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A metastructural model of mental disorders and pathological personality traits

  • A. G. C. Wright (a1) and L. J. Simms (a2)



Psychiatric co-morbidity is extensive in both psychiatric settings and the general population. Such co-morbidity challenges whether DSM-based mental disorders serve to effectively carve nature at its joints. In response, a substantial literature has emerged showing that a small number of broad dimensions – internalizing, externalizing and psychoticism – can account for much of the observed covariation among common mental disorders. However, the location of personality disorders within this emerging metastructure has only recently been studied, and no studies have yet examined where pathological personality traits fit within such a broad metastructural framework.


We conducted joint structural analyses of common mental disorders, personality disorders and pathological personality traits in a sample of 628 current or recent psychiatric out-patients.


Bridging across the psychopathology and personality trait literatures, the results provide evidence for a robust five-factor metastructure of psychopathology, including broad domains of symptoms and features related to internalizing, disinhibition, psychoticism, antagonism and detachment.


These results reveal evidence for a psychopathology metastructure that (a) parsimoniously accounts for much of the observed covariation among common mental disorders, personality disorders and related personality traits, and (b) provides an empirical basis for the organization and classification of mental disorder.


Corresponding author

* Address for correspondence: A. G. C. Wright, Ph.D., Department of Psychology, University of Pittsburgh, 4121 Sennott Square, 210 S. Bouquet Street, Pittsburgh, PA 1526, USA. (Email:


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Achenbach, TM (1966). The classification of children's psychiatric symptoms: a factor-analytic study. Psychological Monographs: General and Applied 80, 137.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association: Washington, DC.
Asparouhov, T, Muthén, B (2009). Exploratory structural equation modeling. Structural Equation Modeling 16, 397438.
Bakan, D (1966). The Duality of Human Existence. Rand McNally: Chicago.
Benjamin, LS (1996). Interpersonal Diagnosis and Treatment of Personality Disorders. Guilford Press: New York.
Blanco, C, Krueger, RF, Hasin, DS, Liu, SM, Wang, S, Kerridge, BT, Saha, T, Olfson, M (2013). Mapping common psychiatric disorders: structure and predictive validity in the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 70, 199207.
Brown, TA (2006). Confirmatory Factor Analysis for Applied Research. Guilford: New York.
Clark, LA (2005). Temperament as a unifying basis for personality and psychopathology. Journal of Abnormal Psychology 114, 505.
De Fruyt, F, De Clercq, B, De Bolle, M, Wille, B, Markon, K, Krueger, RF (2013). General and maladaptive traits in a five-factor framework for DSM-5 in a university student sample. Assessment 20, 295307.
Eysenck, HJ (1967). The Biological Basis of Personality. Transaction Publishers: New Brunswick and London.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute: New York.
Gore, WL, Widiger, TA (2013). The DSM-5 dimensional trait model and five-factor models of general personality. Journal of Abnormal Psychology 122, 816821.
Harkness, AR, Reynolds, SM, Lilienfeld, SO (2014). A review of systems for psychology and psychiatry: adaptive systems, Personality Psychopathology Five (PSY-5), and the DSM-5. Journal of Personality Assessment 96, 121139.
Hill, J, Pilkonis, PA, Bear, J (2010). Social domains, personality, and interpersonal functioning. In Handbook of Interpersonal Psychology: Theory, Research, Assessment and Therapeutic Interventions (ed. Horowitz, L. and Strack, S.), pp. 281296. Wiley: New York.
Hopwood, CJ, Wright, AGC, Ansell, EB, Pincus, AL (2013). The interpersonal core of personality pathology. Journal of Personality Disorders 27, 271295.
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.
Hyman, SE (2010). The diagnosis of mental disorders: the problem of reification. Annual Review of Clinical Psychology 6, 155179.
Insel, TR, Cuthbert, BN, Garvey, MA, Heinssen, RK, Pine, DS, Quinn, KJ, Sanislow, C, Wang, P (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748751.
Kendler, KS, Aggen, SH, Knudsen, GP, Røysamb, E, Neale, MC, Reichborn-Kjeennerud, T (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV Axis I and Axis II disorders. American Journal of Psychiatry 168, 2939.
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929937.
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617627.
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 819.
Kotov, R, Chang, SW, Fochtmann, LJ, Mojtabai, R, Carlson, GA, Sedler, MA, Bromet, EJ (2010 a). Schizophrenia in the internalizing–externalizing framework: a third-dimension? Schizophrenia Bulletin 37, 11681178.
Kotov, R, Gamez, W, Schmidt, F, Watson, D (2010 b). Linking “big” personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychological Bulletin 136, 768821.
Kotov, R, Ruggero, CJ, Krueger, RF, Watson, D, Yuan, Q, Zimmerman, M (2011). New dimensions in the quantitative classification of mental illness. Archives of General Psychiatry 68, 10031011.
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921926.
Krueger, RF, Derringer, J, Markon, KE, Watson, D, Skodol, AE (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological Medicine 42, 18791890.
Krueger, RF, Eaton, NR, Clark, LA, Watson, D, Markon, KE, Derringer, J, Skodol, A, Livesley, WJ (2011). Deriving an empirical structure of personality pathology for DSM-5. Journal of Personality Disorders 25, 170191.
Krueger, RF, Markon, KE (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111133.
Lahey, BB, Rathouz, PJ, van Hulle, C, Urbano, RC, Krueger, RF, Applegate, B, Garriock, HA, Chapman, DA, Waldman, ID (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. Journal of Abnormal Child Psychology 36, 187206.
Markon, KE (2010). Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychological Medicine 40, 273288.
Markon, KE, Krueger, RF, Watson, D (2005). Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. Journal of Personality and Social Psychology 88, 139157.
Marsh, HW, Lüdtke, O, Muthén, B, Asparouhov, T, Morin, AJ, Trautwein, U, Nagengast, B (2010). A new look at the big five factor structure through exploratory structural equation modeling. Psychological Assessment 22, 471491.
Meyer, B, Pilkonis, PA (2005). An attachment model of personality disorders. In Major Theories of Personality Disorder, 2nd edn (ed. Lenzenweger, M. F. and Clarkin, J. F.), pp. 231281. Guilford Press: New York.
Morey, LC, Krueger, RF, Skodol, AE (2013). The hierarchical structure of clinician ratings of proposed DSM-5 pathological personality traits. Journal of Abnormal Psychology 122, 836.
Muthén, L, Muthén, BO (1998–2012). Mplus Users’ Guide, 6th edn. Muthén & Muthén: Los Angeles, CA.
Narrow, WE, Clarke, DE, Kuramoto, SJ, Kraemer, HC, Kupfer, DJ, Greiner, L, Regier, DA (2013). DSM-5 field trials in the United States and Canada, Part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5. American Journal of Psychiatry 170, 7182.
Ofrat, S, Krueger, RF (2012). How research on the meta-structure of psychopathology aids in understanding biological correlates of mood and anxiety disorders. Biology of Mood and Anxiety Disorders 2, 1316.
Pincus, AL (2005). A contemporary integrative interpersonal theory of personality disorders. In Major Theories of Personality Disorder, 2nd edn (ed. Lenzenweger, M. F. and Clarkin, J. F.), pp. 282331. Guilford Press: New York.
Plomin, R, Haworth, C, Davis, O (2009). Common disorders are quantitative traits. Nature Reviews Genetics 10, 872878.
Røysamb, E, Kendler, KS, Tambs, K, Ørstavik, RE, Neale, MC, Aggen, SH, Torgersen, S, Reichborn-Kjennerud, T (2011). The joint structure of DSM-IV Axis I and Axis II disorders. Journal of Abnormal Psychology 120, 198209.
Samuel, DB, Widiger, TA (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: a facet level analysis. Clinical Psychology Review 28, 1326.
Sanislow, CA, Pine, DS, Quinn, KJ, Kozak, MJ, Garvey, MA, Heinssen, RK, Wang, PS, Cuthbert, BN (2010). Developing constructs for psychopathology research: research domain criteria. Journal of Abnormal Psychology 119, 631.
Sass, DA, Schmitt, TA (2010). A comparative investigation of rotation criteria within exploratory factor analysis. Multivariate Behavioral Research 45, 73103.
Saulsman, LM, Page, AC (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review 23, 10551085.
Sheehan, DV, Lecrubier, Y (2010). The Mini International Neuropsychiatric Interview version 6.0 (MINI 6.0). Medical Outcomes System Inc.: Jacksonville, FL.
Sheehan, DV, Lecrubier, Y, Harnett-Sheehan, K, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, G (1998). The M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry 59, 2233.
Siever, LJ, Davis, KL (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry 148, 16471658.
Thomas, KM, Yalch, MM, Krueger, RF, Wright, AGC, Markon, KE, Hopwood, CJ (2013). The convergent structure of DSM-5 personality trait facets and the five-factor model (FFM) trait domains. Assessment 20, 308311.
Watson, D, Stasik, SM, Ro, E, Clark, LA (2013). Integrating normal and pathological personality relating the DSM-5 trait-dimensional model to general traits of personality. Assessment 20, 312326.
Whiteside, SP, Lynam, DR (2001). The five factor model and impulsivity: using a structural model of personality to understand impulsivity. Personality and Individual Differences 30, 669689.
Wiggins, JS (1991). Agency and communion as conceptual coordinates for the understanding and measurement of interpersonal behavior. In Thinking Clearly about Psychology: Essays in Honor of Paul E. Meehl, Vol. 2: Personality and Psychopathology (ed. Cicchetti, D. and Grove, W. M.), pp. 89113. University of Minnesota Press: Minneapolis, MN.
Wolf, AW, Schubert, DSP, Patterson, MB, Grande, TP, Brocco, KJ, Pendleton, L (1988). Associations among major psychiatric diagnoses. Journal of Consulting and Clinical Psychology 56, 292294.
Wright, AGC, Krueger, RF, Hobbs, MJ, Markon, KE, Eaton, NR, Slade, T (2013). The structure of psychopathology: toward an expanded quantitative empirical model. Journal of Abnormal Psychology 122, 281294.
Wright, AGC, Simms, LJ (2014). On the structure of personality disorder traits: conjoint analyses of the CAT-PD, PID-5, and NEO-PI-3 trait models. Personality Disorders: Theory, Research, and Treatment 5, 4354.
Wright, AGC, Thomas, KM, Hopwood, CJ, Markon, KE, Pincus, AL, Krueger, RF (2012). The hierarchical structure of DSM-5 pathological personality traits. Journal of Abnormal Psychology 121, 951957.
Wright, AGC, Zimmermann, J (2015). At the nexus of science and practice: answering basic clinical questions in personality disorder assessment and diagnosis with quantitative modeling techniques. In Personality Disorders: Assessment, Diagnosis, and Research (ed. Huprich, S.), pp. 109144. American Psychological Association: Washington, DC.
Zimmerman, M, Mattia, JI (1999). Psychiatric diagnosis in clinical practice: is comorbidity being missed? Comprehensive Psychiatry 40, 182191.


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