociality and growth in heavy alcohol use. Parent-reported externalizing behavior only mediated the relation between parent antisociality and growth in heavy alcohol use in males. No support was found for internalizing symptoms as a mediator of these relations. Avenues are suggested for further exploring and integrating information about different mediating processes accounting for children of alcoholics' risk for heavy alcohol use.     

Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders.

There is a substantial literature relating the personality trait anxiety sensitivity (AS; tendency to fear anxiety-related sensations) and its lower order dimensions to the mood and anxiety (i.e., internalizing) disorders. However, particularly given the disorders’ high comorbidity rates, it remains unclear whether AS is broadly related to these disorders or if it shows a pattern of differential relations. Meta-analyses of the concurrent relations of AS with the internalizing disorders were conducted based on 117 studies and 792 effect sizes. Mean Anxiety Sensitivity Index scores by diagnostic group and AS–symptom correlations both indicated that AS is most strongly related to panic, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). More specific analyses were also conducted on (a) AS correlations with symptom dimensions within individual disorders and (b) correlations between lower order AS components and symptoms. The meta-analytic correlation matrix for higher order AS–disorder relations was submitted to path analysis, modeling latent Distress disorders and Fear disorders that control for much of the shared variance among the disorders. Results of the path analysis indicated that AS is broadly related to these disorders but that agoraphobia, GAD, panic, and PTSD have the strongest associations. In addition, AS was more strongly related to the latent distress disorders than the fear disorders. Because of the contemporaneous assessment of AS and internalizing disorders in these studies, the results should not be taken to mean that AS has a stronger casual association with certain disorders. Implications for concurrent AS–internalizing relations, interpretations of the AS construct, and structural models of personality and psychopathology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder.

This study examined whether particular forms of parental psychopathology are related to similar forms of comorbid psychopathology in offspring with attention deficit-hyperactivity disorder (ADHD). Parental disorders were assessed using maternal interviews, and child disorders were assessed using multiple-informant interviews for 111 clinic-referred boys (aged 7–12) with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.: American Psychiatric Association, 1987) ADHD. Associations between parental and child internalizing disorders and between parental and child externalizing disorders were found, but associations across categories of disorder (i.e., internalizing and externalizing) were not. Similar relationships were observed in 66 clinic-referred boys without ADHD. These findings support specific modes of familial transmission, in contrast to theories that comorbidity simply reflects more severe psychopathology in children with ADHD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking environmental contributions to child and adolescent psychopathology: A meta-analysis of shared environmental influences.

Behavioral genetic research has concluded that the more important environmental influences result in differences between siblings (referred to as nonshared; e2), whereas environmental influences that create similarities between siblings (referred to as shared; c2) are indistinguishable from zero. However, there is mounting evidence that during childhood and adolescence, c2 may make important contributions to most forms of psychopathology. The aim of the meta-analysis was to empirically confirm this hypothesis. The author examined twin and adoption studies (n = 490) of internalizing and externalizing psychopathology prior to adulthood. Analyses revealed that c2 accounted for 10%–19% of the variance within conduct disorder, oppositional defiant disorder, anxiety, depression, and broad internalizing and externalizing disorders, regardless of their operationalization. When age, informant, and sex effects were considered, c2 generally ranged from 10%–30% of the variance. Importantly, c2 estimates did not vary across twin and adoption studies, suggesting that these estimates reflect actual environmental influences common to siblings. The only exception was attention-deficit/hyperactivity disorder, which appeared to be largely genetic (and particularly nonadditive genetic) in origin. Conceptual, methodological, and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Relations of Problem Behavior Status to Children's Negative Emotionality, Effortful Control, and Impulsivity: Concurrent Relations and Prediction of Change.

The relations of children's internalizing and externalizing problem behaviors to their concurrent regulation, impulsivity (reactive undercontrol), anger, sadness, and fearfulness and these aspects of functioning 2 years prior were examined. Parents and teachers completed measures of children's (N = 185; ages 6 through 9 years) adjustment, negative emotionality, regulation, and behavior control; behavioral measures of regulation also were obtained. In general, both internalizing and externalizing problems were associated with negative emotionality. Externalizers were low in effortful regulation and high in impulsivity, whereas internalizers, compared with nondisordered children, were low in impulsivity but not effortful control. Moreover, indices of negative emotionality, regulation, and impulsivity with the level of the same variables 2 years before controlled predicted stability versus change in problem behavior status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)