Associations of Oppositional Defiant Disorder, Irritability, and Headstrong Dimensions with Other Psychological Disorders in Adolescents

ABSTRACT: The current study aimed to use both multiple regression analyses (MRA) and latent regression analysis (LRA) to examine unique and suppression effects of DSM-5 oppositional defiant disorder irritability and headstrong dimensions with common DSM-5 internalizing (Generalized Anxiety Disorder, Persistent Depressive Disorder, Separation Anxiety Disorder, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder), externalizing (ADHD, and Conduct Disorder), neurodevelopmental (Specific Reading Disorder, Autism Spectrum Disorder, Language Disorder, and Speech Sound Disorder) and eating disorders (Anorexia Nervosa, and Bulimia Nervosa) among clinic-referred adolescents. Parents of 1877 adolescents [boys = 1089, girls = 788; age range = 11 to 17 years] provided ratings of their adolescents’ ODD symptoms and the symptoms for the other 14 disorders. The MRA findings indicated that, generally, internalizing disorders, autism spectrum disorder (ASD), and eating disorders were associated positively and uniquely with the irritability dimension, and externalizing disorders were associated positively and uniquely with the headstrong dimension. With the exception of autism spectrum disorder, the other neurodevelopmental disorders showed little or no associations with irritability or headstrong dimensions. There was little evidence of suppression effects. The LRA findings for unique associations were generally comparable with the MRA findings, except that there was strong evidence for the headstrong dimension suppressing the unique associations involving irritability, and irritability suppressing the unique associations involving the headstrong dimension. These findings raise the possibility that both irritability and headstrong may be transdiagnostic, having a dominant influence on the comorbidity of internalizing (and possibly eating disorders) and externalizing disorders, respectively. To date, there has been little discussion on headstrong being a major transdiagnostic factor for externalizing disorders. Further theoretical, methodological. and clinical implications of the findings are discussed.