On the hierarchical structure of mood and anxiety disorders: confirmatory evidence and elaboration of a model of temperament markers

Abstract

The authors examined D. Watson's (2005) proposed reconceptualization of the diagnostic categories for mood and anxiety disorders for the Diagnostic and Statistical Manual of Mental Disorders--Fifth Edition (DSM-V) and tested an elaboration of the 2-factor (positive and negative activation) model of underlying temperament markers that incorporates A. Tellegen, D. Watson, & L. A. Clark's (1999a, 1999b) higher-order dimension of happiness-unhappiness (or demoralization; see A. Tellegen et al., 2003). In Study 1, 502 undergraduate students completed several symptom measures of mood and anxiety disorders and the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher et al., 2001). Using confirmatory factor analysis, the authors replicated Watson's distress and fear disorder model. Path analyses showed that demoralization was a primary marker of distress disorders, whereas dysfunctional negative emotions was a primary marker of fear disorders. Low positive emotions was a specific marker of depression and social phobia. This 3-factor path model was associated with better fit than was a 2-factor model excluding demoralization. In Study 2, the authors replicated the findings of Study 1 using data from an archival clinical sample of 636 Veterans Affairs hospital outpatients. The authors' findings provide evidence on the important role of demoralization in mood and anxiety disorders.