Skip to main content
Log in

Comorbidity Between and Within Childhood Externalizing and Internalizing Disorders: Reflections and Directions

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-87.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Berkson, J. (1946). Limitations of the application of the four-fold table analysis to hospital data. Biometrics Bulletin, 2, 47-53.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063-1080.

    PubMed  Google Scholar 

  • Cattell, R. C. (1950). Personality: A systematic, theoretical, and factual study. New York: McGraw-Hill.

    Google Scholar 

  • Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336.

    PubMed  Google Scholar 

  • Coccaro, E. F. (1989). Central serotonin and impulsive aggression. British Journal of Psychiatry, 155(Suppl. 8), 52-62.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Feinstein, A. R. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455-468.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Gorenstein, E. E., & Newman, J. P. (1980). Disinhibitory psychopathology: A new perspective and a model for research. Psychological Review, 87, 301-315.

    PubMed  Google Scholar 

  • Gottesman, I. I., & Shields, J. (with Hanson, D. R.). (1982). Schizophrenia: The epigenetic puzzle. New York: Cambridge University Press.

    Google Scholar 

  • Gray, J. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford: Clarendon Press.

    Google Scholar 

  • Guilford, J. P. (1954). Psychometric methods (2nd ed.). New York: McGraw-Hill.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Karpman, B. (1941). On the need for separating psychopathy into two distinct types: symptomatic and idiopathic. Journal of Criminology and Psychopathology, 3, 112-137.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Kessler, R. C., Keller, M. B., & Wittchen, H.-U. (2001). The epidemiology of generalized anxiety disorder. Psychiatric Clinics of North America, 24, 19-39.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921-926.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    Google Scholar 

  • Lykken, D. T. (1995). The antisocial personalities. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • 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.

    Google Scholar 

  • Mayr, E. (1982). The growth of biological thought: Diversity, evolution, and inheritance. Cambridge, MA: Belknap Press.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Meehl, P. E. (2001). Comorbidity and taxometrics. Clinical Psychology: sScience and Practice, 8, 507-519.

    Google Scholar 

  • Newman, J. P., & Kosson, D. S. (1986). Passive avoidance learning in psychopathic and nonpsychopathic offenders. Journal of Abnormal Psychology, 95, 252-256.

    PubMed  Google Scholar 

  • Nicholls, J. G., Licht, B. G., & Pearl, R. A. (1982). Some dangers of using personality questionnaires to study personality. Psychological Bulletin, 92, 572-580.

    Google Scholar 

  • Nunnally, J. C. (1967). Psychometric theory. New York: McGraw-Hill.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Peterson, D. R., Quay, H. C., & Tiffany, T. I. (1961). Personality factors related to juvenile delinquency. Child Development, 32, 355-372.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 98, 219-235.

    Google Scholar 

  • Weiss, B., Susser, K., & Catron, T. (1998). Common and specific features of childhood psychopathology. Journal of Abnormal Psychology, 107, 118-127.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Zinbarg, R. E., & Barlow, D. H. (1996). Structure of anxiety and the anxiety disorders: A hierarchical model. Journal of Abnormal Psychology, 105, 181-193.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023229529866

Navigation