Homotypic and heterotypic psychopathological continuity: a child cohort study

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Heterotypic psychopathological continuity (i.e. one disorder predicting another at a later time point) contradicts the conventional view that psychiatric disorders are discrete, static entities. Studying this phenomenon may help to tease out the complex mechanisms that underpin psychiatric comorbidity. To date, no studies have explicitly compared heterotypic effects within and across higher order dimensions of psychopathology.

Patterns of homotypic and heterotypic psychopathological continuity were examined using cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC, N = 4815). Eight common psychiatric disorders were assessed at age 7.5 and again at age 14 years using the maternal report version of the Development and Well-Being Assessment (DAWBA). Cross-lagged models were used to compare patterns of homotypic and heterotypic continuity within and across three higher order dimensions of psychopathology; internalizing-fear, internalizing-distress, and externalizing.
Homotypic continuity was universal. Considerable heterotypic continuity was observed even after controlling for homotypic continuity and the presence of all disorders at baseline. Heterotypic continuity was more common within higher order dimensions, but a number of significant cross-dimension effects were observed, with ADHD acting as a strong predictor of subsequent internalizing disorders.

Heterotypic continuity may reflect elements of shared aetiology, or local-level interactions between disorders.
Original languageEnglish
Pages (from-to)1135–1145
Number of pages11
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number9
Early online date26 May 2017
Publication statusPublished (in print/issue) - 30 Sept 2017


  • Psychopathology
  • Comorbidity
  • Homo-typic continuity
  • Heterotypic-continuity


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