Patterns of Heterotypic Continuity Associated With the Cross-Sectional Correlational Structure of Prevalent Mental Disorders in Adults

IMPORTANCE: Mental disorders predict future occurrences of both the same disorder (homotypic continuity) and other disorders (heterotypic continuity). Heterotypic continuity is inconsistent with a view of mental disorders as fixed entities. In contrast, hierarchical-dimensional conceptualizations of psychopathology, in which each form of psychopathology is hypothesized to have both unique and broadly shared etiologies and mechanisms, predict both homotypic and heterotypic continuity. OBJECTIVE: To test predictions derived from a hierarchical-dimensional model of psychopathology that (1) heterotypic continuity is widespread, even controlling for homotypic continuity, and that (2) the relative magnitudes of heterotypic continuities recapitulate the relative magnitudes of cross-sectional correlations among diagnoses at baseline. DESIGN, SETTING, AND PARTICIPANTS: Ten prevalent diagnoses were assessed in the same person twice (ie, in 2 waves separated by 3 years). We used a representative sample of adults in the United States (ie, 28 958 participants 18-64 years of age in the National Epidemiologic Study of Alcohol and Related Conditions who were assessed in both waves). MAIN OUTCOMES AND MEASURES: Diagnoses from reliable and valid structured interviews. RESULTS: Adjusting for sex and age, we found that bivariate associations of all pairs of diagnoses from wave 1 to wave 2 exceeded chance levels (P