The p factor and dimensional structural models of youth personality pathology and psychopathology

A Hierarchical Model of the Symptom-Level Structure of Psychopathology in Youth

More comprehensive modelling of psychopathology in youth is needed to facilitate a developmentally informed expansion of the Hierarchical Taxonomy of Psychopathology (HiTOP) model. This study examined a symptom-level model of the structure of psychopathology in youth-most aged 11-17 years-bringing together data from large clinical, community, and representative samples (N = 18,290) and with coverage of nearly all major forms of mental disorders and related content domains (e.g., aggression). The resulting hierarchical and dimensional model was based on the points of convergence among three statistical approaches and included fifteen narrow dimensions nested under four broad dimensions of Internalizing; Externalizing; Eating Pathology; and Uncontrollable Worry, Obsessions, and Compulsions. We position these findings within the context of the existing literature, and articulate implications for future research. Ultimately, these findings add to the rapidly growing literature on the structure of psychopathology in youth and take us a step closer towards understanding (dis-)continuities in psychopathology's structure across the lifespan.

Positive psychotic symptoms as a marker of clinical severity in a transdiagnostic sample of help-seeking adolescents

The present study aimed to examine the association between the presence, number, and type of positive psychotic symptoms (PPS) and clinical severity in adolescent patients. Five hundred-six patients aged 11-17 years were assigned to either the noPPS (n = 341), the delusional beliefs only (del; n = 32), the hallucinations only (hall; n = 80), or the delusional beliefs and hallucinations (del&hall; n = 53) group. Generalized Structural Equation Modeling was applied to identify the best-fitting model representing clinical severity indicated by psychiatric diagnoses, depressivity, personality pathology, non-suicidal self-injury, suicide attempts, perceived stress, and psychosocial impairments, assessed by interviews and questionnaires. The groups were compared concerning the final model's factors. The final model consisted of three factors representing psychopathology and functional impairments, self-harming behavior, and perceived stress (BIC difference to reference model: 103.99). Participants with any PPS scored higher on all factors than the noPPS group (differences in SD: 0.49-1.48). Additionally, the del&hall group scored 1.31 SD higher on psychopathology and functional impairments than the hall group, and 1.16 SD higher on self-harming behavior compared to the del group. Finally, the hall group scored 0.84 SD higher on self-harming behavior than the del group, with no group differences in the other factors. In adolescent patients, the presence of PPS may represent a marker for a more severe form of mental disorder, with hallucinations being indicative of self-harming behavior. Early transdiagnostic assessment of PPS seems indicated as it may inform treatment in the context of clinical staging.

Unpacking the p-factor. Associations Between Maladaptive Personality Traits and General Psychopathology in Female and Male Adolescents

Adolescence is a period of rapid physical, psychological, and neural maturation that makes youth vulnerable to emerging psychopathology, highlighting the need for improved identification of psychopathology risk indicators. Recently, a higher-order latent psychopathology factor (p-factor) was identified that explains latent liability for psychopathology beyond internalizing and externalizing difficulties. However, recent proposals suggest reconceptualizing the p-factor model in terms of impairments in personality encompassing difficulties in both self-regulation (borderline features) and self-esteem (narcissistic features), but this remains untested. To address this, this study examined the p-factor structure and the contribution of borderline and narcissistic features using two cross-sectional data collections. In Study 1, 974 cisgender adolescents (63% assigned females at birth; age range: 13-19; Mage = 16.68, SD = 1.40) reported on internalizing and externalizing problems (YSR) to test via structural equation models (SEM) different theoretical models for adolescent psychopathology. In Study 2, 725 cisgender adolescents (64.5% assigned females at birth; age range: 13-19; Mage = 16.22, SD = 1.32) reported internalizing and externalizing problems (YSR), borderline personality features (BPFSC-11), and narcissistic personality traits (PNI), to explore, via SEM, the contribution of borderline and narcissistic traits to the p-factor and accounting for gender differences. Results confirmed the utility of a bi-factor model in adolescence. Furthermore, findings highlighted the contribution of borderline features and narcissistic vulnerability to general psychopathology. The study provides the first evidence supporting a p-factor model reconceptualized in terms of personality impairments encompassing difficulties in self-regulation and self-esteem in adolescents.

A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum

OBJECTIVE

There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches.

METHODS

We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change.

RESULTS/CONCLUSIONS

Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.

The general psychopathology factor (p) from adolescence to adulthood: Exploring the developmental trajectories of p using a multi-method approach

Considerable attention has been directed towards studying co-occurring psychopathology through the lens of a general factor (p-factor). However, the developmental trajectory and stability of the p-factor have yet to be fully understood. The present study examined the explanatory power of dynamic mutualism theory - an alternative framework that suggests the p-factor is a product of lower-level symptom interactions that strengthen throughout development. Data were drawn from a population-based sample of girls (N = 2450) who reported on the severity of internalizing and externalizing problems each year from age 14 to age 21. Predictions of dynamic mutualism were tested using three distinct complementary statistical approaches including: longitudinal bifactor models, random-intercept cross-lagged panel models (RI-CLPMs), and network models. Across methods, study results document preliminary support for mutualistic processes in the development of co-occurring psychopathology (that is captured in p). Findings emphasize the importance of exploring alternative frameworks and methods for better understanding the p-factor and its development.

The p factor of psychopathology and personality in middle childhood: genetic and gestational risk factors

BACKGROUND

A joint, hierarchical structure of psychopathology and personality has been reported in adults but should also be investigated at earlier ages, as psychopathology often develops before adulthood. Here, we investigate the joint factor structure of psychopathology and personality in eight-year-old children, estimate factor heritability and explore external validity through associations with established developmental risk factors.

METHODS

Phenotypic and biometric exploratory factor analyses with bifactor rotation on genetically informative data from the Norwegian Mother, Father, and Child Cohort (MoBa) study. The analytic sub-sample comprised 10 739 children (49% girls). Mothers reported their children's symptoms of depression (Short Moods and Feelings Questionnaire), anxiety (Screen for Anxiety Related Disorders), attention-deficit/hyperactivity disorder inattention and hyperactivity, oppositional-defiant disorder, conduct disorder (Parent/Teacher Rating Scale for Disruptive Behavior Disorders), and Big Five personality (short Hierarchical Personality Inventory for Children). Developmental risk factors (early gestational age and being small for gestational age) were collected from the Medical Birth Registry.

RESULTS

Goodness-of-fit indices favored a p factor model with three residual latent factors interpreted as negative affectivity, positive affectivity, and antagonism, whereas psychometric indices favored a one-factor model. ADE solutions fitted best, and regression analyses indicated a negative association between gestational age and the p factor, for both the one- and four-factor solutions.

CONCLUSION

Correlations between normative and pathological traits in middle childhood mostly reflect one heritable and psychometrically interpretable p factor, although optimal fit to data required less interpretable residual latent factors. The association between the p factor and low gestational age warrants further study of early developmental mechanisms.

The underlying structure of the Personality Inventory for DSM-5 (PID-5): a general factor of personality psychopathology

BACKGROUND

The psychopathology of personality is currently undergoing a paradigm shift from a categorical to a dimensional approach. This work aimed to study the underlying structure of pathological personality traits of the DSM-5 Alternative Model for Personality Disorders (AMPD). For this purpose, the internal structure of a version of the Personality Inventory for the DSM-5 (PID-5) was examined by a confirmatory factor analysis. This version assesses the five higher-order pathological personality domains (negative affectivity, detachment, antagonism, disinhibition, and psychoticism) and the 25 lower-order pathological personality facets through a reduced number of items. Four alternative models were compared: five-factor oblique; second-order (five first-order factors and one second-order factor); bifactor (five specific factors and a general factor), and one-factor.

PARTICIPANTS AND PROCEDURE

We worked with an Argentinean sample of N = 525 subjects from the general population who answered the Argentine version of the PID-5.

RESULTS

The five-factor model was slightly superior to the second order model, and the bifactor model presented the best fit.

CONCLUSIONS

These findings, while preliminary, suggest that the PID-5 facets could reflect five specific pathological personality traits (which correspond to AMPD domains) but also a general factor (which would reflect a general propensity for psychopathology).

Maladaptive Self- and Interpersonal Functioning Increments General Psychiatric Severity in the Association with Adolescent Personality Pathology

Dimensionalized diagnostic systems, especially the entry criterion of maladaptive self and interpersonal functioning, hold particular advantages for the downward extension of personality pathology to young persons, but require conceptual clarification. The current study evaluated the distinctiveness of maladaptive self and interpersonal functioning by examining its incremental value over and above general psychiatric severity in the association with personality pathology. A community sample of N = 419 youth (50.4% female; M_age = 11.91, SD = 1.19) between the ages of 10 and 14 completed measures of maladaptive self- and interpersonal functioning, general psychiatric severity (internalizing-externalizing spectrum), and personality pathology. Results showed that, as expected, maladaptive self- and interpersonal functioning incremented general psychiatric severity in the association with personality pathology in adolescents. Results contribute to the literature base illustrating the value of the entry criterion of the ICD-11 and AMPD diagnostic system.

A DSM-5 AMPD and ICD-11 compatible measure for an early identification of personality disorders in adolescence–LoPF-Q 12–18 latent structure and short form

The LoPF-Q 12–18 (Levels of Personality Functioning Questionnaire) was designed for clinical use and to promote early detection of personality disorder (PD). It is a self-report measure with 97 items to assess personality functioning in adolescents from 12 years up. It operationalizes the dimensional concept of personality disorder (PD) severity used in the Alternative DSM-5 Model for Personality Disorders and the ICD-11. In this study, we investigated the factorial structure of the LoPF-Q 12–18. Additionally, a short version was developed to meet the need of efficient screening for PD in clinical and research applications. To investigate the factorial structure, several confirmatory factor analysis models were compared. A bifactor model with a strong general factor and four specific factors showed the best nominal fit (CFI = .91, RMSEA = .04, SRMR = .07). The short version was derived using the ant colony optimization algorithm. This procedure resulted in a 20-item version with excellent fit for a hierarchical model with four first order factors to represent the domains and a secondary higher order factor to represent personality functioning (CFI = .98, RMSEA = .05, SRMR = .04). Clinical validity (effect size d = 3.1 between PD patients and controls) and clinical utility (cutoff ≥ 36 providing 87.5% specificity and 80.2% sensitivity) for detecting patients with PD were high for the short version. Both, the long and short LoPF-Q 12–18 version are ready to be used for research and diagnostic purposes.

Identifying Youth at Risk for Suicidal Thoughts and Behaviors Using the "p" factor in Primary Care: An Exploratory Study

Suicide is a major, preventable public health problem. The general factor of psychopathology ("p" factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale alone. Youth (N = 841; mean age 18.02, SD = 3.36) in primary care were universally screened using the Behavioral Health Screen (BHS). Factor analysis and ROC results showed the BHS assesses the p-factor, and the p-factor score demonstrates higher classification accuracy of several types of STB than a depression scale. The p-factor could help clinicians in the identification of youths with STB.

Negative emotionality as a candidate mediating mechanism linking prenatal maternal mood problems and offspring internalizing behaviour

Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother-infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.

The p factor, crime, and criminal justice: A criminological study of Caspi et al.'s general psychopathology general theory

The general psychopathology general theory or p Factor is an influential theoretical development in the social and behavioral sciences, but has yet to gain traction in criminology and criminal justice. Drawing on data from a sample of 1722 federal pretrial defendants, we created a 22-item composite indicator or additive index of the p Factor containing externalizing, internalizing, substance use, paraphilic, and forensic indicators. Negative binomial regression models found that age, sex, and diverse forms of trauma exposure are associated with higher p Factor scores. Higher p scores strongly predicted total, violent, sexual, property, weapon, and drug arrest charges net the effects of demographic features and adverse childhood experiences. There is broad heterogeneity in psychopathology within this sample with nearly 29% of clients exhibiting zero psychopathology, nearly 61% showing average psychopathology or less, and nearly 40% evincing average to exceedingly high psychopathology. As a general theory, the p Factor has considerable potential to inform the assorted morbidities that often accompany criminal activity, including self-harm, reduced global functioning, substance use, and social dysfunction and thus is a parsimonious conceptual framework to understand the overlapping and systemic personal problems that typify chronic and serious criminal offenders.

Future directions in personality pathology development research from a trainee perspective: Suggestions for theory, methodology, and practice

Research on personality disorder (PD) development has received increased attention in the last two decades, spurring reconceptualization in theoretical models of etiology, use of advanced methods, and development of effective treatments. The current manuscript briefly reviews the state of the field and proposes avenues of new research on the development of personality pathology in theoretical, methodological, and clinical veins. We identify the need to adopt a unifying and comprehensive theory to describe PD development across the lifespan, novel statistical methods to complement traditional methods relied on thus far, and the adoption of developmentally sensitive interventions that are disseminated to professionals and trainees alike. These directions for future research aim to augment prevention efforts to reduce the burden of PDs earlier in life.