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

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.

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.

Understanding Perceptions of Nonsuicidal Self-Injury: Descriptive and Injunctive Norms.

Nonsuicidal self-injury (NSSI) is a major public health concern. Web-based personalized feedback interventions (PFIs) may be a cost-effective and efficient way to treat NSSI. In order to develop a PFI, it is imperative to assess descriptive and injunctive norms. The current study examines descriptive and injunctive norms of NSSI within college students and adults in the community, comparing how perceived norms may differ for those who do or do not engage in NSSI. Study 1 calculated percentages of NSSI behavior within the student sample. Study 2 then examined perceived descriptive and injunctive norms between those with and without history of NSSI in both samples. Study 1 indicated that 19% of undergraduate students had histories of NSSI. Additionally, there was a general tendency to overestimate the percentage of people who engage in NSSI and the number of times a typical person engages in NSSI. Finally, those who engaged in NSSI believed that most people do not understand why individuals engage in NSSI; comparatively, the majority of people without history of NSSI still indicated that they understand why others would engage in NSSI. These research findings may be utilized in a PFI to reduce shame and NSSI behavior.

Les progrès dans la réalisation de la classification quantitative de la psychopathologie.

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.

Criterion A of the AMPD in HiTOP.

The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013 ) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP.

The Importance of Considering Clinical Utility in the Construction of a Diagnostic Manual.

The development of major diagnostic manuals primarily has been guided by construct validity rather than clinical utility. The purpose of this article is to summarize recent research and theory examining the importance of clinical utility when constructing and evaluating a diagnostic manual. We suggest that construct validity is a necessary but not sufficient criterion for diagnostic constructs. This article discusses components of clinical utility and how these have applied to the current and forthcoming diagnostic manuals. Implications and suggestions for future research are provided.

Development and Validation of the Five-Factor Borderline Inventory-Super Short Form and Screener.

The Five-Factor Borderline Inventory (FFBI) and FFBI-Short Form (FFBI-SF) are 120-item and 48-item measures that assess the underlying maladaptive personality traits of borderline personality disorder (BPD). The purpose of this study was to develop a super short form (FFBI-SSF) and an FFBI-Screener to facilitate the use of dimensional trait measures for BPD. Using item response theory analyses, the 48-item measure was reduced to 22 items using a large undergraduate sample (N = 1300) and then retested using a Mechanical Turk sample (N = 602), demonstrating strong replicability. IRT was again used to further reduce the measure from 22 items to four items to provide a brief screening tool. Correlations of the FFBI-SSF and Screener with measures of BPD-related variables were compared across five samples (N = 919, 204, 580, 281, and 488). Overall, the FFBI-SSF showed similar relations to the FFBI-SF at the full scale and domain-level scales, while the FFBI-screener demonstrated similar relations at the full scale level. This super short form and screener may best be used in large-scale research studies or as part of a screening tool in clinical settings.

Prevalence rate trends of borderline personality disorder symptoms and self-injurious behaviors in college students from 2017 to 2021.

The current study examines the prevalence rates of borderline personality disorder (BPD) symptoms and nonsuicidal self-injury (NSSI) behaviors amongst college students over a five-year period, including pre- and during the COVID pandemic. Online prescreener surveys were completed by undergraduate students (n = 12,756) attending a large Southern Plains University every semester from Spring of 2017 to Spring of 2021. The percentage of students with NSSI history and significant BPD symptoms were visualized by semester to examine trends over time. A series of logistic regressions and negative binomial regressions were conducted on NSSI history and BPD symptoms to examine whether the endorsement rates have been increasing over time and to compare before and during COVID pandemic. There was an increasing trend of NSSI rates and significant BPD symptoms over time for all sexes. Furthermore, there was a steeper increase in BPD symptoms specifically in female students over the last five years. Additionally, there was a significant increase in odds of elevated BPD symptoms and NSSI behaviors in the college students enrolled during the COVID pandemic compared with pre-COVID. Overall, there has been an increasing trend in BPD symptoms and NSSI rates over the last few years, including during the COVID pandemic.

The Development of the Five-Factor Schizoid Inventory.

The current study sought to provide evidence for a measure of schizoid personality disorder (SZD PD) traits using the Five-Factor Model framework of personality. In the first study, undergraduate participants (n = 496) completed the Five-Factor Schizoid Inventory (FFZI) and other self-report measures. The first half of the sample was used to develop the FFZI, while the second half was used to validate it. The FFZI demonstrated excellent internal consistency, convergent validity with measures of SZD PD and hypothesized IPIP-NEO facets, and discriminant validity with other PDs and non-hypothesized IPIP-NEO facets. The second study recruited MTurk participants (n = 181) and demonstrated preliminary support for the reliability and validity of the FFZI in an online, community sample. Ultimately, these data suggest that the FFZI is a useful measure of SZD PD and provide further evidence that SZD PD can be conceptualized as a maladaptive extension of introversion traits.

Maternal Adverse Childhood Experiences and Perceived Stress During Pregnancy: The Role of Personality.

This study explores the role of personality traits in the relationship between maternal adverse childhood experiences (ACEs) and perceived stress during pregnancy. Pregnancy can be a stressful time for new mothers. ACEs have been associated with elevated levels of pregnancy stress, and have also been linked to the Big Five dimensions of personality, including a positive association with neuroticism. The Big Five have also been associated with perceptions of stress, and there is evidence to suggest that personality may be one mechanism through which ACEs disrupt psychosocial functioning during pregnancy. The sample included 177 pregnant girls and women (ages 15-40) from two prenatal clinics serving diverse and low-income patients. Participants completed online questionnaires on perceived stress, ACEs, and the Ten Item Personality Inventory. Results of a path analysis and test of mediation showed significant indirect effects from ACEs to perceived stress mediated independently by neuroticism and conscientiousness. Mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, experienced high levels of perceived stress during pregnancy. High neuroticism and low conscientiousness associated with early adverse experiences increase the risk for perceived stress during pregnancy. Screening for ACEs may help identify mothers at risk for perinatal stress and provide the opportunity for additional support for maternal emotion regulation and mental health.

What is already known on this subject?Research has shown that experiencing adversity during childhood is associated with higher levels of stress during pregnancy. Early life adversity has also been associated with all Big Five personality traits and personality has been implicated as an important factor contributing to psychosocial functioning and well-being.What this study adds?Findings from the current study indicated that experiences of childhood adversity were associated with perceived stress during pregnancy, with significant indirect effects through the personality dimensions of neuroticism and conscientiousness. That is, mothers with high ACEs reported higher neuroticism and lower conscientiousness, and in turn, reported experiencing high levels of perceived stress during pregnancy.

Clinical utility of the Five-Factor Model of personality disorder.

There exists a great deal of research regarding the validity of the Five-Factor Model (FFM) of personality disorder. One of the most common objections to this model is concern regarding clinical utility. This article discusses clinical utility in terms of three fundamental components (i.e., ease of usage, communication, and treatment). In addition, a considerable number of recent empirical studies have examined whether the FFM compares well to personality disorder diagnostic categories with respect to all three components of clinical utility. The purpose of the current article is to provide a description of the implications of each component of clinical utility as it relates to the FFM and to acknowledge and address the empirical findings.

Five-factor measure of borderline personality traits.

This study provides psychometric data for a new self-report measure of borderline personality traits from the perspective of the Five-factor model (FFM) of general personality. Subscales were constructed in an undergraduate sample (n = 109) to assess maladaptive variants of 12 FFM traits (e.g., Affective Dysregulation as a maladaptive variant of FFM Vulnerability). On the basis of data from a second undergraduate sample (n = 111), the Five Factor Borderline Inventory (FFBI) subscales were shown to have good internal consistency, convergent, discriminant, and incremental validity. These psychometric results were replicated in a clinical sample of female residents at a substance abuse treatment facility (n = 94).

Development of Measures for the Hierarchical Taxonomy of Psychopathology (HiTOP): A Collaborative Scale Development Project.

In this article, we describe the collaborative process that is underway to develop measures for the Hierarchical Taxonomy of Psychopathology (HiTOP). The HiTOP model has generated much interest in the psychiatric literature in recent years, but research applications and clinical translation of the model require measures that are specifically keyed to the model. To that end, the Measures Development Workgroup of HiTOP has been engaged in a collaborative effort to develop both questionnaire and interview methods that (a) are specifically tied to the elements of the HiTOP structure, and (b) provide one means of testing that structure. The work has been divided among five subgroups that are focused on specific HiTOP spectra. Our scale development methods are rooted in the principles of construct valid scale development. This report describes Phase 1 of this project, summarizes the methods and results thus far, and discusses the interplay between measurement and HiTOP model revisions. Finally, we discuss future phases of the scale development and the steps we are taking to improve clinical utility of the final measures.

HiTOP Assessment of Externalizing Antagonism and Disinhibition.

This article outlines the Phase 1 efforts of the HiTOP Measure Development group for externalizing constructs, which include disinhibited externalizing, antagonistic externalizing, attention deficit hyperactivity disorder, substance use, and externalizing/maladaptive behaviors. We provide background on the constructs included and the process and issues involved in developing a measure for this diverse range of psychopathology symptoms, traits, and behaviors.

Catastrophizing, negative affectivity, and borderline personality disorder.

The core features of borderline personality disorder (BPD) include problematic interpersonal relationships, behavioral and affective dysregulation, identity problems, and cognitive dysregulation. Cognitive dysregulation, such as catastrophizing, rumination, and thought suppression, contributes to emotion dysregulation in BPD. Previous research suggested that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD symptoms. We predicted that catastrophizing similarly will serve as a mediator between negative affect intensity/reactivity and BPD symptoms. Two samples completed the study. First, students (N = 191) self-selected to participate in an online study through the university psychology research recruitment system. Additionally, a second sample using Amazon Mechanical Turk (MTurk; N = 172) was utilized. Catastrophizing partially mediated the relationship between negative affect intensity/reactivity and BPD symptoms. Across these samples, results suggest that catastrophizing may have a significant role in understanding BPD symptoms, which is similar with rumination. Limitations and future directions are also discussed.

The Development of the Informant Five-Factor Borderline Inventory.

Borderline personality disorder (BPD) is one of the most studied personality disorders and is associated with significant outcomes such as suicide. Although BPD is represented in DSM-5 as a categorical diagnosis, it may be better characterized dimensionally, such as from the perspective of the five-factor model of general personality (FFM). The Five-Factor Borderline Inventory (FFBI) assesses BPD from the perspective of maladaptive variants of FFM traits. Previous research suggests that informant-reports may increase the validity of personality disorder assessment, providing additional information that may supplement self-report. Therefore, the current study developed an informant measure of the FFBI, Informant Five-Factor Borderline Inventory (IFFBI) and examined its convergent and discriminant validity compared with the self-report FFBI, FFM, and traditional measure of BPD. Overall, the IFFBI demonstrated good convergent validity and moderate discriminant validity with the FFBI, FFM, and other traditional measures of BPD.

Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda.

Despite the emphasis on evidence-based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM-5 Section 2. This is perhaps not surprising given the complex heterogeneity and co-morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.

Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology.

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Five-factor model of personality disorder: a proposal for DSM-V.

The predominant dimensional model of general personality structure within psychology is the five-factor model (FFM). Research indicates that the personality disorders of the American Psychiatric Association's diagnostic manual can be understood as maladaptive variants of the domains and facets of the FFM. The current review provides a proposal for the classification of personality disorder from the perspective of the FFM. Discussed as well are implications and issues associated with an FFM of personality disorder, including the integration of a psychiatric nomenclature with general personality structure, the inclusion of a domain of openness to experience, the identification of problems in living associated with maladaptive personality traits, the setting of a diagnostic threshold, prototypal matching, feasibility, and clinical utility.

Clinical utility and DSM-V.

The construction of the American Psychiatric Association's diagnostic manual has been guided primarily by concerns of construct validity rather than of clinical utility, despite claims by its authors that the highest priority has in fact been clinical utility. The purpose of this article was to further articulate the concept and importance of utility when constructing and evaluating a diagnostic construct. It is suggested that a relative emphasis on validity over utility is justifiable but that matters of clinical utility should not be neglected. Discussed in particular is ease of usage, communication, and treatment planning. Suggestions for future research are provided.