The Indispensable Value of a Coherent Phenotypic Model of Psychopathology

Understanding anxiety symptoms as aberrant defensive responding along the threat imminence continuum

Threat-anticipatory defensive responses have evolved to promote survival in a dynamic world. While inherently adaptive, aberrant expression of defensive responses to potential threat could manifest as pathological anxiety, which is prevalent, impairing, and associated with adverse outcomes. Extensive translational neuroscience research indicates that normative defensive responses are organized by threat imminence, such that distinct response patterns are observed in each phase of threat encounter and orchestrated by partially conserved neural circuitry. Anxiety symptoms, such as excessive and pervasive worry, physiological arousal, and avoidance behavior, may reflect aberrant expression of otherwise normative defensive responses, and therefore follow the same imminence-based organization. Here, empirical evidence linking aberrant expression of specific, imminence-dependent defensive responding to distinct anxiety symptoms is reviewed, and plausible contributing neural circuitry is highlighted. Drawing from translational and clinical research, the proposed framework informs our understanding of pathological anxiety by grounding anxiety symptoms in conserved psychobiological mechanisms. Potential implications for research and treatment are discussed.

Towards a contemporary approach for understanding personality pathology in developmental context: An integrative model

Traditional categorical approaches to classifying personality disorders are limited in important ways, leading to a shift in the field to dimensional approaches to conceptualizing personality pathology. Different areas of psychology – personality, developmental, and psychopathology – can be leveraged to understand personality pathology by examining its structure, development, and underlying mechanisms. However, an integrative model that encompasses these distinct lines of inquiry has not yet been proposed. In order to address this gap, we review the latest evidence for dimensional classification of personality disorders based on structural models of maladaptive personality traits, provide an overview of developmental theories of pathological personality, and summarize the Research Domain Criteria (RDoC) initiative, which seeks to understand underlying mechanisms of psychopathology. We conclude by proposing an integrative model of personality pathology development that aims to elucidate the developmental pathways of personality pathology and its underlying mechanisms.

The comorbidity structure of fear, distress and compulsive disorders in an acute psychiatric sample

Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD), collectively referred to as compulsive disorders, have typically not been included in structural research on the internalizing spectrum due to low prevalence in community samples. The current study examined the higher-order structure of anxiety, depressive and compulsive disorders among patients in a psychiatric partial hospital program (N = 2,178). We applied confirmatory factor analysis to diagnostic data obtained at admission and compared several competing models of the comorbidity structure. A one-factor model accounted well for the co-occurrence of all the disorders. A two-factor model comprised of fear and distress factors, wherein compulsive disorders loaded on fear, also fit the data well. However, a very large factor correlation (r = 0.86) suggested limited discriminant validity of fear and distress in the sample. Alternate models that featured a distinct compulsivity factor were not viable owing to large correlations between fear and compulsive disorders. Overall, our findings indicate that a broad internalizing dimensions underlies not only anxiety and depression, but also compulsive disorders, in an acute psychiatric population. Future studies using symptom-level data are needed to replicate these results and determine the structure of internalizing disorders from the bottom up, starting with narrowly defined symptom components.