How things fall apart: understanding the nature of internalizing through its relationship with impairment

The literature suggests that internalizing psychopathology relates to impairment incrementally and gradually. However, the form of this relationship has not been characterized. This form is critical to understanding internalizing psychopathology, as it is possible that internalizing may accelerate in effect at some level of severity, defining a natural boundary of abnormality. Here, a novel method-semiparametric structural equation modeling-was used to model the relationship between internalizing and impairment in a sample of 8,580 individuals from the 2000 British Office for National Statistics Survey of Psychiatric Morbidity, a large, population-representative study of psychopathology. This method allows one to model relationships between latent internalizing and impairment without assuming any particular form a priori and to compare models in which the relationship is constant and linear. Results suggest that the relationship between internalizing and impairment is in fact linear and constant across the entire range of internalizing variation and that it is impossible to nonarbitrarily define a specific level of internalizing beyond which consequences suddenly become catastrophic in nature. Results demonstrate the phenomenological continuity of internalizing psychopathology, highlight the importance of impairment as well as symptoms, and have clear implications for defining mental disorder.