Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP).

Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.

Negative Mood Dysregulation Loads Strongly Onto Common Factors With Many Forms of Psychopathology: Considerations for Assessing Nonspecific Symptoms.

There have been proposals to expand definitions for categorical disorders and dimensionally conceptualized syndromes (e.g., psychopathy) to include negative mood lability and dysregulation (NMD). Factor analytic results are often presented in support of these proposals, and we provide factor analytic demonstrations across clinically oriented samples showing that NMD indicators load strongly onto factors with a range of psychopathology. This is unsurprising from a transdiagnostic perspective but shows that factor analysis could potentially be used to justify expanding definitions for specific constructs even though NMD indicators show strong, nonspecific loadings on psychopathology factors ranging widely in nature. Expanding construct definitions and assessment approaches to emphasize NMD also may negatively impact discriminant validity. We agree that targeting NMD is essential for comprehensive assessment, but our demonstrative analyses highlight a need for using factor analysis and other statistical methods in a careful, theoretically driven manner when evaluating psychopathology structure and developing measures.

Fluctuations in anger, depressive symptoms, and self-injurious thoughts and behaviors throughout partial hospitalization treatment.

Self-injurious thoughts and behavior (SITB), including passive and active suicidal ideation (SI) and self-harm (SH) urges and behavior, are critical phenomena to predict and target during treatment. Partial hospital programs (PHP) provide unique opportunities to understand how negative affect (e.g., depression and anger) and SITB fluctuate daily. The current study aimed to explore associations between aspects of negative affect (depression and anger) and types of SITB throughout PHP treatment. PHP patients (N = 1625) who attend at least five days of treatment were included in the current sample. Anger-related symptoms, depressive symptoms, SH urges, SH occurrence, passive SI, and active SI were measured daily. A series of generalized linear mixed models were conducted to examine whether depressive and anger-related symptoms predicted SITB across patients (between-person) and throughout PHP treatment (within-person). At the between-person level, higher average depressive symptoms predicted greater severity of all forms of SITB, whereas higher average anger-related symptoms predicted greater severity SH urges and occurrence. At the within-person level, increases in depressive symptoms were associated with increases in all aspects of SITB, whereas increases in anger-related symptoms predicted increases in passive and active SI. The current study suggests that monitoring changes in negative affect throughout treatment can provide possible targets to reduce SITB.

A Bridge Between DSM-5 Section II Personality Disorder Criteria and ICD-11 Personality Disorder Trait Domains.

The organization of personality pathology into trait domains (vs. specific disorders) in ICD-11 represents an important shift in personality disorder (PD) nosology. However, to facilitate clinical implementation, a bridge is needed between this system and the DSM-5 Section II system familiar to many researchers and clinicians. In this study, individual DSM-5 PD criteria were assigned to ICD-11 trait domains based on the published Clinical Descriptions and Diagnostic Requirements. This scoring scheme was examined empirically alongside DSM-5 PD dimensions (using SIDP ratings from the MIDAS project; N = 2,147 outpatients) in terms of descriptive properties and relations with psychosocial morbidity and functioning. Most PD criteria could be matched to at least one ICD-11 trait domain, indicating considerable cross-system continuity. However, points of incongruity are noteworthy for research and clinical applications. Results provide key information for bridging categorical and dimensional frameworks, indicating that the shift toward trait-based PD models need not be as disruptive as feared.

Factor analysis in personality disorders research: Modern issues and illustrations of practical recommendations.

The development of factor analysis is uniquely situated within psychology, and the development of many psychological theories and measures are likewise tethered to the common use of factor analysis. In this article, we review modern methodological controversies and developments of factor analytic techniques through concrete demonstrations that span the exploratory-confirmatory continuum. Also, we provide recommendations for working through common challenges in personality disorders research. To help researchers conduct riskier tests of their theory-implied models, we review what factor analysis is and is not, as well as some dos and don'ts for engaging in the process of model evaluation and selection. Throughout, we also emphasize the need for closer alignment between factor models and our theories, as well as clearer statements about which criteria would support or refute the theories being tested. Consideration of these themes appears promising in terms of advances in theory, research, and treatment surrounding the nature and impact of personality disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Focusing Narrowly on Model Fit in Factor Analysis Can Mask Construct Heterogeneity and Model Misspecification: Applied Demonstrations across Sample and Assessment Types.

This study builds upon research indicating that focusing narrowly on model fit when evaluating factor analytic models can lead to problematic inferences regarding the nature of item sets, as well as how models should be applied to inform measure development and validation. To advance research in this area, we present concrete examples relevant to researchers in clinical, personality, and related subfields highlighting two specific scenarios when an overreliance on model fit may be problematic. Specifically, we present data analytic examples showing that focusing narrowly on model fit may lead to (a) incorrect conclusions that heterogeneous item sets reflect narrower homogeneous constructs and (b) the retention of potentially problematic items when developing assessment measures. We use both interview data from adult outpatients (N = 2,149) and self-report data from adults recruited online (N = 547) to demonstrate the importance of these issues across sample types and assessment methods. Following demonstrations with these data, we make recommendations focusing on how other model characteristics (e.g., factor loading patterns; carefully considering the content and nature of factor indicators) should be considered in addition to information provided by model fit indices when evaluating factor analytic models.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

The Development of Preliminary HiTOP Internalizing Spectrum Scales.

As part of a broader project to create a comprehensive self-report measure for the Hierarchical Taxonomy of Psychopathology consortium, we developed preliminary scales to assess internalizing symptoms. The item pool was created in four steps: (a) clarifying the range of content to be assessed, (b) identifying target constructs to guide item writing, (c) developing formal definitions for each construct, and (d) writing multiple items for each construct. This yielded 430 items assessing 57 target constructs. Responses from a heterogeneous scale development sample (N = 1,870) were subjected to item-level factor analyses based on polychoric correlations. This resulted in 39 scales representing a total of 213 items. The psychometric properties of these scales replicated well across the development sample and an independent validation sample (N = 496 adults). Internal consistency analyses established that most scales assess relatively narrow forms of psychopathology. Structural analyses demonstrated the presence of a strong general factor. Additional analyses of the 35 nonsexual dysfunction scales revealed a replicable four-factor structure with dimensions we labeled Distress, Fear, Body Dysmorphia, and Mania. A final set of analyses established that the internalizing scales varied widely-and consistently-in the strength of their associations with neuroticism and extraversion.

Preliminary Scales for ICD-11 Personality Disorder: Self and Interpersonal Dysfunction Plus Five Personality Disorder Trait Domains.

The ICD-11 personality disorder model is the first fully dimensional assessment of personality pathology. It consists of a personality disorder (PD) dysfunction-severity dimension, which encompasses both self- and interpersonal dysfunction, and six optional qualifiers for five prominent personality traits-Negative Affectivity (NA), Detachment (DET), Dissociality (DSL), Disinhibition (DSN), and Anankastia (ANK)-plus a borderline pattern that is defined by the criteria of DSM-IV borderline PD. This article reports on the development of a new self-report measure to assess self- and interpersonal dysfunction and the five trait qualifiers. It is the first comprehensive measure of the ICD-11 PD model in that (a) it is the only one to include both PD dysfunction-severity as well as trait scales and because (b) it is based on the Clinical Description and Diagnostic Guidelines, which are more detailed than the "statistical" model description that is currently on the ICD-11 website. The authors wrote 992 items and then reduced the pool to 300 items by eliminating redundancy and selecting the consensus best few items for each subconstruct. Data were collected using an online sample of 383 Prolific workers. Using exploratory factor analysis, seven domain scales were developed, each of which contained two to four scales assessing components of the domain. These preliminary scales' psychometrics were excellent, as were the domains' and their components' convergent and discriminant validity, with a few generally minor exceptions. Structural analyses at the component level revealed a three-factor structure consisting of two moderately correlated Internalizing factors, one centered on Self Dysfunction with two NA components and a DSN component (Distractibility) and the other on Interpersonal Dysfunction with DET and ANK components; as well as an Externalizing factor with DSL and a DSN component (Reckless Impulsivity) that was uncorrelated with the other two factors. Two aspects of the results in particular are striking: (1) ANK was not the opposite end of a DSN dimension, but rather contributed to an Internalizing Interpersonal Dysfunction dimension and (2) DSN had both an Internalizing and an Externalizing component. Implications of the findings and study limitations are discussed.

Three recommendations based on a comparison of the reliability and validity of the predominant models used in research on the empirical structure of psychopathology.

The present study compared the primary models used in research on the structure of psychopathology (i.e., correlated factor, higher-order, and bifactor models) in terms of structural validity (model fit and factor reliability), longitudinal measurement invariance, concurrent and prospective predictive validity in relation to important outcomes, and longitudinal consistency in individuals' factor score profiles. Two simpler operationalizations of a general factor of psychopathology were also examined-a single-factor model and a count of diagnoses. Models were estimated based on structured clinical interview diagnoses in two longitudinal waves of nationally representative data from the United States (n = 43,093 and n = 34,653). Models that included narrower factors (fear, distress, and externalizing) were needed to capture the observed multidimensionality of the data. In the correlated factor and higher-order models these narrower factors were reliable, largely invariant over time, had consistent associations with indicators of adaptive functioning, and had moderate stability within individuals over time. By contrast, the fear- and distress-specific factors in the bifactor model did not show good reliability or validity throughout the analyses. Notably, the general factor of psychopathology (p factor) performed similarly well across tests of reliability and validity regardless of whether the higher-order or bifactor model was used; the simplest (single factor) model was also comparable across most tests, with the exception of model fit. Given the limitations of categorical diagnoses, it will be important to repeat these analyses using dimensional measures. We conclude that when aiming to understand the structure and correlates of psychopathology it is important to (a) look beyond model fit indices to choose between different models, (b) examine the reliability of latent variables directly, and (c) be cautious when isolating and interpreting the unique effects of specific psychopathology factors, regardless of which model is used. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Beyond Distress and Fear: Differential Psychopathology Correlates of PTSD Symptom Clusters.

BACKGROUND: Research suggests that re-experiencing and avoidance are "core" PTSD symptoms, but there has been little research explicating their unique connections to psychopathology other than internalizing conditions such as depression and anxiety. We aim to unpack symptom heterogeneity within PTSD by exploring associations between re-experiencing and avoidance clusters and major psychopathology domains in a dimensional metastructural framework (e.g., the Hierarchical Taxonomy of Psychopathology, or HiTOP). METHOD: We used a trauma-exposed community sample (n = 233, 66.1% female, mean age = 45 years) to compare re-experiencing and avoidance's associations with factor-analytically derived dimensions generally corresponding to HiTOP structure: Distress, Fear, Detachment, Antagonism, Disinhibition, Thought Disorder, and Compulsivity. RESULTS: Both re-experiencing and avoidance were robustly related to Fear. Re-experiencing was particularly related to Distress and Thought Disorder, whereas avoidance was related to domains involving overinhibition (e.g., Compulsivity). Relative to avoidance, re-experiencing had broader and more substantial associations with psychopathology, partly as a function of its greater saturation with dysphoria. LIMITATIONS: Coverage of PTSD symptoms was limited to questionnaire measurement of re-experiencing and avoidance clusters. Results need to be replicated in samples selected for posttraumatic psychopathology. CONCLUSION: Although they are strongly intercorrelated and both are robustly related to Fear, re-experiencing and avoidance differ substantially in their unique relations with other forms of psychopathology, and re-experiencing may be less specific to PTSD than previously thought. These differences can be used to understand the etiology and phenomenology of re-experiencing and avoidance in greater depth to inform more targeted and effective interventions for posttraumatic psychopathology.

What Is the General Factor of Psychopathology? Consistency of the p Factor Across Samples.

Bifactor analyses have become a popular way to model a general psychopathology factor (or p factor) that accounts for correlations among higher order internalizing, externalizing, and thought-disorder dimensions. However, to advance dimensional nosology and construct validation of the p factor, this body of research needs to be synthesized. This study focuses on the p factor as a substantive construct by testing its consistency across samples and models. Bifactor analyses were run for three large epidemiological and clinical data sets: National Comorbidity Survey, Collaborative Psychiatric Epidemiology Surveys, and Methods to Improve Diagnostic Assessment and Services. Despite generally good model fit and strong factor congruence, interpretation of the p factor varied across samples and methods. This limited consistency suggests a lack of clear, generalizable operationalization of the p factor for applications such as measure development. Results are interpreted in terms of implications for the p factor as a substantive construct.

Examining the Criterion Validity and Diagnostic Specificity of Self-Report Measures of Narcissism and Mania.

We examined the validity of self-report measures of narcissism and mania by relating them to interview-based ratings of psychopathology. Narcissism scales were taken from the Narcissistic Personality Inventory (NPI), the Personality Diagnostic Questionnaire-4+, and the Short Dark Triad. Mania measures included the Altman Self-Rated Mania Scale (ASRM) and scales taken from the Hypomanic Personality Scale (HPS) and Expanded Version of the Inventory of Depression and Anxiety Symptoms. Our analyses addressed two key issues. The first issue was whether these scales demonstrated significant criterion validity (e.g., whether the HPS scales correlated significantly with interview ratings of mania). The second issue was whether they displayed specificity to their target constructs (e.g., whether the NPI scales correlated more strongly with ratings of narcissistic personality disorder than with other forms of psychopathology). All of the narcissism scales-including all three NPI subscales-correlated significantly with interview ratings of narcissistic personality disorder and showed considerable evidence of diagnostic specificity. Most of the mania scales also displayed good criterion validity and diagnostic specificity. However, two measures-the ASRM and the HPS Social Vitality subscale-had weak, nonsignificant associations with interview ratings of manic episodes; these findings raise concerns regarding their validity as specific indicators of mania.

Aspects of extraversion and their associations with psychopathology.

Extraversion shows both negative and positive associations with psychopathology. Previous work in this area has focused largely on either a broad higher order extraversion domain score or on specific lower-order extraversion facets. The goal of this study was to explicate how two intermediate aspects of the trait-communal extraversion and agentic extraversion-relate to psychopathology. We examined these relations using the Communal Extraversion (e.g., enjoy spending time with people, would describe myself as cheerful, like places that are crowded and exciting) and Agentic Extraversion (e.g., speak my mind, take charge in a group of people, like the sensation of going really fast) scales from the Faceted Inventory of the Five-Factor Model (FI-FFM; Watson, Nus, & Wu, 2019). As expected, Communal Extraversion generally showed negative associations with psychopathology; it had particularly strong links to indicators of internalizing, including depression symptoms (correlations generally ranged from -.40 to -.60) and various forms of social dysfunction (most correlations ranged from -.35 to -.60). In marked contrast, Agentic Extraversion tended to have positive associations with psychopathology; it displayed particularly substantial links to indicators of mania, narcissism/narcissistic personality disorder, and traits related to externalizing (correlations generally ranged from .25 to .50). Regression results demonstrated that aspect-level analyses generated substantial increases in predictive power over the FI-FFM Extraversion domain score. This basic pattern of results replicated over time, across gender, and across both self-rated and interview-based indicators of psychopathology. These findings establish the value of examining relations with extraversion at the aspect level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Anxious, but not depressive, symptoms are associated with poorer prospective memory performance in healthy college students: Preliminary evidence using the tripartite model of anxiety and depression.

Prospective memory (PM) - or memory for tasks to be completed in the future - is essential for daily functioning. Although depression and anxiety have been shown to impair PM performance, few studies have explored the relative contributions of different symptom domains. Here, we examined the relation between anxiety, depression, negative mood, and PM performance using the tripartite model. The tripartite model attributes the substantial overlap between anxiety and depression to general distress/negative affect. Twenty-seven non-diagnosed undergraduate participants first completed self-report measures of depression (Beck Depression Inventory-II), anxiety (Beck Anxiety Inventory [BAI], State Trait Anxiety Inventory [STAI]), and affect (Positive and Negative Affect Schedule). They were then given an event-based PM instruction to be completed during three ongoing cognitive tasks. Depressive symptoms and positive affect were unrelated to PM performance. Higher anxiety symptoms (BAI, r = -0.62; STAI, r = -0.41) and negative affect (r = -0.45) were associated with poorer PM performance, with anxiety doubling the variance explained over-and-above negative affect ( Δ R2 = 0.20). These preliminary results suggest that anxiety symptoms may be uniquely related to impairments in PM function, and highlight the need for future studies to consider the individual contributions of symptoms to understand changes in cognition and behavior.

Mode of administration effects in psychopathology assessment: Analyses of gender, age, and education differences in self-rated versus interview-based depression.

Respondents may answer sensitive questions differently depending on the mode of assessment (e.g., questionnaire, interview). The possibility of differences in these mode effects across groups is an important assessment consideration given the implications for test-score validity and bias. Although differences in mode effects are highly relevant to issues in clinical assessment, research is limited and generally fails to make use of psychometrically sound methods. The present research argues for greater attention to demographic differences in mode effects with regard to the assessment of psychopathology. Analyses of differences in mode effects in depression assessment are presented for gender, age, and education based on data from 440 community adults. Depression symptom ratings from a structured clinical interview were regressed on a self-report state depression composite score; analyses tested for differences of intercept and slope across gender, age, and education. Neither slope nor intercept differences were found for gender, but intercept differences were obtained for both age and level of education. These results indicate that younger and better educated respondents receive somewhat lower than expected ratings of depression in interviews, given their level of self-rated symptoms. These findings suggest that use of a single mode of assessment over- or underpredicts depression in certain participants. More generally, they demonstrate the value of multimethod assessment of psychopathology and justify further inquiry into mode-effect differences in clinical assessment. (PsycINFO Database Record