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).

Assessing dark triad dimensions from the perspective of moral disengagement and DSM-5 alternative model of personality disorder traits

The present study aimed to test the relationships of Dark Triad constructs with propensity toward moral disengagement and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Alternative Model of Personality Disorder (AMPD) maladaptive personality traits. A total of 279 community-dwelling adult participants (41.6% male; Mage = 32.27 years) were administered the Two-Dimensional Mach-IV Scale, Five-Factor Narcissism Inventory-Short Form, Triarchic Psychopathy Measure, Personality Inventory for DSM-5, and Moral Disengagement Scale. Multiple regression results showed differential associations between Dark Triad construct traits and propensity toward moral disengagement. Correlation analyses showed that all Dark Triad trait dimensions could be substantially described in terms of AMPD maladaptive trait profile. When the effect of Moral Disengagement Scale scores was taken into account in relative importance weights analysis (Radjusted2 = .66), DSM-5 AMPD maladaptive trait profile explained 27% of the variance in the "Dark Triad" latent factor over and above the effect of moral disengagement. As a whole, our findings supported the idea that the Dark Triad personality constructs are likely to share a common core of antagonistic maladaptive personality traits. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

DSM-5 personality domains as correlates of non-suicidal self-injury severity in an Italian sample of adolescent inpatients with self-destructive behaviour

To evaluate the associations between DSM-5 alternative model of personality disorder dysfunctional personality domains and the clinician's ratings of non-suicidal self-injury (NSSI) severity, a sample of consecutively admitted Italian adolescent inpatients (N = 100) were administered the Italian translations of the DSM-5 Clinician Rating Scale-NSSI (CRS-NSSI), the Personality Inventory for DSM-5 (PID-5), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II) and the Children's Depression Inventory (CDI). Bivariate association analyses showed that PID-5 negative affectivity scores and CDI total score were significantly associated with CRS-NSSI ratings. PID-5 negative affectivity score proved to be a significant predictor of the CRS-NSSI score even when the effect of the CDI total score was held constant. Our results highlighted that specific risk factors for NSSI severity may be identified even among NSSI adolescents. © 2019 John Wiley & Sons, Ltd.

Assessing the relationships between self-reports of childhood adverse experiences and DSM-5 alternative model of personality disorder traits and domains: A study on Italian community-dwelling adults

A body of research suggests that child maltreatment may not represent an uncommon phenomenon. Adverse childhood experiences have been consistently linked to a variety of mental disorders, including personality disorder. Starting from these considerations, we aimed at testing the associations between retrospective self-reports of childhood abuse and Personality Inventory for DSM-5 (PID-5) traits and domains in a sample of community-dwelling adult participants (N = 369; 41.2% male). PID-5 scales yielded 63 (52.5%) rank-order correlations with self-reports of childhood abuse that were significant at Bonferroni-corrected p level (i.e. p < 0.00042), with values ranging from 0.18 to 0.36. According to Fisher's z-test for correlation coefficient homogeneity, the wide majority of the correlations were reproduced across male participants and female participants. Partial rank-order correlation analyses highlighted specific personality profiles that were uniquely, albeit modestly associated with memories of childhood abuse. Confirming and extending previous findings, our results showed that retrospective reports of childhood abuse are significantly, albeit moderately associated with different dysfunctional personality traits, at least in Italian community-dwelling adults. As a whole, our data seemed to stress the importance of PID-5 traits and domains in improving our understanding of the relationships between self-reports of childhood abuse and dysfunctional personality dimensions in adulthood. © 2019 John Wiley & Sons, Ltd.

Are fit indices used to test psychopathology structure biased? A simulation study

Structural models of psychopathology provide dimensional alternatives to traditional categorical classification systems. Competing models, such as the bifactor and correlated factors models, are typically compared via statistical indices to assess how well each model fits the same data. However, simulation studies have found evidence for probifactor fit index bias in several psychological research domains. The present study sought to extend this research to models of psychopathology, wherein the bifactor model has received much attention, but its susceptibility to bias is not well characterized. We used Monte Carlo simulations to examine how various model misspecifications produced fit index bias for 2 commonly used estimators, WLSMV and MLR. We simulated binary indicators to represent psychiatric diagnoses and positively skewed continuous indicators to represent symptom counts. Across combinations of estimators, indicator distributions, and misspecifications, complex patterns of bias emerged, with fit indices more often than not failing to correctly identify the correlated factors model as the data-generating model. No fit index emerged as reliably unbiased across all misspecification scenarios. Although, tests of model equivalence indicated that in one instance fit indices were not biased-they favored the bifactor model, albeit not unfairly. Overall, results suggest that comparisons of bifactor models to alternatives using fit indices may be misleading and call into question the evidentiary meaning of previous studies that identified the bifactor model as superior based on fit. We highlight the importance of comparing models based on substantive interpretability and their utility for addressing study aims, the methodological significance of model equivalence, as well as the need for implementation of statistical metrics that evaluate model quality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The replicability of the personality inventory for DSM-5 domain scale factor structure in U.S. and non-U.S. samples: A quantitative review of the published literature

The present study aimed at quantitatively synthesizing published studies on the replicability of the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; PID-5) domain factor structure in U.S. and non-U.S. cultural contexts. A literature search was conducted, and 23 studies based on 25 samples (N = 24,240) were included. Seven studies provided data on the factor replicability of the PID-5 in the U.S. and 16 studies yielded PID-5 factor replicability data in non-U.S. countries. The majority (n = 17, 68.0%) of the studies were based on community/student samples. Median congruence coefficient (CC) values ranged from .92 to .98 in U.S. studies, and from .91 to .97 in non-U.S. studies. No significant effect of sample type, translation, and geographic area on CC values was observed. Meta-analytic structural equation modeling results supported the homogeneity of the PID-5 scale correlation matrices across both U.S. studies, root mean square error of approximation (RMSEA) = .039, and non-U.S. studies, RMSEA = .045. Dimensionality analyses of the pooled correlation matrix provided evidence for a 5-factor structure of the PID-5 scales in both U.S. and non-U.S. studies; the resulting factor loading matrices were highly similar to the normative U.S. factor loading matrix. As a whole, our findings support the generalizability of the PID-5 factor structure, suggesting the replicability of Negative Affectivity, Detachment, Antagonism, and Psychoticism factors across different samples, translations, age groups, and nations. Further studies on samples from non-Western Europe countries, as well as from specific population, are needed before drawing definitive conclusions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A correlated traits, correlated methods model for thin-slice child personality assessment

Recent research has illustrated the utility and accuracy of a thin-slice (TS) approach to child personality assessment, whereby unacquainted observers provide personality ratings of children after exposure to brief behavioral episodes. The current study sought to expand on this approach by exploring formal multitrait-multimethod (MTMM) models for child TS data comprising ratings from a comprehensive set of TS situations. Results using data from a sample of 326 community children 9-10 years of age indicated that a correlated traits, correlated methods (CTCM) model can be used to represent individual differences in children's behavior as manifest across different situations. Indicator variables derived from a CTCM differentially correlated with traditional parental ratings of behavior, moreover, and provide predictive and incremental validity regarding child competencies and behavior. Results illustrate the utility of a TS approach in the assessment of childhood personality and inform understanding of issues encountered in applying different MTMM models to these types of empirical data. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Further evidence that psychopathology networks have limited replicability and utility: Response to Borsboom et al. (2017) and Steinley et al. (2017)

In our target article, we tested the replicability of 4 popular psychopathology network estimation methods that aim to reveal causal relationships among symptoms of mental illness. We started with the focal data set from the 2 foundational psychopathology network papers (i.e., the National Comorbidity Survey-Replication) and identified the National Survey of Mental Health and Wellbeing as a close methodological match for comparison. We compared the psychopathology networks estimated in each data set-as well as in 10 sets of random split-halves within each data set-with the goal of quantifying the replicability of the network parameters as they are interpreted in the extant psychopathology network literature. We concluded that current psychopathology network methods have limited replicability both within and between samples and thus have limited utility. Here we respond to the 2 commentaries on our target article, concluding that the findings of Steinley, Hoffman, Brusco, and Sher (2017)-along with other recent developments in the literature-provide further conclusive evidence that psychopathology networks have poor replicability and utility. (PsycINFO Database Record

Measurement of pathological personality traits according to the DSM-5: A Polish adaptation of the PID-5. Part I - theoretical foundations

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes a novel hybrid system of personality disorder diagnosis in addition to the one pre-viously laid down in the DSM-IV-TR. This alternative diagnostic system, published within Section III of the DSM-5, was hoped to overcome the inherent limitations of categorical diagnosis by integrating the categorical and dimensional approaches to personality disorders. As such, it constitutes a bridge between psychiatric pathology classifications and findings from psychological research on the structure of normal personality.At the core of the hybrid DSM-5 system lies a new model of pathological personality traits, operationalized using the Personality Inventory for DSM-5 (PID-5). This paper outlines the background and main features of the DSM-5 hybrid system of personality disorder diagnosis with a focus on the dimensional model of pathological traits and definitions thereof. The cur-rent status, application potential and limitations of the DSM-5 diagnostic system and the pathological traits model are also discussed. In another paper, the authors present the PID-5 inventory and report on a study investigating a Polish adaptation of this instrument.

Psychology's Replication Crisis and Clinical Psychological Science

Despite psychological scientists' increasing interest in replicability, open science, research transparency, and the improvement of methods and practices, the clinical psychology community has been slow to engage. This has been shifting more recently, and with this review, we hope to facilitate this emerging dialogue. We begin by examining some potential areas of weakness in clinical psychology in terms of methods, practices, and evidentiary base. We then discuss a select overview of solutions, tools, and current concerns of the reform movement from a clinical psychological science perspective. We examine areas of clinical science expertise (e.g., implementation science) that should be leveraged to inform open science and reform efforts. Finally, we reiterate the call to clinical psychologists to increase their efforts toward reform that can further improve the credibility of clinical psychological science.

Bifactor and Hierarchical Models: Specification, Inference, and Interpretation

Bifactor and other hierarchical models have become central to representing and explaining observations in psychopathology, health, and other areas of clinical science, as well as in the behavioral sciences more broadly. This prominence comes after a relatively rapid period of rediscovery, however, and certain features remain poorly understood. Here, hierarchical models are compared and contrasted with other models of superordinate structure, with a focus on implications for model comparisons and interpretation. Issues pertaining to the specification and estimation of bifactor and other hierarchical models are reviewed in exploratory as well as confirmatory modeling scenarios, as are emerging findings about model fit and selection. Bifactor and other hierarchical models provide a powerful mechanism for parsing shared and unique components of variance, but care is required in specifying and making inferences about them.

Modeling Response Style Using Vignettes and Person-Specific Item Response Theory

Responses to survey data are determined not only by item characteristics and respondents' trait standings but also by response styles. Recently, methods for modeling response style with personality and attitudinal data have turned toward the use of anchoring vignettes, which provide fixed rating targets. Although existing research is promising, a few outstanding questions remain. First, it is not known how many vignettes and vignette ratings are necessary to identify response style parameters. Second, the comparative accuracy of these models is largely unexplored. Third, it remains unclear whether correcting for response style improves criterion validity. Both simulated data and data observed from a population-representative sample responding to a measure of personality pathology (the Personality Inventory for DSM-5 [PID-5]) were modeled using an array of response style models. In simulations, most models estimating response styles outperformed the graded response model (GRM), and in observed data, all response style models were superior to the GRM. Correcting for response style had a small, but in some cases significant, effect on the prediction of self-reported social dysfunction.

Progress in achieving quantitative classification of psychopathology

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.

Examining neural correlates of psychopathology using a lesion-based approach

Studies of individuals with focal brain damage have long been used to expand understanding of the neural basis of psychopathology. However, most previous studies were conducted using small sample sizes and relatively coarse methods for measuring psychopathology or mapping brain-behavior relationships. Here, we examined the factor structure and neural correlates of psychopathology in 232 individuals with focal brain damage, using their responses to the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Factor analysis and voxel-based lesion symptom mapping were used to examine the structure and neural correlates of psychopathology in this sample. Consistent with existing MMPI-2-RF literature, separate internalizing, externalizing, and psychotic symptom dimensions were found. In addition, a somatic dimension likely reflecting neurological symptoms was identified. Damage to the medial temporal lobe, including the hippocampus, was associated with scales related to both internalizing problems and psychoticism. Damage to the medial temporal lobe and orbitofrontal cortex was associated with both a general distrust of others and beliefs that one is being personally targeted by others. These findings provide evidence for the critical role of dysfunction in specific frontal and temporal regions in the development of psychopathology.

Item Response Theory Analyses, Factor Structure, and External Correlates of the Italian Translation of the Personality Inventory for DSM-5 Short Form in Community-Dwelling Adults and Clinical Adults

To assess the psychometric properties of the Italian translation of the 100-item short form of the Personality Inventory for DSM-5 (PID-5-SF), 2,143 community-dwelling adults (59.6% female), and 706 adult clinical participants (52.4% female) were administered the Italian translation of the PID-5. Clinical participants were also administered the Structured Clinical Interview for DSM-IV (SCID-II), and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Item response theory analysis showed that all proposed PID-5-SF items showed adequate item discrimination parameters in both community-dwelling adults and clinical adults. All PID-5-SF trait scales showed satisfactory internal consistency estimates. PID-5-SF five-factor structure closely matched the factor structure of the PID-5 in both community-dwelling participants and clinical participants and was invariant across the two samples that participated in this study. Moreover, the factor structure of the PID-5-SF closely replicated the factor of the PID-5-SF that was originally reported in Maples et al.'s study. In our clinical sample, dominance analysis results showed that PID-5-SF scales explained a nonnegligible and significant amount of variance in both SCID-II and PDQ-4+ ratings of selected DSM-5 Section II personality disorder, and the use of the PID-5-SF did not result in a substantial loss of information as compared with the original PID-5.

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.

Structure as cause and representation: Implications of descriptivist inference for structural modeling across multiple levels of analysis

What does a structural model reflect? Different answers to this question implicitly underlie different nosological paradigms. Traditionally, structural analysis has been seen as a process of identifying true or causative values, states, or conditions. This paradigm has faced mounting challenges, however, as psychopathology theory and research has come to encompass different levels of analysis, with concomitant questions about what constructs are most "correct." Here, we discuss an alternative descriptivist paradigm, in which models are seen as the process of identifying optimally parsimonious, generalizable representations of observations. This paradigm allows for an integration of theoretical and methodological approaches that are often seen in mutual opposition, and recasts traditional measurement and structural models in a new light. In this article, we explain the descriptivist perspective, illustrating important concepts using empirical examples from the Human Connectome Project and this issue. We address structural theory within the context of varying levels of analysis, demonstrating how the descriptivist approach can elucidate the nature of hierarchical features and provide a framework for empirically delineating psychopathology structure. (PsycINFO Database Record

On studying narcissism in personality inventories rather than the Narcissistic Personality Inventory: Reply to Miller and Lynam (2017)

Miller and Lynam's (2017) commentary proved to be very helpful in clarifying that ralerting-CV and rcontrast-CV coefficient values reported in our study indicated that the Narcissistic Personality Inventory (NPI) yielded a trait profile much more closely aligned with expert ratings of Diagnostic and Statistical Manual of Mental Disorders (4th edition; DSM-IV) narcissistic personality disorder (NPD) than did other measures. The commentary gives us the opportunity to make it clear that our study was designed to demonstrate the clinical usefulness of Personality Inventory for DSM-5 (PID-5) domain and trait scales in profiling pathological narcissism. Thus, demonstrating the superiority/inferiority of the Pathological Narcissism Inventory (PNI) over the NPI was not among the aims of our study. The publication of the commentary also gives us the opportunity to clarify the reasons why we think that the interpretation of the ralerting-CV and rcontrast-CV coefficients deserves some cautions. As a final remark, we think that the time has come to move from personality disorder classifications based on "clinical wisdom" to a redefinition of personality pathology in terms of systems of traits. (PsycINFO Database Record

Evidence that psychopathology symptom networks have limited replicability

Network analysis is quickly gaining popularity in psychopathology research as a method that aims to reveal causal relationships among individual symptoms. To date, 4 main types of psychopathology networks have been proposed: (a) association networks, (b) regularized concentration networks, (c) relative importance networks, and (d) directed acyclic graphs. The authors examined the replicability of these analyses based on symptoms of major depression and generalized anxiety between and within 2 highly similar epidemiological samples (i.e., the National Comorbidity Survey-Replication [n = 9282] and the National Survey of Mental Health and Wellbeing [n = 8841]). Although association networks were stable, the 3 other types of network analysis (i.e., the conditional independence networks) had poor replicability between and within methods and samples. The detailed aspects of the models-such as the estimation of specific edges and the centrality of individual nodes-were particularly unstable. For example, 44% of the symptoms were estimated as the "most influential" on at least 1 centrality index across the 6 conditional independence networks in the full samples, and only 13-21% of the edges were consistently estimated across these networks. One of the likely reasons for the instability of the networks is the predominance of measurement error in the assessment of individual symptoms. The authors discuss the implications of these findings for the growing field of psychopathology network research, and conclude that novel results originating from psychopathology networks should be held to higher standards of evidence before they are ready for dissemination or implementation in the field. (PsycINFO Database Record

Reliability, Factor Structure, and Associations With Measures of Problem Relationship and Behavior of the Personality Inventory for DSM-5 in a Sample of Italian Community-Dwelling Adolescents

In order to assess the reliability, factorial validity, and criterion validity of the Personality Inventory for DSM-5 (PID-5) among adolescents, 1,264 Italian high school students were administered the PID-5. Participants were also administered the Questionnaire on Relationships and Substance Use as a criterion measure. In the full sample, McDonald's ω values were adequate for the PID-5 scales (median ω = .85, SD = .06), except for Suspiciousness. However, all PID-5 scales showed average inter-item correlation values in the .20-.55 range. Exploratory structural equation modeling analyses provided moderate support for the a priori model of PID-5 trait scales. Ordinal logistic regression analyses showed that selected PID-5 trait scales predicted a significant, albeit moderate (Cox & Snell R² values ranged from .08 to .15, all ps < .001) amount of variance in Questionnaire on Relationships and Substance Use variables.

On the relationships between DSM-5 dysfunctional personality traits and social cognition deficits: A study in a sample of consecutively admitted Italian psychotherapy patients

This study aims at testing the hypothesis that the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) alternative model of personality disorder (AMPD) traits may be significantly associated with deficits on 2 different social cognition tasks, namely, the Reading the Mind in the Eyes Test and the Movie for the Assessment of Social Cognition, in a sample of consecutively admitted inpatients and outpatients. The sample was composed of 181 consecutively admitted participants (57.5% women; mean age = 38.58 years). Correlation coefficients and partial correlation coefficients were computed in order to assess the associations among social cognition tasks, DSM-5 AMPD traits, and dimensionally assessed DSM-5 Section II personality disorders. Specific maladaptive traits listed in the DSM-5 AMPD were significantly associated with Reading the Mind in the Eyes Test scores and Movie for the Assessment of Social Cognition scores, even when the effect of selected DSM-5 Section II personality disorders was controlled for. Our results support the relevance of studying social cognitive functioning in subjects suffering from personality disorders.