The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP)

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI)

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

The Utility of the Five Factor Model of Personality as an Organizing Framework for Autism-Related Traits

Growing research suggests that clinical psychological traits are contiguous with normal personality and can be located within the same psychometric frameworks. In this article, we examined whether autism-related traits (ARTs) can plausibly be located within the Five Factor Model (FFM) of personality. Across two studies (Ns = 408 and 423), participants completed measures of ARTs, broad FFM domains, and narrower FFM facets. We used empirically derived criteria to evaluate whether ARTs overlapped (i.e., shared variance) with the FFM domains to a degree that was comparable to FFM facets. Results suggested that most socially oriented ARTs could be represented as facets of the extraversion domain, whereas behaviorally oriented ARTs were more peripheral to the FFM. Cognitively oriented ARTs were less consistently linked with the FFM. These findings highlight the value of the FFM as an organizing framework for ARTs, marking an important step toward synthesis across the personality and autism literatures.

How can qualitative in-depth interviews optimize cross-cultural measurement of academic resilience?

This study explores how qualitative in-depth interviews can optimize the measurement of academic resilience across cultures, addressing the challenges faced by Chinese university students in academic setbacks. Employing a mixed-methods approach, we conducted in-depth interviews analyzed through grounded theory using Nvivo 14 and developed a measurement scale for academic resilience among Chinese students. Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) using IBM SPSS AMOS 28 were performed to validate the scale's psychometric properties. The findings reveal that Chinese students exhibit unique cultural traits in coping with academic setbacks, such as face-saving concerns, guilt, self-blame, and a preference for stability. Their coping strategies involve self-reflection, cognitive restructuring, and external support seeking, shaped by cultural influences. The Chinese University Students' Academic Setback Resilience Scale (CUSASRS) comprises dimensions of proactive coping strategies, learning engagement, and perceptions of academic adversity, offering a comprehensive representation of psychological and behavioral responses. This study contributes to understanding the cultural influences on academic resilience among Chinese students and provides empirical evidence for scale design and intervention strategies.

Parsing the heterogeneity of social motivation in autism

BACKGROUND

Social motivation is posited as a key factor in the expression of the autism phenotype. However, lack of precision in both conceptualization and measurement has impeded a thorough understanding of its diverse presentation and associated outcomes. This study addresses this gap by identifying subgroups of autism characterized by deficits in distinct facets of social motivation, relative to normative benchmarks.

METHODS

Data were from 509 participants with autism, aged 5-to-21 years (M = 10.43, SD = 3.67; 81% male), enrolled in the Healthy Brain Network. Latent profile analysis was employed to identify subgroups characterized by unique configurations of reticence, seeking, and maintaining facets of social motivation, derived from a comprehensive multi-instrument factor analysis of symptom and screening measures. Pearson's chi-square tests and one-way analysis of variance were performed to explore subgroup differences in demographic characteristics, cognitive abilities, co-occurring psychopathologies, and other aspects of social functioning.

RESULTS

Four distinct subgroups were identified: Engaged (n = 247), exhibiting the fewest challenges across each area; Inhibited (n = 143), characterized by high reticence, mild challenges in seeking, and few challenges in maintaining; Aloof (n = 68), characterized by challenges with seeking and maintaining but relatively low reticence; and Avoidant (n = 52), characterized by the highest challenges across all areas. Subgroups did not differ in terms of chronological age or sex. The Engaged subgroup exhibited the fewest challenges in other aspects of social functioning and co-occurring psychopathologies, while the Avoidant subgroup exhibited the greatest challenges, and with the Inhibited and Aloof profiles falling in between.

CONCLUSIONS

This study highlights the heterogeneous nature of deficits in social motivation in autism relative to normative benchmarks, suggesting potential avenues for tailored interventions aimed at addressing the specific challenges experienced by individuals within each subgroup. Nevertheless, there remains a need to develop more refined measurement tools capable of capturing even finer-grained aspects and diverse expressions of social motivation, facilitating further characterization of individual differences across diagnostic boundaries.

Personality Functioning, Problems in Living, and Personality Traits

The publication of the Alternative Model of Personality Disorder (AMPD) was a signpost achievement in the personality assessment. However, research on the AMPD has generally not led to either a deeper understanding of personality disorder or personality assessment or new ideas about how to provide better care for people with personality disorder diagnoses. A significant portion of research has focused on narrow issues and appears to be driven in part by ideological differences between scholars who prefer Criterion A (personality functioning) or Criterion B (maladaptive traits). I trace these issues to ambiguity about the concept of personality functioning as defined in the AMPD and its conceptual distinction from personality traits and problems in living. In this paper, I reground these concepts in coherent and distinct definitions, elaborate upon the implications of their differences, and show how these differences can help clarify and reorient AMPD research to focus on generating clinically useful models for personality pathology and personality assessment.

Trait state occasion (TSO) modeling of event-related potentials (ERPs)

Brain-based markers of psychopathology reflect risk factors for future mental illness or indicators of current disease states. One solution to differentiating trait-like risk factors from indicators of disease states is trait-state-occasion (TSO) modeling, a novel structural equation model that uses repeated observations to parse variance due to stable factors (i.e., trait) from that due to momentary changes (i.e., state). To date, TSO models have largely been applied to self-report data, with only a handful of studies applying TSO models to psychophysiological markers. Importantly, these psychophysiological studies have only applied TSO models to resting-state activity, making this the first study to model psychophysiological responses to stimuli in this way. This study conducted a "proof-of-concept" to examine trait- and state-variance in event-related potential (ERP) responses (specifically, startle-elicited N1 and P3 ERPs) to unpredictable threat in 83 adults across three time-points. TSO models were applied for the following condition contrasts: unpredictable shock>no shock and unpredictable shock>predictable shock. TSO models fit well for the N1 and P3 for both condition contrasts. In comparison to responses to no shock and predictable shock, respectively, the N1 and P3 to unpredictable threat showed substantial trait variance (N1 = 66 % & 84 %, P3 = 69 % & 71 %), less state residual variance (N1 = 32 % & 15 %, P3 = 28 % & 25 %) variance, and little autoregressive variance (N1 = 3 % & 2 %, P3 = 4 % & 6 %). Longitudinal modeling of task-based brain data can elucidate novel findings regarding the relative contribution of trait-/state-factors of biomarkers reflecting responses to stimuli.

What characterizes a well-functioning person? Perspectives from Scandinavian laypeople and mental health professionals

Functioning describes how well a person handles life, but the constituents of functioning and its measurement remain subjects of debate among researchers. However, approaches investigating how the concept of functioning is understood among laypeople and practitioners have received less attention. The present study uses a bottom-up approach to explore the concept of functioning among laypeople and mental health professionals in a Scandinavian context. Participants were asked to describe a person doing well in life and a person not doing well in life, resulting in a total of 2,345 statements from 128 laypeople and 78 mental health professionals. Initially, statements were rated according to the meta-concepts of Agency and Communion. This analysis revealed a dominant prevalence of Agency across groups, with laypeople demonstrating a heightened emphasis on Agency when characterizing an individual not doing well in life, suggesting an intensified focus on personal responsibility and achievement when describing dysfunction. Next, an independent semantic domain analysis was used to elucidate and identify distinctive features of functioning within the statements. This revealed a shared conceptualization of functioning among both laypeople and mental health professionals based on three main domains: (1) thriving; (2) daily activities and social roles; and (3) personality features. The findings underscore the importance of considering subjective experiences of thriving, efficacy in managing daily tasks and roles, and personality traits in attaining a comprehensive understanding of functioning levels.

Examining the role of personality functioning in a hierarchical taxonomy of psychopathology using two years of ambulatory assessed data

The Hierarchical Taxonomy of Psychopathology (HiTOP) arranges phenotypes of mental disorders based on empirical covariation, ranging from narrowly defined symptoms to higher-order spectra of psychopathology. Since the introduction of personality functioning (PF) in DSM-5 and ICD-11, several studies have identified PF as a predictor of transdiagnostic aspects of psychopathology. However, the role of PF in the HiTOP classification system has not been systematically examined. This study investigates how PF can be integrated into HiTOP, whether PF accounts for transdiagnostic variance captured in higher-order spectra, and how its predictive value for future affective well-being (AWB) and psychosocial impairment (PSI) compares to the predictive value of specific psychopathology beyond PF. To this end, we examined two years of ambulatory assessed data on psychopathology, PF, PSI, and AWB of N = 27,173 users of a mental health app. Results of bass-ackwards analyses largely aligned with the current HiTOP working model. Using bifactor modeling, aspects of PF were identified to capture most of the internalizing, thought disorder, and externalizing higher-order factor variance. In longitudinal prediction analyses employing bifactor-(S-1) modeling, PF explained 58.6% and 30.6% of variance in PSI and AWB when assessed across one year, respectively, and 33.1% and 23.2% of variance when assessed across two years. Results indicate that personality functioning may largely account for transdiagnostic variance captured in the higher-order components in HiTOP as well as longitudinal outcomes of PSI and AWB. Clinicians and their patients may benefit from assessing PF aspects such as identity problems or internal relationship models in a broad range of mental disorders. Further, incorporating measures of PF may advance research in biological psychiatry by providing empirically sound phenotypes.

Philosophy of psychiatry: theoretical advances and clinical implications

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Risk and resilience factors for psychopathology during pregnancy: An application of the Hierarchical Taxonomy of Psychopathology (HiTOP)

Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.

Psychosis superspectrum I: Nosology, etiology, and lifespan development

This review describes the Hierarchical Taxonomy of Psychopathology (HiTOP) model of psychosis-related psychopathology, the psychosis superspectrum. The HiTOP psychosis superspectrum was developed to address shortcomings of traditional diagnoses for psychotic disorders and related conditions including low reliability, arbitrary boundaries between psychopathology and normality, high symptom co-occurrence, and heterogeneity within diagnostic categories. The psychosis superspectrum is a transdiagnostic dimensional model comprising two spectra-psychoticism and detachment-which are in turn broken down into fourteen narrow components, and two auxiliary domains-cognition and functional impairment. The structure of the spectra and their components are shown to parallel the genetic structure of psychosis and related traits. Psychoticism and detachment have distinct patterns of association with urbanicity, migrant and ethnic minority status, childhood adversity, and cannabis use. The superspectrum also provides a useful model for describing the emergence and course of psychosis, as components of the superspectrum are relatively stable over time. Changes in psychoticism predict the onset of psychosis-related psychopathology, whereas changes in detachment and cognition define later course. Implications of the superspectrum for genetic, socio-environmental, and longitudinal research are discussed. A companion review focuses on neurobiology, treatment response, and clinical utility of the superspectrum, and future research directions.

Using Dispositions to Understand Otherwise Intractable Causal Pathways to Psychological Problems During Childhood and Adolescence

Studies of the genetic and environmental factors that make children more or less likely to develop distressing and impairing psychological problems, and studies of the psychobiological pathways through which these causal factors operate, have the goal of improving our understanding of the basic nature of psychological problems to develop better methods of prevention and treatment. For this reason, we have long had our eye on the prize of discovering the causes and psychobiological mechanisms underlying each dimension of psychological problems. There are compelling reasons, however, to seek a different and more achievable prize to understand psychological problems. Dimensions of psychological problems are both far too heterogeneous and too highly correlated to line up with distinct causal pathways. In contrast, a small number of orthogonal cognitive and socioemotional dispositional dimensions are correlated with psychological problems in revealing cross-cutting patterns. Each of these dispositions shares its independent causal pathways with psychological problems and help us understand the complex shared and heterogeneous nature of their causal processes. I outline a strategy for understanding the causes and mechanisms of psychological problems using studies of independently measured dispositions.

Irritability and Temperament: Concurrent and Prospective Relationships in Childhood and Adolescence

OBJECTIVE

Irritability symptoms are closely associated with, and may reflect, temperament traits, particularly negative affectivity (NA). However, there are few empirical data on the relationships between child temperament and irritability symptoms.

METHOD

We investigated cross-sectional and longitudinal relationships between irritability symptoms and temperament traits from age 3-15 in a community sample of 609 children and their parents. Irritability symptoms were assessed through structured interviews with parents at ages 3/6, and inventories completed by parents and youth at ages 12/15. Temperament traits were assessed using parent reports at ages 3/6, and parent and child reports at ages 12/15. Path analysis and structural equation modeling were used to explore longitudinal associations from ages 3-6 and 12-15, respectively.

RESULTS

Higher levels of irritability symptoms at ages 3/6 were concurrently associated with higher levels of NA and lower levels of effortful control (EC). In adolescence, higher irritability symptoms were concurrently associated with higher negative temperament and disinhibition. In longitudinal analyses from age 3-6 and 12-15, irritability symptoms showed modest but significant stability after adjusting for the stability of temperament traits. However, there were significant differences in the stability paths at age 3-6, reflecting lower stability of irritability symptoms. Finally, EC at age 3 predicted increased irritability symptoms at age 6, while irritability symptoms at age 3 predicted increased NA at age 6.

CONCLUSION

Irritability symptoms are robustly associated with both temperamental NA and difficulty regulating attention and behavior. These findings help situate irritability symptoms within widely accepted temperament/personality taxonomies.

Decoding the language of fear: Unveiling objective and subjective indicators in rodent models through a systematic review and meta-analysis

While rodent models are vital for studying mental disorders, the underestimation of construct validity of fear indicators has led to limitations in translating to effective clinical treatments. Addressing this gap, we systematically reviewed 5054 articles from the 1960 s, understanding underlying theoretical advancement, and selected 68 articles with at least two fear indicators for a three-level meta-analysis. We hypothesized correlations between different indicators would elucidate similar functions, while magnitude differences could reveal distinct neural or behavioral mechanisms. Our findings reveal a shift towards using freezing behavior as the primary fear indicator in rodent models, and strong, moderate, and weak correlations between freezing and conditioned suppression ratios, 22-kHz ultrasonic vocalizations, and autonomic nervous system responses, respectively. Using freezing as a reference, moderator analysis shows treatment types and fear stages significantly influenced differences in magnitudes between two indicators. Our analysis supports a two-system model of fear in rodents, where objective and subjective fears could operate on a threshold-based mechanism.

Translating the Transdiagnostic: Aligning Assessment Practices With Research Advances

Researchers and clinicians working within the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, Text Rev (DSM-5-TR) framework face a difficult question: what does it mean to have an evidence-based assessment of a nonevidence-based diagnostic construct? Alternative nosological approaches conceptualize psychopathology as (a) hierarchical, allowing researchers to move between levels of description and (b) dimensional, eliminating artificial dichotomies between disorders and the dichotomy between mental illness and mental well-being. In this article, we provide an overview of ongoing efforts to develop validated measures of transdiagnostic nosologies (i.e., the Hierarchical Taxonomy of Psychopathology; HiTOP) with applications for measurement-based care. However, descriptive models like HiTOP, which summarize patterns of covariation among psychopathology symptoms, do not address dynamic processes underlying the problems associated with psychopathology. Ambulatory assessment, well-suited to examine such dynamic processes, has also developed rapidly in recent decades. Thus, the goal of the current article is twofold. First, we provide a brief overview of developments in constructing valid measures of the HiTOP model as well as developments in ambulatory assessment practices. Second, we outline how these parallel developments can be integrated to advance measurement-based treatment. We end with a discussion of some major challenges for future research to address to integrate advances more fully in transdiagnostic and ambulatory assessment practices.

Callous-Unemotional Traits in Adolescents' Daily Life: Associations with Affect and Emotional and Conduct Problems

Intensive longitudinal methods (e.g., daily diary) inform understanding of dynamic processes by parsing within-person state-like fluctuations from stable between-person trait-like differences. In this exploratory study, we investigated whether self-reported callous-unemotional (CU) traits (callousness, uncaring) demonstrated daily fluctuations, as well as whether daily CU traits were associated with multiple forms of daily emotional and behavioral functioning. A sample of 99 adolescents (55.8% female; Mage = 14.60 years) provided baseline information and completed a naturalistic 30-day diary reporting on CU traits, positive and negative affect, and emotional and conduct problems in their daily lives. Dynamic structural equation modeling revealed that many CU traits items showed within-person autoregressive and cross-lagged links; however, there was substantial between-person variation in within-person fluctuations across items. At the subscale level, cross-day associations were observed between callousness and uncaring, conduct problems and uncaring, positive affect and callousness, negative affect and emotional problems, and emotional problems and negative affect. By harnessing intensive longitudinal data, our findings provide preliminary state-level evidence of CU traits, as well as functional information with regards to CU traits and emotional and behavioral problems in daily life. We consider the implications of our findings in terms of informing future CU traits intensive longitudinal evaluations.

Mapping Psychosis Risk States onto the Hierarchical Taxonomy of Psychopathology Using Hierarchical Symptom Dimensions

Clinical high risk for psychosis (CHR) is a transdiagnostic risk state. However, it is unclear how risk states such as CHR fit within broad transdiagnostic models such as the Hierarchical Taxonomy of Psychopathology (HiTOP). In this study, a hierarchical dimensional symptom structure was defined by unfolding factor analysis of self-report data from 3,460 young adults (mage=20.3). A subsample (n=436) completed clinical interviews, 85 of whom met CHR criteria. Regression models examined relationships between symptom dimensions, CHR status, and clinician-rated symptoms. CHR status was best explained by a reality distortion dimension, with contributions from internalizing dimensions. Positive and negative attenuated psychotic symptoms were best explained by multiple psychotic and nonpsychotic symptom dimensions including reality distortion, distress, fear, detachment, and mania. Attenuated psychotic symptoms are a complex presenting problem warranting comprehensive assessment. HiTOP can provide both diagnostic precision and broad transdiagnostic coverage, making it a valuable resource for use with at-risk individuals.

The nature and neurobiology of fear and anxiety: State of the science and opportunities for accelerating discovery

Fear and anxiety play a central role in mammalian life, and there is considerable interest in clarifying their nature, identifying their biological underpinnings, and determining their consequences for health and disease. Here we provide a roundtable discussion on the nature and biological bases of fear- and anxiety-related states, traits, and disorders. The discussants include scientists familiar with a wide variety of populations and a broad spectrum of techniques. The goal of the roundtable was to take stock of the state of the science and provide a roadmap to the next generation of fear and anxiety research. Much of the discussion centered on the key challenges facing the field, the most fruitful avenues for future research, and emerging opportunities for accelerating discovery, with implications for scientists, funders, and other stakeholders. Understanding fear and anxiety is a matter of practical importance. Anxiety disorders are a leading burden on public health and existing treatments are far from curative, underscoring the urgency of developing a deeper understanding of the factors governing threat-related emotions.

Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems

Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

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).

How can the DSM-5 alternative model of personality disorders advance understanding of depression?

BACKGROUND

The DSM-5 introduced an alternative model of personality disorder (AMPD) that includes personality dysfunction plus maladaptive-range traits. This study clarifies relations of depression diagnoses and symptoms with AMPD personality pathology.

METHOD

Two samples (Ns 402 and 601) of outpatients and community-dwelling adults completed four depression (criteria met for major depressive disorder and dysthymia; dysphoria and low well-being scales), ten trait (two scales for each of five domains-negative affectivity, detachment, disinhibition, antagonism, psychoticism), and eight dysfunction (four scales for each of two domains-self- and interpersonal pathology) measures. Diagnoses were made using a semi-structured interview; other measures were self-reports. We quantified cross-sectional relations between depression and personality pathology with correlation and multiple regression analyses.

RESULTS

Collectively (median R²; ps < 0.0001), the trait (0.46) and dysfunction (0.50) scales predicted the depression measures strongly, with most predictive power shared (0.41) between traits and dysfunction. However, trait and dysfunction scales altogether predicted depression (median R² = 0.54) more strongly than either domain alone, ps < 0.0001. Participants with depression diagnoses showed elevations on all nonadaptive trait and personality dysfunction measures, particularly negative temperament/affectivity and self-pathology measures.

LIMITATIONS

Generalization of findings to other populations (e.g., adolescents), settings (e.g., primary care), and measures (e.g., traditional personality disorder diagnoses) is uncertain. Cross-sectional analyses did not test changes over time or establish causality.

CONCLUSIONS

The AMPD is highly relevant to depression. Assessment of personality pathology, including both personality dysfunction and maladaptive-range traits, stands to advance understanding of depression in adults.

Toward Precision Characterization and Treatment of Psychopathology: A Path Forward and Integrative Framework of the Hierarchical Taxonomy of Psychopathology and the Research Domain Criteria

A critical mission of psychological science is to conduct research that ultimately improves the lives of individuals who experience psychopathology. One important aspect of accomplishing this mission is increasing the likelihood that treatments will work for each person. I contend that treatment prognosis can be improved by moving toward a precision-medicine model. I advance a principle-driven framework for working toward these objectives. First, I synthesize the Hierarchical Taxonomy of Psychopathology and the Research Domain Criteria and demonstrate how integrating these models facilitates precision characterization of psychopathology. Second, I outline and demonstrate a systematic process for approaching treatment selection by leveraging precisely characterized representations of psychopathology. Finally, I advocate the research and clinical applications of this framework. Although clinical and psychological scientists are conducting exciting, multidisciplinary, and methodologically rigorous research in their respective domains, the impact of these pursuits will be maximized in the context of a unifying theoretical framework that supports a clear guiding mission.

Classification and assessment of fear and anxiety in personality and psychopathology

We examine fear and anxiety in the context of structural models of personality (the five-factor model, or FFM) and psychopathology (the Hierarchical Taxonomy of Psychopathology, or HiTOP); we also highlight important issues related to their assessment. Anxiety is a sustained, future-oriented response to potential threat. Trait measures of anxiety represent a core facet within the broader domain of neuroticism in the FFM. Anxiety-related symptoms are indicators of the distress subfactor within the internalizing spectrum in HiTOP. In contrast, fear is a brief, present-focused response to an acute threat. We distinguish between two ways of assessing individual differences in fear. The first type assesses phobic responses to specific stimuli. Phobia measures are moderately correlated with measures of neuroticism in the FFM and define the fear subfactor of internalizing in HiTOP. The second type assesses individual differences in harm avoidance versus risk taking. Measures of risk taking (i.e., low fear) are moderately related to disinhibition/low conscientiousness and antagonism/low agreeableness in the FFM and are indicators of the externalizing superspectrum in HiTOP.

An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability

OBJECTIVE

More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF).

METHOD

Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes.

RESULTS

The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD.

CONCLUSIONS

Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.

Mapping established psychopathology scales onto the Hierarchical Taxonomy of Psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) organizes phenotypes of mental disorder based on empirical covariation, offering a comprehensive organizational framework from narrow symptoms to broader patterns of psychopathology. We argue that established self-report measures of psychopathology from the pre-HiTOP era should be systematically integrated into HiTOP to foster cumulative research and further the understanding of psychopathology structure. Hence, in this study, we mapped 92 established psychopathology (sub)scales onto the current HiTOP working model using data from an extensive battery of self-report assessments that was completed by community participants and outpatients (N = 909). Content validity ratings of the item pool were used to select indicators for a bifactor-(S-1) model of the p factor and five HiTOP spectra (i.e., internalizing, thought disorder, detachment, disinhibited externalizing, and antagonistic externalizing). The content-based HiTOP scales were validated against personality disorder diagnoses as assessed by standardized interviews. We then located established scales within the taxonomy by estimating the extent to which scales reflected higher-level HiTOP dimensions. The analyses shed light on the location of established psychopathology scales in HiTOP, identifying pure markers and blends of HiTOP spectra, as well as pure markers of the p factor (i.e., scales assessing mentalizing impairment and suspiciousness/epistemic mistrust).

Utility and validity of the Brief Psychiatric Rating Scale (BPRS) as a transdiagnostic scale

The Brief Psychiatric Rating Scale (BPRS) was originally conceived to assess psychopathology in several psychiatric disorders, making it an appropriate candidate to be used as a transdiagnostic instrument. We analyzed the utility and validity of the BPRS in a diagnostically heterogeneous sample of 600 psychiatric inpatients. As a comparator, we chose the mini-ICF-APP, a scale used to measure functioning and impairment across the diagnostic spectrum. Both scales had good internal consistency. The BPRS and the mini-ICF-APP showed a moderate correlation, with good levels of agreement. We were able to identify general symptoms present across the diagnostic spectrum, influencing severity and a cluster of symptoms specific for each diagnosis. Our results show the utility and validity of the BPRS as a transdiagnostic assessment tool that could easily be introduced in routine clinical work.

Intergenerational transmission of depressive and anxiety disorders: Mediation via youth personality

Youth personality is hypothesized to mediate the intergenerational transmission of internalizing disorders. However, this has rarely been examined. We tested whether the intergenerational transmission of depressive and anxiety disorders is mediated by youth neuroticism and extraversion, and how parent personality influenced these relationships. Participants included 550 adolescent girls, aged 13-15 years at baseline (T1), and a coparticipating biological parent. Depressive and anxiety disorders were assessed by interview at T1, and adolescents were reinterviewed every 9 months for 3 years (T2-T5). Parent and youth personality was assessed at T1. Four path models examined direct and indirect effects of parent psychopathology and personality (neuroticism and extraversion) on youth outcomes, with youth neuroticism and extraversion as mediators in separate models. In the model examining the effects of parent psychopathology via T1 youth neuroticism, there were direct effects of parent depression on T2-T5 youth depressive disorders and indirect effects of parent anxiety disorders on T2-T5 youth depressive and anxiety disorders. When parent neuroticism was added, indirect effects of T1 parent anxiety disorders and neuroticism on T2-T5 youth depressive and anxiety disorders via T1 youth neuroticism were significant. In the model examining T1 youth extraversion as a mediator, there were significant direct effects of parent depressive and anxiety disorders on T2-T5 youth depressive and anxiety disorders, respectively. Finally, when adding parent extraversion, indirect effects of parent extraversion on T2-T5 youth depressive and anxiety disorders via youth extraversion were significant. Parent and youth personality play important roles in the intergenerational transmission of depressive and anxiety disorders. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The prognostic utility of personality traits versus past psychiatric diagnoses: Predicting future mental health and functioning

Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically-relevant outcomes. The current study directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (ΔR2=06-.15), symptom chronicity (ΔR2=.03-.06), and functioning (ΔR2=.02-.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings, beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with HiTOP model.

Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication

OBJECTIVE

Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study.

METHODS

The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity.

RESULTS

A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct.

CONCLUSION

This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.

The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm : LATENT STRUCTURE OF PSYCHOPATHOLOGY

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.

Reinforcement sensitivity predicts affective psychopathology via emotion regulation: Cross-sectional, longitudinal and quasi-experimental evidence

The current article presents a model wherein reinforcement sensitivity predicts depression and anxiety via trait preferences for concomitant emotion regulation strategies. In Study 1 (N = 593), BAS sensitivity positively predicted reappraisal and BIS sensitivity negatively predicted it. Reappraisal then negatively predicted depression. BIS sensitivity also predicted rumination, which predicted both depression and anxiety. Study 2a confirmed the model developed in Study 1 with an independent sample (N = 513) and examined the relationships longitudinally. While the cross-sectional relationships were generally maintained, reinforcement sensitivity did not predict reappraisal. In Study 2b, participants (N = 218) were assessed a third time one year later, at the onset of the COVID-19 pandemic. During this stressful time, BAS sensitivity did longitudinally predict reappraisal. These studies highlight the role of emotion regulation in mediating the relationship between reinforcement sensitivity and affective pathology, particularly during times of high stress.

Folk Classification and Factor Rotations: Whales, Sharks, and the Problems With the Hierarchical Taxonomy of Psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group people with similar self-reported symptoms (i.e., like-goes-with-like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory-building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the DSM is used in clinical settings while researchers focus on developing a falsifiable theory-based classification system.

Psychopathy: Current Knowledge and Future Directions

Research on psychopathy has progressed considerably in recent years against the backdrop of important advances in the broader field of clinical psychological science. My major aim in this review is to encourage integration of investigative work on dispositional, biobehavioral, and developmental aspects of psychopathy with counterpart work on general psychopathology. Using the triarchic model of psychopathy as a frame of reference, I offer perspective on long-standing debates pertaining to the conceptualization and assessment of psychopathy, discuss how dispositional facets of psychopathy relate to subdimensions of internalizing and externalizing psychopathology, and summarize findings from contemporary biobehavioral and developmental research on psychopathy. I conclude by describing a systematic strategy for coordinating biobehavioral-developmental research on psychopathy that can enable it to be informed by, and help inform, ongoing research on mental health problems more broadly. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The structure of dimensions of psychopathology in normative and clinical samples: Applying causal discovery to MMPI-2-RF scales to investigate clustering of psychopathology spectra and p-factors

We applied a Bayesian Constraint-based Causal Discovery method (BCCD) to examine the hierarchical structure of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Restructured Clinical (RC) scales. Two different general psychopathology super spectra (p-factor) scales were extracted from (1) all RC scales and (2) all RC scales except the RCd (Demoralization) scale. These p-factor scales were included in separate models to investigate the structure of dimensions of psychopathology in a normative (n = 3,242) and clinical (n = 2,466) sample, as well as the combined normative/clinical sample (N = 5,708), by applying the BCCD algorithm to obtain a data-driven reconstruction of the internal hierarchical structure of the MMPI-2-RF. Research on the underlying structure of the MMPI-2-RF has clinical relevance as well as conceptual relevance in the context of the HiTOP model. Results demonstrated that the syndromes measured with the RC-scales-in presence of a p-factor-cluster into six spectra: internalizing, disinhibited-externalizing, antagonistic-externalizing, thought disorder, detachment, and somatoform. These results may support a super spectrum construct, as it was necessary for obtaining a bottom-up reconstruction of this six-spectrum structure. We found support for superiority of a broad super spectrum with additional variance over and above demoralization, as it resulted in the clearest structure (i.e., clustering of the RC scales). Furthermore, our results indicate independent support for the bifactor structure model of psychopathology.

Multidimensional conceptualization of identity and psychopathology: Assessing mental health disparities from an intersectional and dimensional framework

Black, Indigenous, and People of Color (BIPOC) currently constitute 40% of the US population and will become the majority by 2045. Current mental health systems have not sufficiently accounted for disparities, inequities, and social determinants impacting BIPOC lives. We outline several advances that could improve mental health disparities research. Research on BIPOC requires mental health assessment accurately capturing multiple facets of one's identity, taking into account the complexities of multifaceted historical oppression. Assessing (personality) psychopathology in a dimensional and hierarchical manner could provide greater insight into mental health disparities between diverse identity individuals. We encourage studying moderators that are protective assets for BIPOC-such as resiliency and community factors-as opposed to deficit-dominant, category-based, and majority-dominant assessments.

Differential Effects of Psychological Interventions in Online and Face-to-Face Settings on DSM-5 and ICD-11 Maladaptive Trait Domains: An Exploratory Pilot Study

While mental health treatments have proven to be effective for a range of mental health problems, there is comparably little research on its effects on personality disorders or difficulty (PD). New dimensional conceptualizations of PD such as the ICD-11 PD model enable the cost- and time-effective dimensional assessment of severity and style of PD. Furthermore, they constitute a promising tool to investigate PD, not only as a treatment endpoint but also as a predictive or influencing factor for mental health treatments. In this study, we investigated the effects in two different mental health treatment settings [online (N = 38); face-to-face and blended [FTF/blended] (N = 35)] on the reduction of maladaptive personality traits as well as the interaction between maladaptive personality patterns and the response on primary endpoints (i.e., mental distress). Results indicate that both treatment settings have comparable within-group effects on the reduction of distress symptoms, while the treatment in the FTF/blended setting seems to have a stronger impact on the reduction of maladaptive traits. Further, reduction of maladaptive trait expressions was a reliable predictor of treatment response in the FTF/blended setting while explaining less variance in the online setting. Beyond the promising findings on the utility of maladaptive trait change as an outcome measure, we discuss possible applications as an information source for treatment decisions.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

The dynamics, processes, mechanisms, and functioning of personality: An overview of the field

Personality psychology has long focused on structural trait models, but it can also offer a rich understanding of the dynamics, processes, mechanisms, and functioning of individual differences or entire persons. The field of personality dynamics, which works towards such an understanding, has experienced a renaissance in the last two decades. This review article seeks to act as a primer of that field. It covers its historical roots, summarizes current research strands - along with their theoretical backbones and methodologies - in an accessible way, and sketches some considerations for the future. In doing so, we introduce relevant concepts, give an overview of different topics and phenomena subsumed under the broad umbrella term 'dynamics', and highlight the interdisciplinarity as well as applied relevance of the field. We hope this article can serve as a useful overview for scholars within and outside of personality psychology who are interested in the dynamic nature of human behaviour and experience.

The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.