Skip to main content

The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes

  • Mark D. Kramer (a1), Robert F. Krueger (a1) and Brian M. Hicks (a1)

We hypothesized that gender differences in average levels on the internalizing and externalizing factors that account for co-morbidity among common psychopathological syndromes in both men and women account for gender differences in the prevalence of specific syndromes.


The latent structure of 11 syndromes was examined in a middle-aged (mean age=52.66 years, s.d.=5.82) sample of 2992 (37% men) members of the community-based Minnesota Twin Registry (MTR) assessed using 10 scales of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and an adult antisocial behavior scale. Confirmatory factorial invariance models were applied to a best-fitting, internalizing–externalizing model.


A ‘strong gender invariance model’ fit best, indicating that gender differences in the means of individual syndromes were well accounted for by gender differences in mean levels of internalizing and externalizing. Women exhibited higher mean levels of internalizing (d=0.23) and lower mean levels of externalizing (d=−0.52) than men.


These findings suggest that risk factors for common mental disorders exhibiting gender differences may influence prevalence at the latent factor level. Future research may benefit from focusing on both the latent factor and individual syndrome levels in explaining gender differences in psychopathology.

Corresponding author
*Address for correspondence: M. D. Kramer or R. F. Krueger, Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN 55455, USA. (Email:
Hide All
Agrawal A, Jacobson KC, Prescott CA, Kendler KS (2004). A twin study of personality and illicit drug use and abuse/dependence. Twin Research 7, 7281.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision American Psychiatric Association: Washington, DC.
Bijl RV, Ravelli A, van Zessen G (1998). Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 33, 587595.
Brook JS, Whiteman M, Finch SJ, Cohen P (1996). Young adult drug use and delinquency: childhood antecedents and adolescent mediators. Journal of the American Academy of Child and Adolescent Psychiatry 35, 15841592.
Busseri MA, Willoughby T, Chalmers H (2007). A rationale and method for examining reasons for linkages among adolescent risk behaviors. Journal of Youth and Adolescence 36, 279289.
Butler PD, Nemeroff CB (1990). Corticotropin-releasing factor as a possible cause of comorbidity in anxiety and depressive disorders. In Comorbidity of Mood and Anxiety Disorders (ed. D Maser J. and Cloninger C.), pp. 413435. American Psychiatric Association: Washington, DC.
Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 677685.
Costa P Jr., Terracciano A, McCrae RR (2001). Gender differences in personality traits across cultures: robust and surprising findings. Journal of Personality and Social Psychology 81, 322331.
de Wit H, Richards JB (2004). Dual determinants of drug use in humans: reward and impulsivity. In Nebraska Symposium on Motivation. Vol. 50: Motivational Factors in the Etiology of Drug Abuse (ed. Bevins R. A. and Bardo M. T.), pp. 1955. University of Nebraska Press: Lincoln.
Fanous A, Gardner CO, Prescott CA, Cancro R, Kendler KS (2002). Neuroticism, major depression and gender: a population-based twin study. Psychological Medicine 32, 719728.
First MB, Spitzer RL, Williams JBW, Gibbon M (1997). Structured Clinical Interview for DSM-IV (SCID). American Psychiatric Association: Washington, DC.
Giancola PR, Parker AM (2001). A six-year prospective study of pathways toward drug use in adolescent boys with and without a family history of a substance use disorder. Journal of Studies on Alcohol 62, 166178.
Giancola PR, Tarter RE (1999). Executive cognitive functioning and risk for substance abuse. Psychological Science 10, 203205.
Goodwin RD, Gotlib IH (2004). Gender differences in depression: the role of personality factors. Psychiatry Research 126, 135142.
Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA (2004 a). Nicotine dependence and psychiatric disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 11071115.
Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP (2004 b). Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 361368.
Guo J, Hill KG, Hawkins JD, Catalano RF, Abbott RD (2002). A developmental analysis of sociodemographic, family, and peer effects on adolescent illicit drug initiation. Journal of the American Academy of Child and Adolescent Psychiatry 41, 838845.
Hawkins J, Catalano RF, Miller JY (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological Bulletin 112, 64105.
Hicks BM, Blonigen DM, Kramer MD, Krueger RF, Patrick CJ, Iacono WG, McGue M (2007). Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: a longitudinal-twin study. Journal of Abnormal Psychology 116, 433447.
Holdcraft LC, Iacono WG, McGue MK (1998). Antisocial personality disorder and depression in relation to alcoholism: a community-based sample. Journal of Studies on Alcohol 59, 222226.
Hudson JI, Mangweth B, Pope HG Jr., De Col C, Hausmann A, Gutweniger S, Laird NM, Biebl W, Tsuang MT (2003). Family study of affective spectrum disorder. Archives of General Psychiatry 60, 170177.
Hudson JI, Pope HG Jr. (1990). Affective spectrum disorder: does antidepressant response identify a family of disorders with a common pathophysiology? American Journal of Psychiatry 147, 552564.
Iacono WG, Carlson SR, Taylor J, Elkins IJ, McGue M (1999). Behavioral disinhibition and the development of substance-use disorders: findings from the Minnesota Twin Family Study. Development and Psychopathology 11, 869900.
Jardine R, Martin NG, Henderson AS (1984). Genetic covariation between neuroticism and the symptoms of anxiety and depression. Genetic Epidemiology 1, 89107.
Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Meltzer H (2003). The national psychiatric morbidity surveys of Great Britain: initial findings from the Household Survey. International Review of Psychiatry 15, 2942.
Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ (1993). A longitudinal twin study of personality and major depression in women. Archives of General Psychiatry 50, 853862.
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, 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.
Klose M, Jacobi F (2004). Can gender differences in the prevalence of mental disorders be explained by sociodemographic factors? Archives of Women's Mental Health 7, 133148.
Knutson B, Wolkowitz OM, Cole SW, Chan T, Moore EA, Johnson RC, Terpstra J, Turner RA, Reus VI (1998). Selective alteration of personality and social behavior by serotonergic intervention. American Journal of Psychiatry 155, 373379.
Krueger RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921926.
Krueger RF, Caspi A, Moffitt TE, Silva PA (1998). The structure and stability of common mental disorders (DSM-III-R): a longitudinal–epidemiological study. Journal of Abnormal Psychology 107, 216227.
Krueger RF, Caspi A, Moffitt TE, Silva PA, McGee R (1996). Personality traits are differentially linked to mental disorders: a multitrait-multidiagnosis study of an adolescent birth cohort. Journal of Abnormal Psychology 105, 299312.
Krueger RF, Hicks BM, Patrick CJ, Carlson SR, Iacono WG, McGue M (2002). Etiologic connections among substance dependence, antisocial behavior and personality: modeling the externalizing spectrum. Journal of Abnormal Psychology 111, 411424.
Lykken DT, Bouchard TJ Jr., McGue M, Tellegen A (1990). The Minnesota Twin Family Registry: some initial findings. Acta Geneticae Medicae et Gemellologiae 39, 3570.
Lynam DR, Miller JD (2004). Personality pathways to impulsive behavior and their relations to deviance: results from three samples. Journal of Quantitative Criminology 20, 319341.
Meredith W (1993). Measurement invariance, factor analysis and factorial invariance. Psychometrika 58, 525543.
Moffitt TE, Caspi A, Rutter M, Silva PA (2001). Sex Differences in Antisocial Behaviour: Conduct disorder, Delinquency, and Violence in the Dunedin Longitudinal Study. Cambridge University Press: New York, NY.
Muthén LK, Muthén BO (2004). MPlus User's Guide. Muthén & Muthén: Los Angeles, CA.
Nishizawa S, Benkelfat C, Young SN, Leyton M, Mzengeza S, de Montigny C, Blier P, Diksic M (1997). Differences between males and females in rates of serotonin synthesis in human brain. Proceedings of the National Academy of Sciences USA 94, 53085313.
Nolen-Hoeksema S (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology 100, 569582.
Nolen-Hoeksema S (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology 109, 504511.
Nolen-Hoeksema S (2004). Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review 24, 9811010.
Nolen-Hoeksema S, Jackson B (2001). Mediators of the gender difference in rumination. Psychology of Women Quarterly 25, 3747.
Nolen-Hoeksema S, Larson J, Grayson C (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology 77, 10611072.
Reinherz HZ, Giaconia RM, Hauf AM, Wasserman MS, Paradis AD (2000). General and specific childhood risk factors for depression and drug disorders by early adulthood. Journal of the American Academy of Child and Adolescent Psychiatry 39, 223231.
Roberts SB, Kendler KS (1999). Neuroticism and self-esteem as indices of the vulnerability to major depression in women. Psychological Medicine 29, 11011109.
Robins LN, Regier DA (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press: New York.
Sher KJ, Bartholow BD, Wood MD (2000). Personality and substance use disorders: a prospective study. Journal of Consulting and Clinical Psychology 68, 818829.
Tarter RE, Kirisci L, Mezzich A, Cornelius JR, Pajer K, Vanyukov M, Gardner M, Blackson T, Clark D (2003). Neurobehavior disinhibition in childhood predicts early age at onset of substance use disorder. American Journal of Psychiatry 160, 10781085.
Tellegen A (in press). Manual for the Multidimensional Personality Questionnaire. University of Minnesota Press: Minneapolis.
Watson D, Gamez W, Simms LJ (2005). Basic dimensions of temperament and their relation to anxiety and depression: a symptom-based perspective. Journal of Research in Personality 39, 4666.
Watson D, Kotov R, Gamez W (2006). Basic dimensions of temperament in relation to personality and psychopathology. In Personality and Psychopathology (ed. Krueger R. F. and Tackett J. L.). Guilford Press: New York, NY.
Wills TA, Vaccaro D, McNamara G (1994). Novelty seeking, risk taking, and related constructs as predictors of adolescent substance use: an application of Cloninger's theory. Journal of Substance Abuse 6, 120.
Young E, Korszun A (1999). Women, stress, and depression: sex differences in hypothalamic–pituitary–adrenal axis regulation. In Review of Psychiatry Series. Vol. 18: Gender Differences in Mood and Anxiety Disorders: From Bench to Bedside (ed. Leibenluft E.), pp. 3152. American Psychiatric Association: Washington, DC.
Young EA, Abelson JL, Cameron OG (2004). Effect of comorbid anxiety disorders on the hypothalamic–pituitary–adrenal axis response to a social stressor in major depression. Biological Psychiatry 56, 113120.
Zimmerman M, Mattia JI (2001 a). The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Comprehensive Psychiatry 42, 175189.
Zimmerman M, Mattia JI (2001 b). A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Archives of General Psychiatry 58, 787794.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 7
Total number of PDF views: 63 *
Loading metrics...

Abstract views

Total abstract views: 402 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.