Facets of externalizing psychopathology in relation to inhibitory control and error processing

The Co-occurrence of Personality Disorders and Substance Use Disorders

PURPOSE OF REVIEW

Despite significant negative outcomes, the co-occurrence of personality disorders (PDs) and substance use disorders (SUDs) continues to be underrecognized, and the mechanisms contributing to this co-occurrence remain unclear. This review summarizes recent work on PD-SUD co-occurrence, with a focus on borderline and antisocial PDs, general substance use patterns among those with PDs, and the association of personality traits with SUDs.

RECENT FINDINGS

The prevalence of co-occurring PD-SUD is generally high, with estimates ranging depending on the type of PD and SUD, the population assessed, and the sampling methods and measures used. Current theoretical explanations for co-occurrence include shared etiology and predisposition models, with research highlighting the importance of transactional processes. Potential underlying mechanisms include personality traits and transdiagnostic characteristics. Recent research has increased focus on substances besides alcohol, dimensional models of personality pathology, and transactional explanations of co-occurrence, but more research is needed to disentangle the nuanced PD-SUD relationship.

Developmental cascades of behavior problems and cognitive ability from toddlerhood to middle childhood: A 9-year longitudinal study

Little is known about the direction, ordering, and uniqueness of longitudinal associations between behavior problems and cognitive ability, from toddlerhood to middle childhood. A developmental cascade model was tested in the present study to examine the transactional processes in 103 Chinese children at the ages of 1, 2, 7, and 9 years. Behavior problems were assessed using the maternal reported Infant-Toddler Social and Emotional Assessment at the ages of 1, 2 and parental reported Children Behavior Checklist at the ages of 7, 9. Cognitive ability was measured using Bayley Scales of Infant and Toddler Development at the ages of 1, 2 and Wechsler Intelligence Scale for Children at the ages of 7, 9. The results revealed the stability of behavior problems and cognitive ability from age 1 to age 9 years and concurrent associations between externalizing and internalizing problems. Unique longitudinal associations were identified between (1) age 1 cognitive ability and age 2 internalizing problems, (2) age 2 externalizing problems and age 7 internalizing problems, (3) age 2 externalizing problems and age 7 cognitive ability, (4) age 7 cognitive ability and age 9 externalizing problems. The results indicated essential targets for future interventions aimed at reducing children's behavior problems at 2 years old and promoting cognitive ability at 1 year old and 7 years old.

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.

Disentangling cognitive processes in externalizing psychopathology using drift diffusion modeling: Antagonism, but not disinhibition, is associated with poor cognitive control

Although externalizing psychopathology has been linked to deficits in cognitive control, the cognitive processes underlying this association are unclear. Here, we provide a theoretical account of how research on cognitive processes can help to integrate and distinguish personality and psychopathology. We then apply this account to connect the two major subcomponents of externalizing, Antagonism and Disinhibition, with specific control processes using a battery of inhibitory control tasks and corresponding computational modeling. Participants (final N = 104) completed the flanker, go/no-go, and recent probes tasks, as well as normal and maladaptive personality inventories and measures of psychological distress. We fit participants' task behavior using a hierarchical drift diffusion model (DDM) to decompose their responses into specific cognitive processes. Using multilevel structural equation models, we found that Antagonism was associated with faster RTs on the flanker task and lower accuracy on flanker and go/no-go tasks. These results were complemented by DDM parameter associations: Antagonism was linked to decreased threshold and drift rate parameter estimates in the flanker task and a decreased drift rate on no-go trials. Altogether, our findings indicate that Antagonism is associated with specific impairments in fast (sub-second) inhibitory control processes involved in withholding prepared/prepotent responses and filtering distracting information. Disinhibition and momentary distress, however, were not associated with task performance.

Event-related potential (ERP) measures of error processing as biomarkers of externalizing disorders: A narrative review

Previous studies have shown that electrophysiological measures of error processing are affected in patients at risk or diagnosed with internalizing disorders, hence, suggesting that error processing could be a suitable biomarker for internalizing disorders. In this narrative review, we will evaluate studies that address the role of event-related potential (ERP) measures of error-processing in externalizing disorders and discuss to what extend these can be considered a biomarker for externalizing disorders. Currently, there is evidence for the notion that electrophysiological indices of error processing such as the error-related negativity (ERN) and error positivity (Pe) are reduced in individuals with substance use disorders, attention-deficit/hyperactivity disorder, and in forensic populations. However, it remains unclear whether this is also the case for other understudied disorders such as behavioral addiction. Furthermore, to fully understand how these deficits affect day to day behavior, we encourage research to focus on testing current theories and hypotheses of ERN and Pe. In addition, we argue that within an externalizing disorder, individual differences in error processing deficits may be related to prognosis and gender of the patient, methodological issues and presence of comorbidity. Next, we review studies that have related treatment trajectories with ERP measures of error processing, and we discuss the prospect of improving error processing as a treatment option. We conclude that ERP measures of error processing are candidate biomarkers for externalizing disorders, albeit we strongly urge researchers to continue looking into the predictive value of these measures in the etiology and treatment outcome through multi-method and longitudinal designs.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.