Psychological Medicine

Thematic section: A proposal for a meta-structure for DSM-V and ICD-11

Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11

Paper 6 of 7 of the thematic section: ‘A proposal for a meta-structure for DSM-V and ICD-11’

R. F. Kruegera1 c1 and S. C. Southa2

a1 Departments of Psychology and Psychiatry, Washington University in St Louis, St Louis, MO, USA

a2 Department of Psychology, Purdue University, Lafayette, IN, USA


Background The extant major psychiatric classifications DSM-IV and ICD-10 are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of the etiology. In an attempt to group mental disorders on the basis of etiology, five clusters have been proposed. We consider the validity of the fifth cluster, externalizing disorders, within this proposal.

Method We reviewed the literature in relation to 11 validating criteria proposed by the Study Group of the DSM-V Task Force, in terms of the extent to which these criteria support the idea of a coherent externalizing spectrum of disorders.

Results This cluster distinguishes itself by the central role of disinhibitory personality in mental disorders spread throughout sections of the current classifications, including substance dependence, antisocial personality disorder and conduct disorder. Shared biomarkers, co-morbidity and course offer additional evidence for a valid cluster of externalizing disorders.

Conclusion Externalizing disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

(Received May 22 2008)

(Revised February 03 2009)

(Accepted May 12 2009)

(Online publication October 01 2009)