Stress responsivity and the structure of common mental disorders: Transdiagnostic internalizing and externalizing dimensions are associated with contrasting stress appraisal biases.

• Type of Material: Article
• Authors: Christopher C. Conway, College of William and Mary; Lisa R. Starr, University of Rochester; Emmanuel P. Espejo, VA San Diego Healthcare System; Patricia Brennan, Emory University; Constance Hammen, University of California
• Language: English
• Date: 2016-11
• Publisher: American Psychological Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Psychological Association.
• Final Published Version (URL): http://dx.doi.org/10.1037/abn0000163
• Title of Journal or Parent Work: Journal of Abnormal Psychology
• ISSN: 0021-843X
• Volume: 125
• Issue: 8
• Start Page: 1079
• End Page: 1089
• Grant/Funding Information: This research was supported by the National Health and Medical Research Council, the Mater Misericordiae Mother’s Hospital in Queensland, Australia, and the National Institute of Mental Health grant R01MH52239.
• Keywords: Transdiagnostic; Stress reactivity; Externalizing; Internalizing; Appraisal
• Research Categories: Psychology, Behavioral

Abstract

Biased stress appraisals critically relate to the origins and temporal course of many—perhaps most—forms of psychopathology. We hypothesized that aberrant stress appraisals are linked directly to latent internalizing and externalizing traits that, in turn, predispose to multiple disorders. A high-risk community sample of 815 adolescents underwent semistructured interviews to assess clinical disorders and naturalistic stressors at ages 15 and 20. Participants and blind rating teams separately evaluated the threat associated with acute stressors occurring in the past year, and an appraisal bias index (i.e., discrepancy between subjective and team-rated threat) was generated. A two-factor (Internalizing and Externalizing) latent variable model provided an excellent fit to the diagnostic correlations. After adjusting for the covariation between the factors, adolescents’ threat overestimation prospectively predicted higher standing on Internalizing, whereas threat underestimation prospectively predicted elevations on Externalizing. Cross-sectional analyses replicated this pattern in early adulthood. Appraisals were not related to the residual portions of any diagnosis in the latent variable model, suggesting that the transdiagnostic dimensions mediated the connections between stress appraisal bias and disorder entities. We discuss implications for enhancing the efficiency of emerging research on the stress response and speculate how these findings, if replicated, might guide refinements to psychological treatments for stress-linked disorders.