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

Psychol Med. 2009 Dec;39(12):2061-70. doi: 10.1017/S0033291709990328. Epub 2009 Oct 1.


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.

Publication types

  • Review

MeSH terms

  • Aggression / psychology
  • Antisocial Personality Disorder / classification
  • Antisocial Personality Disorder / diagnosis
  • Antisocial Personality Disorder / genetics
  • Antisocial Personality Disorder / psychology
  • Cognition Disorders / classification
  • Cognition Disorders / diagnosis
  • Cognition Disorders / genetics
  • Cognition Disorders / psychology
  • Comorbidity
  • Conduct Disorder / classification*
  • Conduct Disorder / diagnosis*
  • Conduct Disorder / genetics
  • Conduct Disorder / psychology
  • Diagnostic and Statistical Manual of Mental Disorders*
  • Humans
  • Internal-External Control*
  • International Classification of Diseases*
  • Mental Disorders / classification*
  • Mental Disorders / diagnosis*
  • Mental Disorders / genetics
  • Mental Disorders / psychology
  • Personal Construct Theory
  • Personality Disorders / classification*
  • Personality Disorders / diagnosis*
  • Personality Disorders / genetics
  • Personality Disorders / psychology
  • Phenotype
  • Prognosis
  • Risk Factors
  • Social Environment
  • Substance-Related Disorders / classification*
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / genetics
  • Substance-Related Disorders / psychology
  • Temperament