Is it time to discard the Diagnostic and Statistical Manual of Mental Disorders (DSM) in psycho-oncology?

The conceptual basis of psychopathology within cancer survivorship is critical, as the chosen conceptualisation informs assessment and explanatory models, as well as interventions and supportive care approaches. The validity of a chosen conceptualisation of psychopathology is therefore paramount for ensuring cancer survivors receive high-quality and efficacious care and support that can be iteratively improved via coordinated research efforts. In this paper, we discuss the traditional diagnostic approach to conceptualising psychopathology within cancer care, including the diagnostic system the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) [1], and the significant issues it presents within cancer survivorship. We detail and discuss how an alternate conceptualisation of psychopathology may enhance both research and practice within psycho-oncology. We ultimately pose, and provide our perspective, on the question "Is it Time to Discard the DSM in Psycho-Oncology?"

Development and validation of the Acquiring and Saving Motives Questionnaires: For use in clinical and nonclinical populations.

Our consumer-driven culture has negative impacts for individuals who are vulnerable to clinical hoarding and compulsive shopping. Because of this, there is an ever-present need to have standardized tools to assess why we acquire and save things we might not need. In this article, we present the development of the Acquiring Motives Questionnaire (AMQ) and Saving Motives Questionnaire (SMQ), which were written based on a thorough literature review and consultation with 22 experts in the field. After piloting with two large nonclinical samples, we administered the measures to another large nonclinical sample (N = 535; Mage = 24.4, 74.2% female, 54.6% White) and then a community sample of individuals with hoarding disorder and/or compulsive buying-shopping disorder and controls without any mental health diagnoses (N = 159; Mage = 42.54, 85.5% female, 59.7% White). Confirmatory factor analyses supported a 14-factor model for the AMQ and a 14-factor model for the SMQ. All subscales demonstrated good internal consistency (ω = 0.81-0.96), 2-week test-retest reliability (intraclass correlation coefficient = 0.67-0.83), and convergent, divergent, and criterion validity. The measures also distinguished between controls and individuals with hoarding and/or compulsive buying diagnoses. Findings highlight that acquiring and saving behaviors are both motivated by the pursuit of positive emotions and the avoidance of negative emotions, which is consistent with our theoretical understanding of these clinical issues. Based on our findings, we make suggestions for psychological interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Structure of psychopathology in adolescents and its association with high-risk personality traits.

The present study examined high-risk personality traits and associations with psychopathology across multiple levels of a hierarchical-dimensional model of psychopathology in a large adolescent, general population sample. Confirmatory factor analyses were run using data from two randomized controlled trials of Australian adolescents (N = 8,654, mean age = 13.01 years, 52% female). A higher-order model - comprised of general psychopathology, fear, distress, alcohol use/harms, and conduct/inattention dimensions - was selected based on model fit, reliability, and replicability. Indirect-effects models were estimated to examine the unique associations between high-risk personality traits (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) and general and specific dimensions and symptoms of psychopathology. All personality traits were positively associated with general psychopathology. After accounting for general psychopathology, anxiety sensitivity was positively associated with fear; negative thinking was positively associated with distress; impulsivity was positively associated with conduct/inattention; and sensation seeking was positively associated with alcohol use/harms and conduct/inattention, and negatively associated with fear. Several significant associations between personality traits and individual symptoms remained after accounting for general and specific psychopathology. These findings contribute to our understanding of the underlying structure of psychopathology among adolescents and have implications for the development of personality-based prevention and early intervention programs.

Principles and procedures for revising the hierarchical taxonomy of psychopathology.

Quantitative, empirical approaches to establishing the structure of psychopathology hold promise to improve on traditional psychiatric classification systems. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a framework that summarizes the substantial and growing body of quantitative evidence on the structure of psychopathology. To achieve its aims, HiTOP must incorporate emerging research in a systematic, ongoing fashion. In this article, we describe the historical context and grounding of the principles and procedures for revising the HiTOP framework. Informed by strengths and shortcomings of previous classification systems, the proposed revisions protocol is a formalized system focused around three pillars: (a) prioritizing systematic evaluation of quantitative evidence by a set of transparent criteria and processes, (b) balancing stability with flexibility, and (c) promoting inclusion over gatekeeping in all aspects of the process. We detail how the revisions protocol will be applied in practice, including the scientific and administrative aspects of the process. Additionally, we describe areas of the HiTOP structure that will be a focus of early revisions and outline challenges for the revisions protocol moving forward. The proposed revisions protocol is designed to ensure that the HiTOP framework reflects the current state of scientific knowledge on the structure of psychopathology and fulfils its potential to advance clinical research and practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Studying fine-grained elements of psychopathology to advance mental health science.

Given the now well-recognized limitations of traditional classification systems for research, this editorial proposes to advance mental health science by focusing research efforts on studying fine-grained elements of mental health and illness such as symptoms, mechanisms, and processes. Our own perspectives are informed by three approaches in particular that have gained traction over the last decade: the Hierarchical Taxonomy of Psychopathology, the network or systems approach, and the National Institute of Mental Health Research Domain Criteria. Drawing on these and other perspectives as well as the diverse views of the author teams that contributed to this Special Section, we summarize the state of the field and propose an ambitious plan for the way ahead. Specifically, we propose that embracing pluralistic, multimethod, and multisystem approaches offers a way forward. This will require strategies to reduce research waste and much stronger channels for communication to identify confluence, discoveries, and dead ends within and between disciplines. We are optimistic this will lead to a better understanding of the mechanisms underpinning psychopathology and ultimately to more effective interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Elemental psychopathology: distilling constituent symptoms and patterns of repetition in the diagnostic criteria of the DSM-5.

BACKGROUND: The DSM-5 features hundreds of diagnoses comprising a multitude of symptoms, and there is considerable repetition in the symptoms among diagnoses. This repetition undermines what we can learn from studying individual diagnostic constructs because it can obscure both disorder- and symptom-specific signals. However, these lost opportunities are currently veiled because symptom repetition in the DSM-5 has not been quantified. METHOD: This descriptive study mapped the repetition among the 1419 symptoms described in 202 diagnoses of adult psychopathology in section II of the DSM-5. Over a million possible symptom comparisons needed to be conducted, for which we used both qualitative content coding and natural language processing. RESULTS: In total, we identified 628 distinct symptoms: 397 symptoms (63.2%) were unique to a single diagnosis, whereas 231 symptoms (36.8%) repeated across multiple diagnoses a total of 1022 times (median 3 times per symptom; range 2-22). Some chapters had more repetition than others: For example, every symptom of every diagnosis in the bipolar and related disorders chapter was repeated in other chapters, but there was no repetition for any symptoms of any diagnoses in the elimination disorders, gender dysphoria or paraphilic disorders. The most frequently repeated symptoms included insomnia, difficulty concentrating, and irritability - listed in 22, 17 and 16 diagnoses, respectively. Notably, the top 15 most frequently repeating diagnostic criteria were dominated by symptoms of major depressive disorder. CONCLUSION: Overall, our findings lay the foundation for a better understanding of the extent and potential consequences of symptom overlap.

Improving hierarchical models of individual differences: An extension of Goldberg's bass-ackward method.

Goldberg's (2006) bass-ackward approach to elucidating the hierarchical structure of individual differences data has been used widely to improve our understanding of the relationships among constructs of varying levels of granularity. The traditional approach has been to extract a single component or factor on the first level of the hierarchy, two on the second level, and so on, treating the correlations between adjoining levels akin to path coefficients in a hierarchical structure. This article proposes three modifications to the traditional approach with a particular focus on examining associations among all levels of the hierarchy: (a) identify and remove redundant elements that perpetuate through multiple levels of the hierarchy; (b) (optionally) identify and remove artefactual elements; and (c) plot the strongest correlations among the remaining elements to identify their hierarchical associations. Together these steps can offer a simpler and more complete picture of the underlying hierarchical structure among a set of observed variables. The rationale for each step is described, illustrated in a hypothetical example and three basic simulations, and then applied in real data. The results are compared with the traditional bass-ackward approach together with agglomerative hierarchical cluster analysis, and a basic tutorial with code is provided to apply the extended bass-ackward approach in other data. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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).

Assessing Functional Impairment in Youth: Development of the Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I).

This study described the psychometric properties of a self-report measure of functional impairment related to anxiety and depression in adolescents, the Adolescent Life Interference Scale for Internalizing symptoms (ALIS-I). A clinical sample of 266 adolescents and a community sample of 63 adolescents, aged 11 to 18 years (Mean = 14.7, SD = 1.71) completed the ALIS-I and additional measures assessing internalizing problems. Exploratory factor analyses indicated four distinct but correlated factors of life interference related to personal withdrawal/avoidance, peer problems, problems with study/work, and somatic symptoms. Reliability and retest reliability (8-12 weeks) of the total score were high and psychometric properties of the subscales were acceptable. The ALIS-I effectively discriminated between clinical and community control groups, and expected correlations were shown between ALIS-I subscales and other related symptom measures. The ALIS-I is a promising instrument for the assessment of functional impairment related to internalizing disorders in youth.

Difficulties with emotion regulation and weight/shape concerns as predictors of eating disorder behaviors among adolescents.

BACKGROUND: Difficulties with emotion regulation are a proposed key transdiagnostic factor of mental health difficulties, including eating disorders. However, it remains unclear whether difficulties with emotion regulation prospectively predict engagement in eating disorder behaviors. The current study examined whether difficulties with emotion regulation were associated with eating disorder behaviors after 1 year, in addition to weight and shape concerns. METHOD: A community sample of high school students (n = 3,074; 53.2% girls) completed self-report measures of eating behaviors, weight/shape concerns, and difficulties with emotion regulation at two timepoints, 1 year apart. RESULTS: Findings indicated that greater difficulties with emotion regulation were uniquely associated with engaging in binge eating, fasting, and purging after 1 year. However, only greater weight and shape concerns, not difficulties with emotion regulation, were uniquely associated with engaging in driven exercise. Limited associations were detected for the frequency of eating disorder behaviors. Additionally, exploratory analyses were conducted to examine potential onset and persistence of eating disorder behaviors. Few gender differences were observed across analyses, with the exception of driven exercise, which was linked to difficulties with emotion regulation only among adolescent boys, but not girls. CONCLUSIONS: Findings suggest that difficulties with emotion regulation are a distinct factor in the occurrence of some eating disorder behaviors among adolescents. Exploratory findings further suggest that difficulties with emotion regulation appear to be particularly involved in the persistence of these behaviors in adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Meta-analysis of structural evidence for the Hierarchical Taxonomy of Psychopathology (HiTOP) model.

BACKGROUND: The Hierarchical Taxonomy of Psychopathology (HiTOP) is a classification system that seeks to organize psychopathology using quantitative evidence - yet the current model was established by narrative review. This meta-analysis provides a quantitative synthesis of literature on transdiagnostic dimensions of psychopathology to evaluate the validity of the HiTOP framework. METHODS: Published studies estimating factor-analytic models from diagnostic and statistical manual of mental disorders (DSM) diagnoses were screened. A total of 120,596 participants from 35 studies assessing 23 DSM diagnoses were included in the meta-analytic models. Data were pooled into a meta-analytic correlation matrix using a random effects model. Exploratory factor analyses were conducted using the pooled correlation matrix. A hierarchical structure was estimated by extracting one to five factors representing levels of the HiTOP framework, then calculating congruence coefficients between factors at sequential levels. RESULTS: Five transdiagnostic dimensions fit the DSM diagnoses well (comparative fit index = 0.92, root mean square error of approximation = 0.07, and standardized root-mean-square residual = 0.03). Most diagnoses had factor loadings >|0.30| on the expected factors, and congruence coefficients between factors indicated a hierarchical structure consistent with the HiTOP framework. CONCLUSIONS: A model closely resembling the HiTOP framework fit the data well and placement of DSM diagnoses within transdiagnostic dimensions were largely confirmed, supporting it as valid structure for conceptualizing and organizing psychopathology. Results also suggest transdiagnostic research should (1) use traits, narrow symptoms, and dimensional measures of psychopathology instead of DSM diagnoses, (2) assess a broader array of constructs, and (3) increase focus on understudied pathologies.

Do We Need a Novel Framework for Classifying Psychopathology? A Discussion Paper.

Introduction: The ICD-11 and DSM-5 are the leading systems for the classification of mental disorders, and their relevance for clinical work and research, as well as their impact for policy making and legal questions, has increased considerably. In recent years, other frameworks have been proposed to supplement or even replace the ICD and the DSM, raising many questions regarding clinical utility, scientific relevance, and, at the core, how best to conceptualize mental disorders. Method: As examples of the new approaches that have emerged, here we introduce the Hierarchical Taxonomy of Psychopathology (HiTOP), the Research Domain Criteria (RDoC), systems and network approaches, process-based approaches, as well as a new approach to the classification of personality disorders. Results and Discussion: We highlight main distinctions between these classification frameworks, largely related to different priorities and goals, and discuss areas of overlap and potential compatibility. Synergies among these systems may provide promising new avenues for research and clinical practice.

Meta-analytic tests of measurement invariance of internalizing and externalizing psychopathology across common methodological characteristics.

Factor analytic models of common mental disorders have been hypothesized to be affected by various methodological features, which could undermine the assumption that Internalizing and Externalizing reflect part of the natural structure of psychopathology. In this study, we addressed this issue by testing whether and how methodological features affect the empirical structure of psychopathology using meta-analytic measurement invariance models of Internalizing and Externalizing across multiple sample characteristics. Published studies estimating factor analytic models from Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses were screened. A total of 47 samples (N = 118,966) were included in the meta-analysis. Data were pooled into meta-analytic correlation matrices using random effects models that accounted for sampling variability. Multigroup confirmatory factor analytic models of Internalizing and Externalizing were fit to the pooled matrix of DSM diagnoses to test invariance of the structure, factor loadings, and factor covariance. Results supported partial or full invariance across (a) samples selected versus not selected for psychopathology, (b) diagnoses defined by binary DSM thresholds versus dimensional symptoms counts, and (c) diagnoses based on lifetime versus current symptoms. Tentative analyses indicated noninvariance across samples that made diagnoses using hierarchical exclusion rules versus those that did not. Our study suggests that the Internalizing and Externalizing structure is largely robust to common methodological characteristics thought to impact factor analytic models. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Model fit is a fallible indicator of model quality in quantitative psychopathology research: A reply to Bader and Moshagen.

As evidenced by our exchange with Bader and Moshagen (2022), the degree to which model fit indices can and should be used for the purpose of model selection remains a contentious topic. Here, we make three core points. First, we discuss the common misconception about fit statistics' abilities to identify the "best model," arguing that mechanical application of model fit indices contributes to faulty inferences in the field of quantitative psychopathology. We illustrate the consequences of this practice through examples in the literature. Second, we highlight the parsimony-adjacent concept of fitting propensity, which is not accounted for by commonly used fit statistics. Finally, we present specific strategies to overcome interpretative bias and increase generalizability of study results and stress the importance of carefully balancing substantive and statistical criteria in model selection scenarios. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research.

The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.

Risk for social anxiety in early adolescence: Longitudinal impact of pubertal development, appearance comparisons, and peer connections.

OBJECTIVES: The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. METHODS: From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness; and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. RESULTS: Separate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. CONCLUSIONS: These results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety.

A Hierarchical Taxonomy of Psychopathology (HiTOP) Primer for Mental Health Researchers.

Mental health research is at an important crossroads as the field seeks more reliable and valid phenotypes to study. Dimensional approaches to quantifying mental illness operate outside the confines of traditional categorical diagnoses, and they are gaining traction as a way to advance research on the causes and consequences of mental illness. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a leading dimensional research paradigm that synthesizes decades of data on the major dimensions of psychological disorders. In this article, we demonstrate how to use the HiTOP model to formulate and test research questions through a series of tutorials. To boost accessibility, data and annotated code for each tutorial are included at OSF (https://osf.io/8myzw). After presenting the tutorials, we outline how investigators can use these ideas and tools to generate new insights in their own substantive research programs.

Eye-tracking to assess anxiety-related attentional biases among a large sample of preadolescent children.

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments.

Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial.

Importance: Elevated levels of blood perfluoroalkyl and polyfluoroalkyl substances (PFASs) have been associated with a range of adverse health outcomes. Firefighters have been exposed to PFASs in firefighting foams and have previously been shown to have higher PFAS levels in blood samples than the general population. No interventions have been shown to reduce PFAS levels. Objective: To examine the effect of blood or plasma donations on PFAS levels in firefighters in Australia. Design, Setting, and Participants: This 52-week, open-label, randomized clinical trial enrolled participants from May 23 to August 23, 2019. Participants were 285 Fire Rescue Victoria staff or contractors with serum levels of perfluorooctane sulfonate (PFOS) of 5 ng/mL or more who were eligible to donate blood, had not donated blood in the 3 months prior to randomization, and were able to provide written informed consent. Analysis was performed on an intention-to-treat basis from May to July 2021. Interventions: Firefighters with baseline PFOS levels of 5 ng/mL or more were randomly assigned to donate plasma every 6 weeks for 12 months, donate blood every 12 weeks for 12 months, or be observed only. Main Outcomes and Measures: The primary end points were changes in the serum PFOS and perfluorohexane sulfonic acid (PFHxS) levels after 12 months of plasma or blood donations or after observation only. Secondary end points included changes in serum PFAS levels from week 52 to week 64, changes in other PFASs, and changes in complete blood count, biochemistry, thyroid function, and lipid profile from screening to week 52. Results: A total of 285 firefighters (279 men [97.9%]; mean [SD] age, 53.0 [8.4] years) were enrolled; 95 were randomly assigned to donate plasma, 95 were randomly assigned to donate blood, and 95 were randomly assigned to be observed. The mean level of PFOS at 12 months was significantly reduced by plasma donation (-2.9 ng/mL; 95% CI, -3.6 to -2.3 ng/mL; P < .001) and blood donation (-1.1 ng/mL; 95% CI, -1.5 to -0.7 ng/mL; P < .001) but was unchanged in the observation group. The mean level of PFHxS was significantly reduced by plasma donation (-1.1 ng/mL; 95% CI, -1.6 to -0.7 ng/mL; P < .001), but no significant change was observed in the blood donation or observation groups. Analysis between groups indicated that plasma donation had a larger treatment effect than blood donation, but both were significantly more efficacious than observation in reducing PFAS levels. Conclusions and Relevance: Plasma and blood donations caused greater reductions in serum PFAS levels than observation alone over a 12-month period. Further research is needed to evaluate the clinical implications of these findings. Trial Registration: anzctr.org.au Identifier: ACTRN12619000204145.

Answering questions about the Hierarchical Taxonomy of Psychopathology (HiTOP): Analogies to whales and sharks miss the boat.

This commentary discusses questions and misconceptions about HiTOP raised by Haeffel et al. (2021). We explain what the system classifies and why it is descriptive and atheoretical, highlighting benefits and limitations of this approach. We clarify why the system is organized according to patterns of covariation or comorbidity among signs and symptoms of psychopathology, and we discuss how it is designed to be falsifiable and revised in a manner that is responsive to data. We refer to the body of evidence for HiTOP's external validity and for its scientific and clinical utility. We further describe how the system is currently used in clinics. In sum, many of Haeffel et al.'s concerns about HiTOP are unwarranted, and for those concerns that reflect real current limitations of HiTOP, our consortium is working to address them, with the aim of creating a nosology that is comprehensive and useful to both scientists and clinicians.