Erratum: The cognitive adaptability and resiliency employment screener (CARES): tool development and testing.

[This corrects the article DOI: 10.3389/fpsyt.2023.1254147.].

Locating triarchic model constructs in the hierarchical structure of a comprehensive trait-based psychopathy measure: Implications for research and clinical assessment.

The triarchic model posits that distinct trait constructs of boldness, meanness, and disinhibition underlie psychopathy. The triarchic model traits are conceptualized as biobehavioral dimensions that can be assessed using different sets of indicators from alternative measurement modalities; as such, the triarchic model would hypothesize that these traits are not confined to any one item set. The present study tested whether the triarchic model dimensions would emerge from a hierarchical-structural analysis of the facet scales of the Elemental Psychopathy Assessment (EPA), an inventory designed to comprehensively index psychopathy according to the five-factor personality model. Study participants (Ns = 811, 170) completed the EPA and three different scale sets assessing the triarchic traits along with criterion measures of antisocial/externalizing behaviors. Bass-ackwards modeling of the EPA facet scales revealed a four-level structure, with factors at the third level appearing similar to the triarchic trait dimensions. An analysis in which scores for the Level-3 EPA factors were regressed onto corresponding latent-trait dimensions defined using the different triarchic scale sets revealed extremely high convergence (ßs = .84-.91). The Level-3 EPA factors also evidenced validity in relation to relevant criteria, approximating and sometimes exceeding that evident for the Level-4 EPA factors. Together, these results indicate that the triarchic trait constructs are embedded in a psychopathy inventory designed to align with a general personality model and effectively predict pertinent external criteria. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A randomized controlled trial to compare the effects of time-restricted eating versus Mediterranean diet on symptoms and quality of life in bipolar disorder.

BACKGROUND: The primary objective of this randomized controlled trial (RCT) is to establish the effectiveness of time-restricted eating (TRE) compared with the Mediterranean diet for people with bipolar disorder (BD) who have symptoms of sleep disorders or circadian rhythm sleep-wake disruption. This work builds on the growing evidence that TRE has benefits for improving circadian rhythms. TRE and Mediterranean diet guidance will be offered remotely using self-help materials and an app, with coaching support. METHODS: This study is an international RCT to compare the effectiveness of TRE and the Mediterranean diet. Three hundred participants will be recruited primarily via social media. Main inclusion criteria are: receiving treatment for a diagnosis of BD I or II (confirmed via DIAMOND structured diagnostic interview), endorsement of sleep or circadian problems, self-reported eating window of ≥ 12 h, and no current mood episode, acute suicidality, eating disorder, psychosis, alcohol or substance use disorder, or other health conditions that would interfere with or limit the safety of following the dietary guidance. Participants will be asked to complete baseline daily food logging for two weeks and then will be randomly allocated to follow TRE or the Mediterranean diet for 8 weeks, during which time, they will continue to complete daily food logging. Intervention content will be delivered via an app. Symptom severity interviews will be conducted at baseline; mid-intervention (4 weeks after the intervention begins); end of intervention; and at 6, 9, and 15 months post-baseline by phone or videoconference. Self-rated symptom severity and quality of life data will be gathered at those timepoints, as well as at 16 weeks post baseline. To provide a more refined index of whether TRE successfully decreases emotional lability and improves sleep, participants will be asked to complete a sleep diary (core CSD) each morning and complete six mood assessments per day for eight days at baseline and again at mid-intervention. DISCUSSION: The planned research will provide novel and important information on whether TRE is more beneficial than the Mediterranean diet for reducing mood symptoms and improving quality of life in individuals with BD who also experience sleep or circadian problems. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06188754.

Variants of the P3 event-related potential operate as indicators of distinct mechanisms contributing to problematic alcohol use.

Considerable research has linked relative reduction in the amplitude of the P3 event-related potential (ERP) during cognitive task performance (i.e., Target-P3) with increased risk of alcohol-related problems. A separate literature indicates that a relative increase in the amplitude of the P3 elicited by cues signaling alcohol availability (i.e., ACR-P3) also is associated with alcohol use and problems. To date, no research has integrated these seemingly discrepant findings. Here, we aimed to demonstrate that P3 amplitudes elicited in different task contexts reflect distinct domains of functioning relevant to problematic alcohol involvement (PAI), and therefore can inform heterogeneity in the etiology of PAI. 156 emerging adults (61% women; 88% White/Non-Hispanic) completed a mental rotation task and a picture-viewing task while ERPs were recorded. Participants also completed questionnaire measures of trait disinhibition, alcohol use, and alcohol-related problems. Findings from regression analyses indicated that (a) Target-P3 was negatively associated and ACR-P3 was positively associated with a PAI latent variable; (b) the two P3s accounted for unique variance in PAI, beyond that accounted for by recent drinking; and (c) the association between Target-P3 and PAI-but not ACR-P3 and PAI-was statistically mediated by trait disinhibition. The present findings highlight the unique contributions of distinct functional domains associated with disinhibition and incentive salience in the etiology of PAI. Moreover, findings are consistent with a nuanced understanding of the P3 ERP, whereby its specific meaning varies according to the task context in which it is elicited.

Whose Signals Are Being Amplified? Toward a More Equitable Clinical Psychophysiology.

Research using psychophysiological methods holds great promise for refining clinical assessment, identifying risk factors, and informing treatment. Unfortunately, unique methodological features of existing approaches limit inclusive research participation and, consequently, generalizability. This brief overview and commentary provides a snapshot of the current state of representation in clinical psychophysiology, with a focus on the forms and consequences of ongoing exclusion of Black participants. We illustrate issues of inequity and exclusion that are unique to clinical psychophysiology, considering intersections among social constructions of Blackness and biased design of current technology used to measure electroencephalography, skin conductance, and other signals. We then highlight work by groups dedicated to quantifying and addressing these limitations. We discuss the need for reflection and input from a wider variety of stakeholders to develop and refine new technologies, given the risk of further widening disparities. Finally, we provide broad recommendations for clinical psychophysiology research.

Attention-deficit/hyperactivity disorder is associated with more alcohol problems and less substance-free reinforcement: A behavioral economics daily diary study of college student drinkers.

OBJECTIVE: Behavioral economic theory suggests that alcohol risk is related to elevated alcohol reinforcing efficacy (demand) combined with diminished availability of reinforcing substance-free activities, but little research has examined these reward-related processes at the daily level in association with comorbid conditions that might influence behavioral patterns and reward. Young people with attention-deficit/hyperactivity disorder (ADHD) report high levels of risky drinking, and this risk may be due in part to elevated demand for alcohol and diminished engagement in enjoyable and valued substance-free activities. METHOD: College student drinkers (N = 101; 48.5% female; 68.3% White; 18-22 years old) with (n = 51) and without (n = 50) ADHD completed 14 consecutive daily diaries (diary entry n = 1,414). We conducted a series of multilevel path models to examine (a) the associations among ADHD and average daily alcohol demand, substance-free enjoyment, and response contingent positive reinforcement (RCPR) for goal-directed behaviors; (b) the associations among concurrent daily alcohol demand, substance-free reinforcement, and RCPR for goal-directed behaviors and daily alcohol use and alcohol-related negative consequences; and (c) the moderating effect of ADHD on these within-day associations. RESULTS: ADHD was significantly associated with more daily alcohol-related negative consequences and less daily substance-free enjoyment and RCPR. Regardless of ADHD status, there were significant associations among behavioral economic risk factors and alcohol use and negative consequences, though effects differed within and between persons. There were no moderating effects of ADHD on within-person associations. CONCLUSIONS: Results expose areas of impairment specific to drinkers with ADHD and advance theory on ADHD and hazardous drinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The cognitive adaptability and resiliency employment screener (CARES): tool development and testing.

Introduction: To decrease psychological risk for content moderators, the study initiated the first steps of developing a robust employment screening tool, namely, the Cognitive Adaptability and Resiliency Employment Screener. Method: The study consisted of three phases with 4,839 total participants. Results: In Phase 1, a set of 76 items were developed and tested via exploratory factor analysis, yielding three factors (i.e., Psychological Perseverance & Agility, Rumination & Emotional Lingering, and Expressiveness & Sociability) and also reducing the scale to 68 items. In Phase 2 through confirmatory factor analysis, the three-factor structure showed good fit (CFI = 0.92, RMSEA = 0.05) and demonstrated sufficient overall reliability. In Phase 3, the convergent validity and divergent validity of the tool were established relative to constructs such as resilience, cognitive control and flexibility, emotion regulation, and optimism. Discussion: Altogether, the findings revealed that the scale demonstrated good psychometric properties that, pending future studies, may serve as a promising employment screener for content moderators.

Challenges and ways forward in bridging units of analysis in clinical psychological science.

For decades, experiential measures (i.e., self- and informant-report) have dominated clinical psychological science as the primary methods of investigating the nature, causes, and consequences of psychopathology. Recent efforts to understand psychopathology in a comprehensive manner, bridging across measurement modalities and study designs, have yielded disappointing results and small cross-domain effect sizes. This problem has stymied progress in diagnosing and treating mental illness. We contend that we continue to struggle to link different units of analysis in psychopathology research because, as a field, we have not learned the lessons that have been detailed in the literature since at least the 1950s. We argue that our reliance on single units of analysis (e.g., only self-report or only neuroimaging) to conceptualize and operationalize psychological constructs lies at the heart of our struggles. Conflation of a construct with its operationalization in a single measurement modality fundamentally limits the ability to understand its manifestation in other units of analysis. To make progress toward a fine-grained understanding of the symptoms, signs, and mechanisms of psychopathology, we must move past the siloed reification of constructs and prioritize new, integrated research paradigms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining trait-like factors as predictors of state-level responses to food intake in women with bulimia nervosa, purging disorder, and controls.

OBJECTIVE: Theories suggest that elevated negative affect and weight/shape concerns explain both who is affected by bulimic symptoms as well as when bulimic symptoms occur, suggesting that individual differences predict within-subject differences. However, few studies have tested this theoretical premise. METHOD: In the present study, participants (N = 119) diagnosed with bulimia nervosa (N = 57), purging disorder (N = 31), and non-eating disorder controls (N = 31) completed measures of negative affect and weight/shape concerns and later made momentary affect and weight/shape concerns ratings before and after an ad lib meal. RESULTS: State negative affect and weight/shape concerns increased post-meal. No moderating effect of trait negative affect was observed for state affect. In contrast, between-subject differences in weight/shape concerns moderated within-subject increases in state weight/shape concerns. Diagnostic group did not account for this effect. DISCUSSION: Findings point to viable treatment targets for disordered eating. Targeting elevated weight/shape concerns early in interventions could facilitate reductions in purging after food intake for bulimia nervosa and purging disorder. PUBLIC SIGNIFICANCE: In the present study, individual differences in weight/shape concerns at baseline predicted greater increases in state weight/shape concerns following eating. These effects were maintained when considering possible differences related to presence and type of eating disorder. Results suggest that targeting weight/shape concerns earlier in treatment may be important for reducing maladaptive responses to eating across eating disorders.

Evaluating training needs in clinical psychology doctoral programs.

OBJECTIVE: Advances in clinical psychology must be accompanied by advances in training. This study assessed training content, quality, and needs during clinical psychology doctoral programs among current or past doctoral students. METHODS: Current or past clinical psychology doctoral students (N = 343) completed an anonymous survey assessing training experiences and needs. A descriptive-focused exploratory factor analysis (EFA) also examined whether common subgroups of academic interests emerged. RESULTS: Most participants reported that they sought training beyond required coursework, primarily in clinical training, cultural competency, and professional development, and reported having taken one or more unhelpful course, including discipline-specific knowledge requirements. Descriptive results from the EFA demonstrated common training areas of interest: diversity topics, biological sciences, clinical practice, and research methods. DISCUSSION: This study demonstrates that trainees and early career psychologists are aware of their nuanced and in some cases, unmet training needs. CONCLUSION: This work foregrounds the need to adapt extant training opportunities to support the next generation of clinical psychologists.

A hypothetical lottery task to assess relative resource allocation toward alcohol and cannabis.

OBJECTIVE: Relative spending on substances (vs. alternatives) is predictive of several substance use outcomes, but it can be challenging to assess. We examined a novel method of assessing relative resource allocation through the use of a hypothetical lottery task wherein participants assume they collected $100,000 United States dollars in lottery winnings and were tasked with allocating their winnings across spending categories (e.g., savings, leisure, alcohol, cannabis). We hypothesized relative allocation of funds toward alcohol and cannabis would be positively associated with more use and problems of each substance. METHOD: College students (N = 479; Mage = 19.9 [SD = 2.2]) reported on their substance use and problems, alcohol and cannabis demand, and the hypothetical lottery task. RESULTS: Relative resource allocation toward alcohol and cannabis on the lottery task positively correlated with alcohol and cannabis demand indices (intensity, breakpoint, Omax, and elasticity [negatively]), respectively. Using zero-inflated modeling, greater relative allocation toward alcohol positively related to alcohol use and problems in models that controlled for alcohol demand indices. For cannabis, relative resource allocation was also positively associated with cannabis use, but not problems, independently from cannabis demand indices. CONCLUSIONS: Results provide initial support for the hypothetical lottery task as an indicator of relative resource allocation toward substances. Generally, these results extend previous behavioral economic research demonstrating the utility of relative resource allocation as a unique predictor of clinically relevant outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing general versus specific liability for externalizing problems in adolescence: Concurrent and prospective prediction of symptoms of conduct disorder, ADHD, and substance use.

This study explored the generality versus specificity of two trait-liability factors for externalizing problems-disinhibition and callousness-in the concurrent and prospective prediction of symptoms of conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and substance use (i.e., alcohol use disorder and history of illicit substance use). Disinhibition involves an impulsive, unrestrained cognitive-behavioral style; callousness entails a dispositional lack of social-emotional sensitivity. Participants were European adolescents from the multisite IMAGEN project who completed questionnaires and clinical interviews at ages 14 (N = 1,504, Mage = 14.41, 51.13% female) and 16 (N = 1,407, Mage = 16.46, 51.88% female). Disinhibition was related concurrently and prospectively to greater symptoms of conduct disorder, ADHD, and alcohol use disorder; higher scores on a general externalizing factor; and greater likelihood of having tried an illicit substance. Callousness was selectively related to greater conduct disorder symptoms. These findings indicate disinhibition confers broad liability for externalizing spectrum disorders, perhaps due to its affiliated deficits in executive function. In contrast, callousness appears to represent more specific liability for antagonistic (aggressive/exploitative) forms of externalizing, as exemplified by antisocial behavior. Results support the utility of developmental-ontogenetic and hierarchical-dimensional models of psychopathology and have important implications for early assessment of risk for externalizing problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Latent variable model of triarchic psychopathy constructs in an incarcerated offender sample: Factor reliability and validity.

The triarchic model of psychopathy posits that three distinct trait dispositions-disinhibition, meanness, and boldness-contribute to the interpersonal, affective, and impulsive-unrestrained features of this condition and is represented to varying degrees in all conceptualizations and measures of psychopathy. Using data for incarcerated males (n = 273) and females (n = 83) from 10 different prisons in Italy, we specified a latent variable model of the triarchic trait constructs in which scale measures of disinhibition, meanness, and boldness composed of items from the following inventories served as indicators: Triarchic Psychopathy Measure, Psychopathic Personality Inventory-Revised, Minnesota Multiphasic Personality Inventory-2 Restructured Form, and NEO Five Factor Inventory. A correlated three-factor solution evidenced adequate model fit, with individual triarchic trait scales loading strongly onto their target factors. The model exhibited comparable fit and factor loadings when specified using data for males only, and its factors showed expected relations with pertinent criterion variables, including measures of normative personality and clinical dysfunction along with staff ratings of prison behavior and release prognosis. Extending prior research with nonclinical participants from the U.S., present study results demonstrate the viability of a latent variable model of the triarchic traits in an incarcerated offender sample from a separate culture (Italy). The significance of this work lies in the potential of the triarchic traits to serve as conceptual-empirical points of reference for integrating findings across studies of psychopathy employing diverse samples and assessment measures. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Boldness moderates cognitive performance under acute threat: Evidence from a task-switching paradigm involving cueing for shock.

Understanding factors that influence behavioral performance in high-pressure contexts is relevant to critical occupations such as first responders, military personnel, and frontline medical workers. A recent study by Yancey et al. (2019) demonstrated an association between boldness, a biobehavioral trait reflecting social dominance and fearlessness, and enhanced task-switching performance during threat of shock relative to a no-shock (safe) condition. This study used a sustained threat manipulation in which cues signaling possible shock were present throughout blocks of multiple task trials. Here, we extended this work by evaluating the relationship between boldness and task-switching performance under acute threat of shock conditions, in which cues signaling possible shock occurred during individual task trials, intermingled with safe trials. Participants (N = 79) completed a task-switching procedure involving acute threat of shock in which unwarned noise probes were presented to elicit blink-startle responses. Boldness was associated with better switching performance under threat versus safe conditions, with high-bold participants who exhibited low startle potentiation during threat showing the best performance. These findings provide additional evidence that dispositional boldness is a meaningful individual difference characteristic related to effective performance in high-pressure situations and have implications for personnel selection and assignment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Unconsidered issues of measurement noninvariance in biological psychiatry: A focus on biological phenotypes of psychopathology.

There is increasing appreciation that certain biological processes may not be equally related to all psychiatric symptoms in a given diagnostic category. Research on the biological phenotyping of psychopathology has begun examining the etiological and treatment implications of identified biotypes; however, little attention has been paid to a critical methodological implication of these results: measurement noninvariance. Measurement invariance is the ability of an instrument to measure the same construct, the same way, across different people, or across different time points for the same individual. If what a measure quantifies differs across different people (e.g., those with or without a particular biotype) or time points, then it is invalid to directly compare means on that measure. Using a running example of inflammatory phenotypes of depression, we first describe the biological phenotyping of psychopathology. Second, we discuss three types of measurement invariance. Third, we demonstrate how differential biology-symptom associations invariably creates measurement noninvariance using a theoretical example and simulated data (for which code is provided). We also show how this issue can lead to false conclusions about the broader diagnostic construct. Finally, we provide several suggestions for addressing these important issues to help advance the field of biological psychiatry.

Reliability and validity of a transdiagnostic measure of reward valuation effort.

To identify biobehavioral mechanisms underlying excessive reward consumption, reward valuation-effort (RV-E) assessments should (a) parallel measures in basic science to permit translation from preclinical to clinical studies; (b) quantify constructs dimensionally from healthy to disease states; and (c) hold relevance across different diagnostic categories. To address these aims, we developed a progressive ratio (PR) task whereby RV-E is measured as breakpoint when participants worked for access to playing a game. We evaluated test-retest reliability of breakpoint and convergent and discriminant validity of interpretations of this score against an established PR task for food. In Study 1, female undergraduates (N = 71; 33% racial minority; 28% ethnic minority) completed the game and food tasks in fasted and fed states. In Study 2, women (N = 189; 29% racial minority; 27% ethnic minority) with eating disorders (n = 158) were compared to controls (n = 31) on tasks. Game task breakpoint demonstrated excellent test-retest reliability, intraclass correlation coefficient (ICC) = .91, 95% CI [.80, -.96], over 2 weeks and convergent validity with the fasted food task (r = .51, p < .001). Consistent with animal models, breakpoint was lower in fed compared to fasted states across tasks, B (SE) = 321.01 (552.40), p < .001. Finally, the game task demonstrated discriminant validity from measurement of satiation. In Study 2, women with eating disorders demonstrated higher breakpoint on both tasks compared to controls, and game PR task breakpoint decreased from a fasted to fed state. The game PR task offers a novel approach for translating results from animal models of RV-E into testable hypotheses in nonclinical and clinical samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differential brain responses to alcohol-related and natural rewards are associated with alcohol use and problems: Evidence for reward dysregulation.

Multiple theoretical perspectives posit that drug use leads to biased valuation of drug-related reward, at the expense of naturally occurring rewarding activities (i.e., reward dysregulation). Recent research suggests that the comparative balance of drug-related and nondrug-related reward valuation is a powerful determinant of substance misuse and addiction. We examined differential neurophysiological responses-indexed with the P3 component of the event-related potential (ERP)-elicited by visual alcohol cues and cues depicting natural reward as a neurobiological indicator of problematic drinking. Nondependent, young adult drinkers (N = 143, aged 18-30 years) completed questionnaire measures assessing alcohol use and problems, and viewed alcohol cues (pictures of alcoholic beverages), high-arousing natural reward cues (erotica, adventure scenes), nonalcoholic beverage cues, and neutral scenes (e.g., household items) while ERPs were recorded. When examined separately, associations of P3-ERP reactivity to alcohol cues and natural reward cues with alcohol use and problems were weak. However, differential P3 response to the two types of cues (i.e., reward dysregulation P3) showed consistent and robust associations with all indices of alcohol use and problems and differentiated high-risk from lower-risk drinkers. The current results support the idea that the differential incentive-motivational value of alcohol, relative to naturally rewarding activities, is associated with increased risk for substance misuse and dependence, and highlight a novel neurophysiological indicator-the reward dysregulation P3-of this differential reward valuation.

A Simulation Study on the Performance of Different Reliability Estimation Methods.

The accuracy of certain internal consistency estimators have been questioned in recent years. The present study tests the accuracy of six reliability estimators (Cronbach's alpha, omega, omega hierarchical, Revelle's omega, and greatest lower bound) in 140 simulated conditions of unidimensional continuous data with uncorrelated errors with varying sample sizes, number of items, population reliabilities, and factor loadings. Estimators that have been proposed to replace alpha were compared with the performance of alpha as well as to each other. Estimates of reliability were shown to be affected by sample size, degree of violation of tau equivalence, population reliability, and number of items in a scale. Under the conditions simulated here, estimates quantified by alpha and omega yielded the most accurate reflection of population reliability values. A follow-up regression comparing alpha and omega revealed alpha to be more sensitive to degree of violation of tau equivalence, whereas omega was affected greater by sample size and number of items, especially when population reliability was low.

Trajectories of reward availability moderate the impact of brief alcohol interventions on alcohol severity in heavy-drinking young adults.

BACKGROUND: Behavioral economic theory predicts that low access to environmental reward is a risk factor for alcohol use disorder (AUD). The Substance-Free Activity Session (SFAS) is a behavioral economic supplement to standard brief alcohol interventions that attempts to increase environmental reward and may therefore have beneficial effects, particularly for individuals with low levels of environmental reward. METHODS: Participants were 393 college students who reported at least 2 heavy-drinking episodes in the past month. Participants were randomly assigned to 1 of 3 conditions following a baseline assessment: a standard alcohol-focused brief motivational intervention plus relaxation training session (BMI + RT), BMI plus Substance-Free Activity Session (BMI + SFAS), or an assessment-only control condition (AO). In a secondary analysis of the data from this study, we used person-centered statistical techniques to describe trajectories of alcohol severity and environmental reward over a 16-month follow-up and examined whether environmental reward levels moderated the effectiveness of the interventions. RESULTS: Piecewise growth mixture modeling identified 2 trajectories of reward availability: low increasing (LR; n = 120) and high stable (HR; n = 273). Depressive symptoms, cannabis use, sensation seeking, and low life satisfaction were associated with a greater probability of classification in the LR trajectory. Alcohol severity was greater in the LR trajectory than the HR trajectory. For students in the LR trajectory, at 1, 6, and 12 months, BMI + SFAS led to greater increases in reward availability and reduced levels of alcohol severity compared with the BMI + RT and AO conditions and at 16 months compared with AO. CONCLUSIONS: Young adults with low levels of environmental reward are at heightened risk for greater alcohol severity and may show greater benefit from brief alcohol interventions that focus on increasing substance-free reward than individuals who are not deficient in reward availability.

Relationship between transdiagnostic dimensions of psychopathology and traumatic brain injury (TBI): A TRACK-TBI study.

Neuropsychiatric symptoms are common, comorbid, and often disabling for patients with traumatic brain injury (TBI). Identifying transdiagnostic symptom dimensions post-TBI may help overcome limitations of traditional psychiatric diagnoses and advance treatment development. We characterized the dimensional structure of neuropsychiatric symptoms at 2-weeks postinjury in n = 1,732 TBI patients and n = 238 orthopedic-injured trauma controls (OTC) from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Symptoms were reported on the Brief Symptom Inventory-18, Patient Health Questionnaire-9 Depression checklist, PTSD Checklist for DSM-5, PROMIS Pain Intensity scale, and Insomnia Severity Index. We established a novel factor model of neuropsychiatric symptoms and evaluated how 3 TBI severity strata and OTC patients differed in symptom severity. The final factor model had 6 first-order factors subsumed by 2 second-order factors: Internalizing (encompassing Depression, Anxiety, and Fear) and Somatic symptoms (Sleep, Physical, Pain). Somatic symptoms fit better as a correlated factor of (vs. a lower-order factor within) Internalizing. All symptom dimensions except for Pain were more severe in 1 or more TBI subgroups, as compared to the OTC group. Milder brain injury was generally associated with more severe symptoms, whereas more general injury severity (higher level of care, e.g., emergency department, intensive care unit) was associated with more pain. The findings indicate a broad factor resembling the internalizing factor of general psychopathology in traumatically injured patients, alongside a distinct somatic symptom factor. Brain injury, especially milder brain injury, may exacerbate liabilities toward these symptoms. These neuropsychiatric dimensions may help advance more precision medicine research for TBI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).