Abstract
The term and concept of “lcomorbidity” has been mired in controversy, although there is little question that the existence of covariation among psychiatric diagnoses poses significant challenges to current models of psychiatric classification and diagnosis. The papers in this Special Section underscore a number of important issues relevant to the comorbidity between and within childhood externalizing and internalizing disorders, and illustrate both methodological and substantive reasons for such comorbidity. Weiss, Susser, and Catron's distinction among common, broad-band specific, and narrow-band specific features provides a helpful framework for understanding the comorbidity of childhood externalizing and internalizing disorders (B, Weiss, K. Susser, & T. Catron, 1998). Hierarchical models of psychopathology help to dissolve the distinction between “splitters” and “lumpers” and point to variables that may elucidate the etiology of externalizing and internalizing disorders.
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Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-87.
Beauchaine, T. P., Katkin, E. S., Strassberg, Z., & Snarr, J. (2001). Disinhibitory psychopathology in male adolescents: Discriminating conduct disorder from attention-deficit/hyperactivity disorder though concurrent assessment of multiple autonomic states. Journal of Abnormal Psychology, 110, 610-624.
Berkson, J. (1946). Limitations of the application of the four-fold table analysis to hospital data. Biometrics Bulletin, 2, 47-53.
Beyers, J. M., & Loeber, R. (2003). Untangling developmental relations between depressed mood and delinquency in male adolescents. Journal of Abnormal Child Psychology, 31, 247-266.
Capaldi, D. M. (1991). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys: I. Familial factors and general adjustment at Grade 6. Development and Psychopathology, 3, 277-300.
Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063-1080.
Cattell, R. C. (1950). Personality: A systematic, theoretical, and factual study. New York: McGraw-Hill.
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336.
Coccaro, E. F. (1989). Central serotonin and impulsive aggression. British Journal of Psychiatry, 155(Suppl. 8), 52-62.
Dallam, S. J., Gleaves, D. H., Cepeda-Benito, A., Silberg, J. L., Kraemer, H. C., & Spiegel, D. (2001). The effects of child sexual abuse: Comment on Rind, Tromovitch, and Bauserman (1998). Psychological Bulletin, 127, 715-733.
DuFort, G. G., Newman, S. C., & Bland, R. C. (1993). Psychiatric comorbidity and treatment seeking: Sources of selection bias in the study of clinical populations. Journal of Nervous and Mental Disease, 181, 467-474.
Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455-468.
Fowles, D. C. (1987). Application of a behavioral theory of motivation to the concepts of anxiety and impulsivity. Journal of Research in Personality, 21, 417-435.
Frances, A., Widiger, T., & Fyer, M. R. (1990). The influence of classification methods on comorbidity. In J. D. Maser & C. R. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 41-59). Washington, DC: American Psychiatric Association Press.
Frick, P. J., Lilienfeld, S. O., Ellis, M., Loney, B., & Silverthorn, P. (1999). The association between anxiety and psychopathy dimensions in children. Journal of Abnormal Child Psychology, 27, 383-392.
Gorenstein, E. E., & Newman, J. P. (1980). Disinhibitory psychopathology: A new perspective and a model for research. Psychological Review, 87, 301-315.
Gottesman, I. I., & Shields, J. (with Hanson, D. R.). (1982). Schizophrenia: The epigenetic puzzle. New York: Cambridge University Press.
Gray, J. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford: Clarendon Press.
Guilford, J. P. (1954). Psychometric methods (2nd ed.). New York: McGraw-Hill.
Joiner, T. E., Catanzaro, S. J., & Laurent, J. (1996). Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients. Journal of Abnormal Psychology, 105, 401-409.
Joiner, T. E., Steer, R. A., Beck, A. T., Schmidt, N. B., Rudd, M. D., & Catanzaro, S. J. (1999). Physiological hyperarousal: Construct validity of a central aspect of the tripartite model of depression and anxiety. Journal of Abnormal Psychology, 108, 290-298.
Kaplan, M. H., & Feinstein, A. R. (1974). The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. Journal of Chronic Diseases, 27, 387-404.
Karpman, B. (1941). On the need for separating psychopathy into two distinct types: symptomatic and idiopathic. Journal of Criminology and Psychopathology, 3, 112-137.
Keiley, M. K., Lofthouse, N., Bates, J. E., Dodge, K. A., & Pettit, G.S. (2003). Differential risks of covarying and pure components in mother and teacher reports of externalizing and internalizing behavior across ages 5 to 14. Journal of Abnormal Child Psychology, 31, 267-283.
Kessler, R. C., Keller, M. B., & Wittchen, H.-U. (2001). The epidemiology of generalized anxiety disorder. Psychiatric Clinics of North America, 24, 19-39.
Kihlstrom, J. F. (2002). To honor Kraepelin...From symptoms to pathology in the diagnosis of mental illness. In L.E. Beutler & Mary L. Malik (Eds.), Rethinking the DSM: A psychological perspective (pp. 279-303). Washington, DC: American Psychological Association.
Klein, D., & Riso, L.P. (1993). Psychiatric disorders: Problems of boundaries and comorbidity. In C.G. Costello (Ed.), Basic issues in psychopathology (pp. 19-66). New York: Guilford Press.
Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921-926.
Lilienfeld, S. O. (1995). Can anxiety and depression be meaningfully differentiated? In S.O. Lilienfeld, Seeing both sides: Classic controversies in abnormal psychology (pp. 116-141). Pacific Grove, CA: Brooks/Cole.
Lilienfeld, S. O., Waldman, I. D., & Israel, A. C. (1994). A critical examination of the term and concept of “comorbidity” in psychopathology research. Clinical Psychology: Science and Practice, 1, 71-83.
Lykken, D. T. (1995). The antisocial personalities. Hillsdale, NJ: Erlbaum.
Maser, J. D., & Cloninger, C. R. (1990). Comorbidity of mood and anxiety disorders: Introduction and overview. In J.D. Maser & C.R. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 3-12). Washington, DC: American Psychiatric Association Press.
Mayr, E. (1982). The growth of biological thought: Diversity, evolution, and inheritance. Cambridge, MA: Belknap Press.
McConaughy, S. H., & Achenbach, T. M. (1994). Comorbidity of empirically matched syndromes in matched general population and clinical samples. Journal of Child Psychology and Psychiatry, 35, 1141-1157.
Meehl, P. E. (2001). Comorbidity and taxometrics. Clinical Psychology: sScience and Practice, 8, 507-519.
Newman, J. P., & Kosson, D. S. (1986). Passive avoidance learning in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology, 95, 252-256.
Nicholls, J. G., Licht, B. G., & Pearl, R. A. (1982). Some dangers of using personality questionnaires to study personality. Psychological Bulletin, 92, 572-580.
Nunnally, J. C. (1967). Psychometric theory. New York: McGraw-Hill.
O'Connor, T. G., McGuire, S., Reiss, D., Hetherington, E. M., & Plomin, R. (1998). Co-occurrence of depressive symptoms and antisocial behavior in adolescence: A common genetic liability. Journal of Abnormal Psychology, 107, 27-37.
Peterson, D. R., Quay, H. C., & Tiffany, T. I. (1961). Personality factors related to juvenile delinquency. Child Development, 32, 355-372.
Quay, H. C. (1964). Dimensions of personality in delinquent boys as inferred from the factor analysis of case history data. Child Development, 35, 479-484.
Tellegen, A. (1982). Brief Manual for the Multidimensional Personality Questionnaire. Unpublished manuscript, University of Minnesota.
Waldman, I. D., & Lilienfeld, S. O. (2001). Applications of taxometric methods to problems of comorbidity: Perspectives and challenges. Clinical Psychology: Science and Practice, 8, 520-527.
Walker, J. L., Lahey, B. B., Russo, M. F., Christ, M. A. G., McBurnett, K., Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1991). Anxiety, inhibition, and conduct disorder in children: Relations to social impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 187-191.
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 98, 219-235.
Weiss, B., Susser, K., & Catron, T. (1998). Common and specific features of childhood psychopathology. Journal of Abnormal Psychology, 107, 118-127.
White, H. R., Bates, M. E., Buyske, S. (2001). Adolescence-limited versus persistent delinquency: Extending Moffitt's hypothesis into adulthood. Journal of Abnormal Psychology, 110, 600-609.
Youngstrom, E. A., Findling, R. L., & Calabrese, J. R. (2003). Who are the co-morbid adolescents? Agreement between psychiatric diagnosis, youth, parent, and teacher report. Journal of Abnormal Child Psychology, 31, 231-245.
Zinbarg, R. E., & Barlow, D. H. (1996). Structure of anxiety and the anxiety disorders: A hierarchical model. Journal of Abnormal Psychology, 105, 181-193.
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Lilienfeld, S.O. Comorbidity Between and Within Childhood Externalizing and Internalizing Disorders: Reflections and Directions. J Abnorm Child Psychol 31, 285–291 (2003). https://doi.org/10.1023/A:1023229529866
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DOI: https://doi.org/10.1023/A:1023229529866