Psychological Medicine

Original Articles

Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders

K. E. Markona1 c1

a1 Department of Psychology, University of Iowa, Iowa City, IA, USA


Background Analyses of co-morbidity patterns among common mental disorders have repeatedly indicated that relationships among disorders can be understood in terms of broad superordinate dimensions. However, these analyses have been based on syndromal-level indicators, which are often heterogeneous, rather than on symptoms, which are presumably more homogeneous.

Method Symptom-level exploratory and confirmatory analyses were used to explore the joint hierarchical organization of Axis I and II psychopathology, using data on 8405 individuals from the 2000 British Psychiatric Morbidity Survey.

Results Analyses indicated that 20 identified subordinate dimensions of psychopathology could be organized into four broad superordinate dimensions: Internalizing, Externalizing, Thought Disorder, and Pathological Introversion.

Conclusions These results extend existing model frameworks ‘downward’ as well as ‘outward’, by analyzing symptoms rather than diagnoses, and by integrating symptoms from Axis I and II disorders in a common framework. This model demonstrates the importance of hierarchy in psychopathology structure, comprises replicable features of psychopathology structure, and has important implications for understanding the nature and organization of mental disorders.

(Received November 12 2008)

(Revised April 14 2009)

(Accepted May 03 2009)

(Online publication June 11 2009)


c1 Address for correspondence: K. E. Markon, Ph.D., Department of Psychology, University of Iowa, 11 Seashore Hall E., Iowa City, IA 52242, USA. (Email: