Understanding the association between normal and maladaptive personality traits: Replication and extension of Morey et al. (2020).

BACKGROUND/OBJECTIVE: The Alternative Model for Personality Disorders (AMPD) within the DSM-5 includes separable components representing general personality dysfunction (Criterion A) and maladaptive personality traits (Criterion B). Some critique Criterion A for accounting for little incremental variance in PD beyond Criterion B. However, Morey et al. (2020) hypothesized that personality dysfunction is a key mechanism through which normal-range traits account for the maladaptive component of personality traits, justifying its inclusion. We sought to replicate and extend this work in a psychiatric sample with mixed methods. METHOD: In total, 152 participants recruited from mental health clinics completed multiple measures of personality dysfunction and normal-range and maladaptive traits. RESULTS: Replication was only partially achieved. The degree of incremental prediction of maladaptive traits and the extent to which personality dysfunction explained the relations between normal-range and maladaptive traits varied significantly across traits, and those effects that reached significance were small in magnitude. Removing variance due to personality dysfunction reduced intercorrelations among maladaptive traits by only a small amount. CONCLUSION: Counter to Morey et al. (2020), our results failed to support maladaptive traits as composites of normal-range traits and personality dysfunction, suggesting that other methods of distinguishing personality pathology severity and style are needed.

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.

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.

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.

Personalized models of personality disorders: using a temporal network method to understand symptomatology and daily functioning in a clinical sample.

BACKGROUND: An ongoing challenge in understanding and treating personality disorders (PDs) is a significant heterogeneity in disorder expression, stemming from variability in underlying dynamic processes. These processes are commonly discussed in clinical settings, but are rarely empirically studied due to their personalized, temporal nature. The goal of the current study was to combine intensive longitudinal data collection with person-specific temporal network models to produce individualized symptom-level structures of personality pathology. These structures were then linked to traditional PD diagnoses and stress (to index daily functioning). METHODS: Using about 100 daily assessments of internalizing and externalizing domains underlying PDs (i.e. negative affect, detachment, impulsivity, hostility), a temporal network mapping approach (i.e. group iterative multiple model estimation) was used to create person-specific networks of the temporal relations among domains for 91 individuals (62.6% female) with a PD. Network characteristics were then associated with traditional PD symptomatology (controlling for mean domain levels) and with daily variation in clinically-relevant phenomena (i.e. stress). RESULTS: Features of the person-specific networks predicted paranoid, borderline, narcissistic, and obsessive-PD symptom counts above average levels of the domains, in ways that align with clinical conceptualizations. They also predicted between-person variation in stress across days. CONCLUSIONS: Relations among behavioral domains thought to underlie heterogeneity in PDs were indeed associated with traditional diagnostic constructs and with daily functioning (i.e. stress) in person-specific networks. Findings highlight the importance of leveraging data and models that capture person-specific, dynamic processes, and suggest that person-specific networks may have implications for precision medicine.

Withdrawal Symptom, Treatment Mechanism, and/or Side Effect? Developing an Explicit Measurement Model for Smoking Cessation Research.

INTRODUCTION: Assessment of withdrawal symptoms, treatment mechanisms, and side effects is central to understanding and improving smoking cessation interventions. Though each domain is typically assessed separately with widely used questionnaires to separately assess each domain (eg, Minnesota Nicotine Withdrawal Scale = withdrawal; Questionnaire of Smoking Urges-Brief = craving; Positive and Negative Affect Schedule = affect; symptom checklist = side effects), there are substantial problems with this implicit "one questionnaire equals one construct" measurement model, including item overlap across questionnaires. This study sought to clarify the number and nature of constructs assessed during smoking cessation by developing an explicit measurement model. METHODS: Two subsamples were randomly created from 1246 smokers in a clinical trial. Exploratory and confirmatory factor analyses were conducted to identify and select a model that best represented the data. Measurement invariance was assessed to determine if the factors and their content were consistent prior to and during the quit. Improvement in construct overlap within this model was compared against the implicit measurement model using correlational analyses. RESULTS: A 5-factor measurement model composed of negative affect, somatic symptoms, sleep problems, positive affect, and craving fits the data well prior to and during quitting. All factor content except somatic symptoms was consistent over time. Correlational analyses indicated that the 5-factor model attenuated construct overlap compared to the implicit model. CONCLUSIONS: The models generated from data-driven approaches (eg, the 5-factor model) reduced overlap and better represented the constructs underlying these measures. This approach created distinct, stable constructs that span over measures of side effects and potential treatment mechanisms. IMPLICATIONS: This study demonstrated that measures assessing treatment mechanisms, withdrawal symptoms, and side effects contain problematic overlap that reduces the clarity of these key constructs. The use of data-driven approaches showed that these measures do not map on to their posited latent constructs (eg, the Minnesota Nicotine Withdrawal Scale does not yield a withdrawal factor). Rather, these measures form distinct, basic processes that may represent more meaningful constructs for future research on cessation and treatment. Assessments designed to individually examine these processes may improve the study of treatment mechanisms.

Personality traits and maladaptivity: Unipolarity versus bipolarity.

OBJECTIVE: Dimensional personality trait models have gained favor as an alternative to categorical personality disorder (PD) diagnosis; however, debate persists regarding whether these traits should be conceptualized as maladaptive at both extremes (i.e., maladaptively bipolar) or just one trait pole (i.e., unipolar). METHOD: To inform the debate on maladaptive bipolarity, linear and nonlinear relations between personality traits and dysfunction were examined in a large psychiatric patient sample (N = 365). Participants self-reported on normal-range and pathological personality domains, life satisfaction, specific interpersonal problems, and broad psychosocial functioning. In addition, participants were interviewed regarding specific psychiatric symptoms and broad psychosocial functioning. RESULTS: All traits related moderately to strongly with at least one dysfunction variable. All traits were predominantly correlated with dysfunction at one pole; however, several small linear relations provided some evidence for maladaptively high Extraversion and Agreeableness. None of the significant nonlinear effects provided clear evidence for maladaptivity at both ends of any trait. CONCLUSIONS: Taken together, these results suggest that broad personality traits are predominantly maladaptive at one extreme; however, in limited cases, the opposite extreme may also be maladaptive.

Clarifying the Links of Conscientiousness With Internalizing and Externalizing Psychopathology.

OBJECTIVE: Although Conscientiousness/disinhibition plays a substantial role in internalizing and externalizing psychopathology, the underlying mechanisms are not well understood. We aim to clarify facet-level associations and to examine whether (a) impairment mediates the link of Conscientiousness with internalizing and externalizing symptoms, and (b) demoralization (assessed via Neuroticism) accounts for their associations. METHOD: A total of 450 participants (Mage = 42; primarily female and Caucasian) who reported current/recent psychiatric treatment completed two measures of domain- and facet-level traits (i.e., NEO-PI-3, PID-5), as well as interview measures of impairment and disorders. Correlation, regression, and mediation analyses were conducted. RESULTS: Internalizing disorders (and particularly, the distress disorders) were uniquely associated with facets related to low self-efficacy, whereas externalizing disorders were uniquely associated with risk-taking and disregarding rules. For the internalizing disorders only, these associations were reduced after accounting for Neuroticism, though associations with distress disorders remained significant. Impairment mediated the link between Conscientiousness and symptoms for internalizing disorders, but not consistently for externalizing disorders. CONCLUSIONS: The internalizing and externalizing disorders are associated with Conscientiousness due to different facet-level content. Demoralization and impairment both contribute to the link between internalizing disorders and Conscientiousness, whereas neither process accounts substantially for the relation of externalizing disorders with Conscientiousness.

How soon they forget: changes to beliefs after learning about tobacco.

University students' beliefs about tobacco and nicotine were assessed before an educational intervention aimed at correcting tobacco-related misinformation. Beliefs were again measured immediately after the intervention, and then again after a 2-, 4-, 6-, or 8-week retention interval. Initially, participants showed significantly more accurate beliefs about tobacco than pre-intervention, but this improvement decreased after the retention interval. Results suggest that methods currently used in an attempt to alleviate tobacco misinformation in the public may be effective for short-term, but not long-term retention. The current study accents the need to design tobacco programs that optimize retention of belief change so that people may use that knowledge confidently in future health-related decisions.

Do self and interpersonal dysfunction cross-sectionally mediate the association between adverse childhood experiences and personality pathology?

Two primary limitations of research on the association between adverse childhood experiences (ACEs) and personality disorder (PD) are (1) failure to consider mechanisms of association and (2) inconsistent results due, in part, to inconsistent approaches to quantifying ACE exposure. The current study will address these limitations by examining the cross-sectional mediating role of self- and interpersonal dysfunction on the association between ACE and three PDs (antisocial, schizotypal, and borderline) using three quantifications of ACE exposure (cumulative, individual, and unique risk). Participants were 149 current or recent psychiatric patients, and data analyses were performed through estimation of a series of cross-sectional mediation models. Taken together, results suggest that (1) the association between ACE and PD is moderate, (2) self- and interpersonal dysfunction cross-sectionally mediate this association, (3) after accounting for variance shared among ACEs, associations between specific ACE subtypes and PD were negligible, (4) much of the association between ACE and PD is accounted for by general processes impacted by all forms of ACE and implicated in all forms of PD, and (5) emotional neglect may uniquely contribute to self- and interpersonal dysfunction and thereby, PD risk.

Developing and Validating a Facial Emotion Recognition Task With Graded Intensity.

Facial emotion recognition (FER) tasks are often digitally altered to vary expression intensity; however, such tasks have unknown psychometric properties. In these studies, an FER task was developed and validated-the Graded Emotional Face Task (GEFT)-which provided an opportunity to examine the psychometric properties of such tasks. Facial expressions were altered to produce five intensity levels for six emotions (e.g., 40% anger). In Study 1, 224 undergraduates viewed subsets of these faces and labeled the expressions. An item selection algorithm was used to maximize internal consistency and balance gender and ethnicity. In Study 2, 219 undergraduates completed the final GEFT and a multimethod battery of validity measures. Finally, in Study 3, 407 undergraduates oversampled for borderline personality disorder (BPD) completed the GEFT and a self-report BPD measure. Broad FER scales (e.g., overall anger) demonstrated evidence of reliability and validity; however, more specific subscales (e.g., 40% anger) had more variable psychometric properties. Notably, ceiling/floor effects appeared to decrease both internal consistency and limit external validity correlations. The findings are discussed from the perspective of measurement issues in the social cognition literature.

Structure of Pathological Personality Traits Through the Lens of the CAT-PD Model.

Personality pathology is increasingly conceptualized within hierarchical, dimensional trait models. The Comprehensive Assessment of Traits Relevant to Personality Disorders (CAT-PD) is a pathological-trait measure with potential to improve on currently prevailing instruments because it has wider content coverage; however, its domain-level structure, which is of scientific and clinical interest, is not established. In this study, we investigated the structure and construct validity of the CAT-PD's domain level to facilitate wider use of the measure. We estimated five- and six-factor models with exploratory factor analysis in a pooled sample of eight independent subsamples (N = 3,987) and found that both models fit the data well; each had interpretable factors that were invariant across gender, sample type, and Black/White racial groups; and the factors had good convergent validity with other measures of maladaptive traits, Big Five personality, and interpersonal problems. Our results support the validity of the CAT-PD for assessing multiple levels of the pathological trait hierarchy.

Age and gender differences in narcissism: A comprehensive study across eight measures and over 250,000 participants.

Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and psychometric evaluation of the Multidimensional Assessment of Social Anxiety (MASA).

OBJECTIVE: Hybrid models of psychopathology propose to combine the current categorical diagnostic system with shared symptom dimensions common across various disorders. Recently, the first empirically derived hybrid model of social anxiety was developed, including both a specific factor for the diagnostic category of social anxiety and 5 nonspecific factors for related symptoms. The present investigation developed a self-report measure-the Multidimensional Assessment of Social Anxiety (MASA)-based on this model to further the research on hybrid models. METHOD: This investigation included three studies across large undergraduate (N = 411; 52.3% male; mean [M] age = 19.6) and clinical (N = 684; 61.4% female; M age = 35.8) samples, involving the administration of the MASA item pool and existing measures of related constructs. RESULTS: Through a series of psychometric evaluations, the initial 466-item pool was reduced to a final 38-item measure that represented 6 distinct scales with adequate model fit, internal consistency, test-retest reliability, and convergent and discriminant validity. CONCLUSIONS: Together, these studies likely will lead to additional research and advances in the development of the hybrid models of the mood and anxiety disorders through the dissemination and administration of the MASA.

Construct validation of narrative coherence: Exploring links with personality functioning and psychopathology.

Narrative coherence serves as an index of the unity in an individual's sense of self-integrating their past self with their present self and allowing them to pursue meaningful goals for their future. It has been assessed using the Life Story Interview. Personality functioning is used to describe an individual's ability to develop stable and integrated representations of the self and others as well as their ability to develop and maintain stable, intimate, and affiliative relationships and meaningfully empathize with others. We studied the links between narrative coherence (based on Life Story Interviews) and personality functioning (as indexed by clinician ratings using the Levels of Personality Functioning Scale) in a psychiatric sample (N = 134) and more generally studied the nomological net surrounding narrative coherence. Contrary to predictions, results revealed that narrative coherence does not serve as a marker of personality functioning. However, we found evidence of an association between narrative coherence and measures of extraversion and psychosocial functioning. This study represents an important step in integrating narrative identity with empirically derived structural models of personality pathology and psychopathology. Implications for future research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Friend Overprotection in Emerging Adulthood: Associations with Autonomy Support and Psychosocial Adjustment.

Overprotection is a known risk factor in parent-child relationships, but has received little attention in the context of friendships. No studies have examined overprotection in emerging-adult friendships. Yet, overprotection may be especially significant during this developmental period given the prevalence of autonomy-seeking and risk-taking behaviors. In this study, we thus investigated whether overprotection is a feature of emerging-adult friendships that is meaningfully associated with psychosocial adjustment. We also examined whether friend autonomy support is one mechanism by which friend overprotection impacts outcomes. University students (N = 363) completed a new self-report measure of friend overprotection developed for this study, and previously validated measures of relationship qualities (friendship quality, helicopter parenting) and internalizing symptoms (social anxiety, depression). We found initial support for the reliability and validity of the new friend overprotection measure. A path analysis revealed positive associations between friend overprotection and friendship quality and internalizing symptoms, with friend autonomy support as an explanatory mechanism of these associations. Findings are novel as they suggest that overprotection is a salient feature of many friendships during emerging adulthood that may impact psychosocial adjustment in both helpful and harmful ways.

Classification and assessment of fear and anxiety in personality and psychopathology.

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

Normative data for PID-5 domains, facets, and personality disorder composites from a representative sample and comparison to community and clinical samples.

The introduction of the alternative model of personality disorders in the fifth edition of the Diagnostic and Statistical Model of Mental Disorders (American Psychiatric Association, 2013) represented a substantive change in how personality disorders (PDs) are diagnosed. One barrier to its adoption (among several) in clinical practice, however, is a lack of information as to what constitutes an elevated score on the 25 domains and facets that comprise Criterion B. Unique sets of facets can be configured to assess any 1 of 6 PDs retained in the alternative model of personality disorders; each of these facets can in turn be added to create a PD sum score. In the current study, using the Personality Inventory for Diagnostic and Statistical Model of Mental Disorders, Fifth Edition (Krueger et al., 2012), we report mean scores using this instrument that align with 1.0, 1.5, and 2.0 SD elevations for the 25 facets, five domains, and six PD composites on the basis of Krueger and colleagues' (2012) representative sample and compare these with those obtained from a community and a clinical sample. These normative data may be useful to clinicians in determining whether a client has elevated scores on pathological personality domains, facets, or PDs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

Role of pregaming motives in accounting for links between maladaptive personality traits and drinking consequences.

College students are at heightened risk of engaging in unhealthy alcohol use that leads to negative consequences (e.g., motor vehicle accidents, poor academic performance). Understanding how individual differences, such as maladaptive personality traits, contribute to that risk could improve intervention efforts. A potential pathway through which personality confers risk for consequences is by influencing students' motivation to drink. In this study of 441 college students, we investigated whether different motivations to pregame, a particularly risky and common drinking practice on college campuses, accounts for links between maladaptive traits and alcohol-related consequences. Results of bivariate analyses showed that all pregaming motives and maladaptive traits (except detachment) were strongly correlated with negative consequences. In path analytic models that adjusted for shared variance between pregaming motives and between maladaptive traits, results showed that traits had indirect effects on total drinking consequences via individual differences in pregaming motives as well as direct effects that were independent of motives. Specifically, antagonism, disinhibition, and negative affectivity predicted more drinking consequences via stronger motives to pregame for instrumental reasons over and above the general motivation to pregame, whereas detachment predicted fewer consequences via weaker instrumental pregaming motives. Antagonism and disinhibition were also associated with more drinking consequences, and detachment with fewer consequences, over and above pregaming motives and general personality problems. Our study indicates that one way maladaptive personality traits may shape alcohol-related consequences in college students is by associations with their motivations to pregame. (PsycInfo Database Record (c) 2022 APA, all rights reserved).