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Vachon and Lynam (2016) recently introduced a new measure of empathy, the Affective and Cognitive Measure of Empathy (ACME). Besides assessing the traditional dimensions of cognitive and affective empathy, the ACME includes an affective dissonance scale that covers "antiempathy," an important feature of the construct with prominent predictive value not included in other empathy measures. The aim of this study is to provide data on the French version of the ACME. A sample of 851 community-dwelling participants (59.4% female) completed online the ACME questionnaire along with other measures of empathy, dark and pathological personality traits, and aggression. The original ACME bifactor exploratory structural equation modeling structure (i.e., the three empathy dimensions of Cognitive, Affective Resonance, and Affective Dissonance with positive and negative wording items as method bifactors) was successfully reproduced with the French version. Furthermore, these scales displayed satisfying internal consistency coefficients, as well as good item properties according to Classical Test Theory. Convergent validity indices were also similar to those reported for the original English version, and scale scores reached full invariance across gender and proved to be partially invariant across language when comparing the present data to those from the original validation study. The French version of the ACME is well aligned with the original English version and offers a valuable alternative to French researchers and clinicians interested in measuring the various dimensions of empathy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The current study focuses on the development and validation of a scoring procedure for malignant narcissism using the Personality Inventory for DSM-5, a self-report measure of Criterion B from the Alternative Model for Personality Disorders. In Study 1, a prototype matching approach was used to aggregate ratings from 15 clinicians specializing in personality disorder treatment and/or assessment. Indices of inter-rater agreement and inter-rater reliability revealed high convergence as to the most important maladaptive facets for malignant narcissism. The scoring procedure, based on additive counts for score computation, included eleven Criterion B facets covering core features of malignant narcissism. Study 2 evaluated the criterion and incremental validity of the scoring procedure in a sample of 288 patients from a personality disorder treatment clinic, as well as in a sample of 1103 participants from the community. In both samples, results from nonparametric mean comparisons, receiver operating characteristic curves, bivariate Pearson correlations, and hierarchical multiple linear regressions showed significant associations between malignant narcissism and broader components of personality functioning, as well as with relevant emotional, relational, and/or behavioral features. This new scoring procedure is a simple and valid method for measuring malignant narcissism, and is suitable for clinical and research settings.

The Alternative Model for Personality Disorders (AMPD), included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the World Health Organization's International Classification of Diseases (11th ed.; ICD-11) are, respectively, hybrid categorical-dimensional and dimensional frameworks for personality disorders (PDs). Both models emphasize personality dysfunction and personality traits. Previous studies investigating the links between the AMPD and ICD-11, and self-reported physical aggression have mostly focused on traits and did not take into account the potential interaction between personality dysfunction and traits. Thus, the aim of this study is to identify dysfunction*trait interactions using regression-based analysis. Outpatients with personality disorder from a specialized public clinic (N = 285) and community participants (N = 995) were recruited to complete self-report questionnaires. Some small-size, albeit significant and clinically/conceptually meaningful personality dysfunction*trait interactions were found to predict physical aggression in both samples. Interaction analyses might further inform, to some degree, about the current discussion pertaining to the potential redundancy between dysfunction and traits, the optimal personality dysfunction structure (in the case of the AMPD), as well as clinical assessment based on AMPD/ICD-11 PD frameworks.

Author(s): Hopwood, Christopher J; Krueger, Robert F; Watson, David; Widiger, Thomas A; Althoff, Robert R; Ansell, Emily B; Bach, Bo; Bagby, R Michael; Blais, Mark A; Bornovalova, Marina A; Chmielewski, Michael; Cicero, David C; Conway, Christopher; De Clerq, Barbara; De Fruyt, Filip; Docherty, Anna R; Eaton, Nicholas R; Edens, John F; Forbes, Miriam K; Forbush, Kelsie T; Hengartner, Michael P; Ivanova, Masha Y; Leising, Daniel; Lukowitsky, Mark R; Lynam, Donald R; Markon, Kristian E; Miller, Joshua D; Morey, Leslie C; Mullins-Sweatt, Stephanie N; Ormel, Johan; Patrick, Christopher J; Pincus, Aaron L; Ruggero, Camilo; Samuel, Douglas B; Sellbom, Martin; Tackett, Jennifer L; Thomas, Katherine M; Trull, Timothy J; Vachon, David D; Waldman, Irwin D; Waszczuk, Monika A; Waugh, Mark H; Wright, Aidan GC; Yalch, Mathew M; Zald, David H; Zimmermann, Johannes

Background Vasovagal reactions (VVRs) are commonly experienced in medical situations such as blood donation. Many believe that psychosocial contagion can contribute to the development of VVRs, but this is largely clinical lore. Purpose The goal of the present investigation was to examine the physiological effects of observing another experience a reaction, focusing on the potential moderating effects of empathy. Methods This study was part of a randomized controlled trial of behavioral techniques on the prevention of VVRs in blood donors. The sample was composed of 530 healthy university students. Measures of symptoms were obtained with the Blood Donation Reactions Inventory (BDRI) and through observation. Physiological variables were measured using respiratory capnometry and a digital blood pressure monitor. The Affective and Cognitive Measure of Empathy was administered to 230 participants. Results Donors who witnessed another experiencing a reaction were more likely to spontaneously report symptoms during the blood draw, to be treated for a reaction, to score higher on the BDRI, and to exhibit smaller compensatory heart rate increases. Donors with higher affective empathy reported more symptoms, exhibited hyperventilation, and were more likely to be treated. Donors with higher cognitive empathy were less likely to require treatment if they witnessed a reaction. Conclusion These results suggest that psychosocial contagion of physical symptoms can occur. The moderating effects of empathy differed depending on the subtype of empathy. Perhaps a better cognitive understanding of how other people are feeling functions as a coping response, whereas feeling sympathetic about others’ distress increases one’s own.

An increased use of models for measuring response styles is apparent in recent years with the multidimensional nominal response model (MNRM) as one prominent example. Inclusion of latent constructs representing extreme (ERS) or midpoint response style (MRS) often improves model fit according to information criteria. However, a test of absolute model fit is often not reported even though it could comprise an important piece of validity evidence. Limited information test statistics are candidates for this task, including the full (M2), ordinal (M2*), and mixed (C2) statistics, which differ in whether additional collapsing of univariate or bivariate contingency tables is conducted. Such collapsing makes sense when item categories are ordinal, which may not hold under the MNRM. More generally, limited information test statistics have gone unevaluated under nominal data and non-ordinal latent trait models. We present a simulation study evaluating the performance of M2, M2*, and C2 with the MNRM. Manipulated conditions included sample size, presence and type of response style, and strength of item slopes on substantive and style dimensions. We found that M2 sometimes had inflated Type I error rates, M2* always had little power, and C2 lacked power under some conditions. M2 and C2 may provide complementary and valuable information regarding model fit.

A persistent criticism of assessing psychopathy during adolescence is that it runs the risk of mistaking normal, transient teenage behavior for the enduring characteristics of a future psychopathic adult. If true, early assessments of psychopathy will produce false positives, branding some non-psychopathic youths as psychopaths. Fundamentally, this criticism is not based on the stability of psychopathy during adolescence, which has been well established elsewhere. Rather, it is based on specific claims regarding the ways in which normal personality traits change during adolescence, potentially concealing psychopathy. This preliminary study tests these claims by examining trait differences across adolescence using the NEO-3 trait profiles of 500 youths (242 males and 258 females) aged 14–20. Our results are straightforward: normal personality traits related to psychopathy are virtually unchanging across this period. Thus, to the extent that youth psychopathy is assessed using personality traits rather than transient, age-specific delinquent behaviors, the risk of false positives is low.

The relation between deficient empathy and sexual aggression is unclear. To capture the nuance of the relation, this study investigated discrete associations between five empathy deficits and four sexually aggressive strategies used to perpetrate a range of sexual acts against women in an online sample of male postsecondary students (n = 298). Associations between empathy deficits and sexual aggression were small overall. Affective dissonance (discordant affective responses to others' experiences) bore the strongest associations with sexual aggression, followed by low sexual empathy (empathy for partners during sexual interactions). Low affective resonance (concordant affective responses to others' experiences) and callous affect (a disregard for others' affective experiences) bore weaker significant associations. Low cognitive empathy (understanding others' emotions) was unrelated to sexual aggression. Furthermore, empathy deficits were more associated with the use of deception and verbal coercion than force, and not associated with victim-intoxication. These results suggest that the relation between deficient empathy and sexual aggression may be more complex than previously assumed.

Author(s): Hopwood, Christopher J; Kotov, Roman; Krueger, Robert F; Watson, David; Widiger, Thomas A; Althoff, Robert R; Ansell, Emily B; Bach, Bo; Michael Bagby, R; Blais, Mark A; Bornovalova, Marina A; Chmielewski, Michael; Cicero, David C; Conway, Christopher; De Clercq, Barbara; De Fruyt, Filip; Docherty, Anna R; Eaton, Nicholas R; Edens, John F; Forbes, Miriam K; Forbush, Kelsie T; Hengartner, Michael P; Ivanova, Masha Y; Leising, Daniel; John Livesley, W; Lukowitsky, Mark R; Lynam, Donald R; Markon, Kristian E; Miller, Joshua D; Morey, Leslie C; Mullins-Sweatt, Stephanie N; Hans Ormel, J; Patrick, Christopher J; Pincus, Aaron L; Ruggero, Camilo; Samuel, Douglas B; Sellbom, Martin; Slade, Tim; Tackett, Jennifer L; Thomas, Katherine M; Trull, Timothy J; Vachon, David D; Waldman, Irwin D; Waszczuk, Monika A; Waugh, Mark H; Wright, Aidan GC; Yalch, Mathew M; Zald, David H; Zimmermann, Johannes

Objective Trajectory approaches are a popular way of identifying subgroups of children and adolescents at high risk for developing alcohol use problems. However, mounting evidence challenges the meaning and utility of these putatively discrete alcohol trajectories, which can be analytically derived even in the absence of real subgroups. This study tests the hypothesis that alcohol trajectories may not reflect discrete groups—that the development of alcohol use is continuous rather than categorical. Method A multiwave longitudinal-epidemiologic twin study was conducted using 3,762 twins (1,808 male and 1,954 female) aged 11 to 29 years from the Minnesota Center for Twin and Family Research (MCTFR). The main outcome measures included various assessments of substance use, psychopathology, personality, and cognitive ability. Results Although multiple trajectories are derived from growth mixture modeling techniques, these trajectories are arrayed in a tiered spectrum of severity, from lower levels of use to higher levels of use. Trajectories show perfect rank-order stability throughout development, monotonic increases in heritability, and perfect rank-order correlations with established correlates of alcohol use, including other substance use behaviors, psychiatric disorders, personality traits, intelligence, and achievement. Conclusion Alcohol trajectories may represent continuous gradations rather than qualitatively distinct subgroups. If so, early detection and interventions for youth based on trajectory subtyping will be less useful than continuous liability assessments. Furthermore, a continuous account of development counters the notion that individuals are predestined to follow one of a few categorically distinct pathways and promotes the opposite idea—that development is mutable, and its continuous terrain can be traversed in many directions.

In this chapter, I provide seven lines of evidence showing that antagonism is the foundation of psychopathy, regardless of model or measure. These include the following: (1) description evidence from classical accounts of psychopathy, (2) translation evidence from Five-Factor Model (FFM) conversions of psychopathy criteria, (3) empirical evidence from meta-analyses associating FFM traits and psychopathy, (4) consensus evidence from expert characterizations of psychopathy using the FFM, (5) similarity evidence from comparisons of trait profiles for antagonism and psychopathy, (6) factor evidence from dimension reduction techniques, and (7) nomological evidence from correlates of psychopathy and FFM traits. Across these approaches, a clear and consistent finding emerges: antagonism is necessary and very nearly sufficient for capturing psychopathy.

There are numerous well-documented problems with the DSM’s polythetic-categorical approach to the delineation of mental disorders. However, the DSM-5 introduces an empirically based dimensional model of personality traits. These traits form a hierarchical structure that represents the organization of dispositions to common mental disorders. We connect emotions to this joint hierarchical structure using a modified set point model, which accommodates major theories linking personality and psychopathology—continuum, risk, scar, and pathoplasty—as well as more dynamic multivariate models. We argue that these traits represent typical causal pathways that can be extracted from a complex web of equifinality and multifinality. Ultimately, research on mood disorders provides a stronger account of their underling traits than the variably endorsed symptoms of their polythetic criteria.

Low empathy is a criterion for most externalizing disorders, and empathy training is a regular component of treatment for aggressive people, from school bullies to sex offenders. However, recent meta-analytic evidence suggests that current measures of empathy explain only 1% of the variance in aggressive behavior. A new assessment of empathy was developed to more fully represent the empathy construct and better predict important outcomes—particularly aggressive behavior and externalizing psychopathology. Across three independent samples ( N = 210-708), the 36-item Affective and Cognitive measure of Empathy (ACME) was internally consistent, structurally reliable, and invariant across sex. The ACME bore significant associations to important outcomes, which were incremental relative to other measures of empathy and generalizable across sex. Importantly, the affective scales of the ACME—particularly a new “Affective Dissonance” scale—yielded moderate to strong associations with aggressive behavior and externalizing disorders. The ACME is a short, reliable, and useful measure of empathy.

Men commit violent crime at substantially higher rates than women. One proposed mediator of this relation is empathy, as men consistently score lower than women on measures of empathy and empathy deficits are thought to characterize violent crime and disorders of aggression. However, recent research suggests that traditional empathy measures are only weakly related to aggression, whereas a new form of “anti-empathy” exhibits much stronger relations. The goal of this study was to investigate the extent to which empathy and anti-empathy indirectly account for sex differences in aggression and antisocial behavior, and whether these relations differ by sex. The current study (N = 369) employed a multifaceted measure of empathy to show that sex differences in aggression were indirectly accounted for by affective empathy and anti-empathy, but not cognitive empathy. The effects of empathy deficits were equivalent for men and women. These findings provide support for empathy as an important and generalizable trait in the sex-aggression association and highlight the usefulness of a focus on specific affective forms.

Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.

Previous research has shown negative affect and emotion dysregulation to be significant predictors of adverse outcomes. Because justice-involved adolescents have demonstrated more negative emotionality and fewer adaptive emotion regulation strategies than their non-justice-involved peers, they may be particularly susceptible to maladaptive behavior. The current study investigated the extent to which negative affect and facets of emotion dysregulation were associated with violence and risky sexual behavior. Participants included 94 justice-involved adolescents who were recruited while waiting for their court date and asked to complete several questionnaires. Results suggest that global negative affect and emotion dysregulation are not associated with violence or risky sexual behavior. However, specific aspects of negative affect (anger) and emotion dysregulation (impulse control difficulties) did predict violence. Examination of conditional effects also suggested that negative affect is significantly associated with violence and risky sexual behavior in adolescents who have specific difficulties regulating their emotions (e.g., poor emotional clarity and limited access to emotion regulation strategies). This study demonstrates the utility of examining negative affect and emotion regulation as heterogeneous constructs that interact in specific ways to predict violence.

This paper evaluates the proposal for antisocial personality disorder (ASPD) in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5). Some aspects of the proposal are appealing: personality disorders will be assessed using trait criteria, and these criteria are similar to trait descriptions of DSM-IV ASPD. Other aspects of the proposal are less appealing. First, the DSM-5 will depend on a newly constructed personality trait system rather than relying on a well validated, widely studied one. Second, the trait profile of ASPD is incomplete; although this profile reflects the traits included in DSM-IV, it maps poorly onto the full personality profile of ASPD. Third, the DSM Workgroup missed an opportunity to finally unify ASPD and psychopathy; history and research suggest that these disorders have diverged mistakenly. Fourth, the newly proposed criteria of impairments in self- and interpersonal functioning are of questionable derivation and utility.

Few investigations have examined the role of affective instability within a broad model of general personality functioning. The present study employed self-report and ecological momentary assessments (EMA) to examine the relations between self-reported Five-Factor Model Neuroticism, EMA average negative affect, and EMA negative affect instability. Results suggest that Neuroticism and negative affect instability are related yet distinct constructs, and that Neuroticism better represents average negative affect across time. Results also suggest that negative affect instability is related to low Agreeableness and specific externalizing facets of Neuroticism, such as Angry Hostility and Impulsiveness. The implications of these findings and potential areas for future research are discussed.

Although pathological gambling (PG) is regarded in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) as a unitary diagnostic construct, it is likely composed of distinct subtypes. In the current report, the authors used cluster analyses of personality traits with a non-treatment-seeking community sample of gamblers and identified 3 PG subtypes. Gamblers partitioned into a simple PG cluster, characterized by low rates of comorbid psychopathology and trait scores near the normative mean; a hedonic PG cluster, characterized by moderate rates of comorbid psychopathology and a proclivity for excitement seeking and positive affect; and a demoralized PG cluster, characterized by high rates of comorbid psychopathology and a propensity toward negative affect, low positive emotionality, and disinhibition. The findings provide preliminary support for an empirically based typology of gamblers, distinguishable in terms of personality structure, which may reflect different etiologies.

The current study reviews and reexamines the association between pathological gambling and personality disorders (PDs). To date, the majority of investigations have examined the prevalence of PDs in a single group of treatment-seeking pathological gamblers (PGs); very few of these studies included a comparison group, and even fewer compared PGs to nonpathological gamblers who, in contrast to nongamblers, resemble PGs in their attraction to and engagement in gambling behavior. The current study included a sample composed of nontreatment-seeking pathological gamblers and a comparison group of nonpathological gamblers (NPGs); these participants completed a self-report instrument (SCID-II/PQ) and were administered a structured clinical interview SCID-II) designed to assess PDs. Compared to the SCID-II, the SCIDII/PQ produced significantly higher PD prevalence rate estimates and symptom endorsements. Although the pattern of specific PD prevalence and symptom endorsement varied somewhat across the instruments, PGs consistently displayed significantly higher levels of borderline PD than NPGs; this pattern endured even after controlling for Axis I disorders and overlap among Axis II PDs.

The goal of this investigation was to examine the personality differences between non-treatment seeking pathological gamblers (PGs) and non-pathological gamblers (NPGs) using the domain and facet traits of the five-factor model of personality (FFM), as measured by the NEO PI-R. Compared to NPGs, PGs scored significantly higher on the neuroticism domain and significantly lower on the conscientiousness domain. Significant differences between PGs and NPGs also emerged for three of four FFM facet traits associated with impulsivity, with PGs scoring higher on impulsiveness and lower on self-discipline and deliberation facets. Both PGs and NPGs had equally high scores (relative to the norm) on excitement-seeking, the fourth facet associated with impulsivity, suggesting that excitement-seeking characterizes gambling behavior rather than pathological gambling. The present findings suggest that the overall personality profile of the PG is one that combines high impulsivity with emotional vulnerability. Importantly, the results also suggest that excitement-seeking, a personality construct akin to sensation-seeking, may not be a specific marker of PG but rather a characteristic common to all those who gamble.

Assumptions regarding the importance of empathy are pervasive. Given the impact these assumptions have on research, assessment, and treatment, it is imperative to know whether they are valid. Of particular interest is a basic question: Are deficits in empathy associated with aggressive behavior? Previous attempts to review the relation between empathy and aggression yielded inconsistent results and generally included a small number of studies. To clarify these divergent findings, we comprehensively reviewed the relation of empathy to aggression in adults, including community, student, and criminal samples. A mixed effects meta-analysis of published and unpublished studies involving 106 effect sizes revealed that the relation between empathy and aggression was surprisingly weak (r = -.11). This finding was fairly consistent across specific types of aggression, including verbal aggression (r = -.20), physical aggression (r = -.12), and sexual aggression (r = -.09). Several potentially important moderators were examined, although they had little impact on the total effect size. The results of this study are particularly surprising given that empathy is a core component of many treatments for aggressive offenders and that most psychological disorders of aggression include diagnostic criteria specific to deficient empathic responding. We discuss broad conclusions, consider implications for theory, and address current limitations in the field, such as reliance on a small number of self-report measures of empathy. We highlight the need for diversity in measurement and suggest a new operationalization of empathy that may allow it to synchronize with contemporary thinking regarding its role in aggressive behavior. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

The study focused on the incremental predictive utility of psychopathy assessed at age 13 with the Childhood Psychopathy Scale (CPS) in predicting arrests and convictions between the ages of 18 and 26. Data from 338 men from the middle sample of the Pittsburgh Youth Study were used. A variety of control variables were included: demographics (race, family structure, socioeconomic status (SES), and neighborhood SES), parenting (physical punishment, inconsistent discipline, lax supervision, and low positive parenting), peer delinquency, and individual difference variables (impulsivity, verbal IQ, attention-deficit hyperactivity disorder, and conduct disorder). CPS scores at age 13 predicted the variety of arrests and convictions 5 to 13 years later, even after controlling for other well-established and well-measured risk factors. The study concluded that juvenile psychopathy is an important and useful risk factor for future antisocial behavior and also considered the implications of the findings and reasons for resistance to the juvenile psychopathy construct.

Psychopathy has shown good construct validity in samples of Caucasian inmates. However, little is known about how well the nomological network surrounding psychopathy generalizes to non-Caucasian and nonincarcerated populations. Using longitudinal and concurrent data from the middle sample of the Pittsburgh Youth Study, this study demonstrates that the validity of total- and facet-level psychopathy is preserved in African American and nonincarcerated samples. Specifically, similar patterns of association were obtained for child variables (child psychopathy, socioeconomic status, risk status, parenting, delinquency, peer delinquency, and impulsivity) and adult variables (children, education, incarceration, unemployment, personality, substance use, and antisocial personality disorder) across ethnicity and conviction status. (PsycINFO Database Record (c) 2011 APA, all rights reserved). Language: en

Depressive personality disorder (DPD) is currently included in the DSM-IV Appendix B, Criteria Sets and Axes Provided for Further Study. Evidence of the clinical utility of DPD will likely play an important role in the determination of whether it warrants inclusion in future editions of DSM. The current investigation examines the capacity of DPD traits to predict overall and preferential treatment outcome for patients with Major Depressive Disorder (MDD) (N = 120) using data from a randomized control trial, which included cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and antidepressant medication (ADM) treatment arms. Patients were treated for 16-20 weeks and completed the Structured Clinical Interview for DSM-IV Axis II Personality Disorders Questionnaire (SCID-II/PQ) and the 17-item Hamilton Rating Scale for Depression immediately before and after treatment. Higher scores on a dimensionalized SCID-II/PQ subscale assessing DPD traits were associated with poor outcome for IPT, but not CBT or ADM. This result remained after accounting for variance associated with other personality disorder (PD) traits; none of the other 10 main text PDs predicted treatment outcome.

This investigation extends previous work on Five-Factor Model (FFM) personality disorder profiles. Specifically, a FFM expert consensus prototype for Depressive Personality Disorder (DPD) using the 30 facets of the NEO Personality Inventory-Revised (NEO PI-R) was developed. Initial validation of this prototype in a psychiatric population employed several clinical scales. When combined with trait information yielded by criteria translation and empirical approaches, the composite FFM profile emphasized several facets that represent the core components of DPD. In addition to several traits represented by the current DSM conceptualization of DPD, such as depressiveness, anxiousness, self-consciousness, and low tendermindedness, the composite profile was also characterized by several unrepresented traits, such as high modesty and low positive emotionality, warmth, assertiveness, trust, and achievement striving. Future definitions of depressive personality, conceptualized either as a DSM-V personality disorder or as a multifaceted construct, should consider these additional traits.

RESULTS Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse. CONCLUSIONS AND RELEVANCE Our findings challenge widely held beliefs about how child abuse should be recognized and treated—a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.