An Initial Investigation of the Joint Classification of Hypomania- and Neurodevelopmental Disorder-Relevant Dimensions Within the Hierarchical Taxonomy of Psychopathology

Conceptualizing adult ADHD with the DSM alternative model of personality disorder

Personality traits and personality disorders are related to ADHD and indicate dysfunction in clinical populations. The goals of this study were to examine how the DSM-5 Alternative Model of Personality Disorder (AMPD) a) indicates the presence of ADHD and b) communicates information about dysfunction over and above ADHD diagnosis. A sample of 330 adult psychiatric patients with and without ADHD (60% female; mean age 33 years) were assessed for ADHD symptoms, personality impairment, maladaptive personality traits, and functional life impairment domains. The maladaptive personality domain Disinhibition and particularly the lower order facet of Distractibility distinguished between individuals with psychiatric difficulties with and without ADHD. Distractibility is strongly related to the ADHD symptom dimension Inattentiveness, and Antagonism to Hyperactivity/impulsivity. General personality impairment augmented ADHD diagnosis in predicting life impairments. The AMPD has utility in ADHD assessments for diagnosis and prognosis.

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI)

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming the limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

Negative Mood Dysregulation Loads Strongly Onto Common Factors With Many Forms of Psychopathology: Considerations for Assessing Nonspecific Symptoms

There have been proposals to expand definitions for categorical disorders and dimensionally conceptualized syndromes (e.g., psychopathy) to include negative mood lability and dysregulation (NMD). Factor analytic results are often presented in support of these proposals, and we provide factor analytic demonstrations across clinically oriented samples showing that NMD indicators load strongly onto factors with a range of psychopathology. This is unsurprising from a transdiagnostic perspective but shows that factor analysis could potentially be used to justify expanding definitions for specific constructs even though NMD indicators show strong, nonspecific loadings on psychopathology factors ranging widely in nature. Expanding construct definitions and assessment approaches to emphasize NMD also may negatively impact discriminant validity. We agree that targeting NMD is essential for comprehensive assessment, but our demonstrative analyses highlight a need for using factor analysis and other statistical methods in a careful, theoretically driven manner when evaluating psychopathology structure and developing measures.

An Exploratory Study of MMPI-2-RF Personality and Psychopathology Profiles of Adults with Autism Spectrum Disorder without Intellectual Disability

OBJECTIVE

More empirical research is needed to disentangle the phenotypes of autism spectrum disorder (ASD) and cluster C personality symptomatology (CCPD), as both show similarities in their clinical presentation. We explored personality and psychopathology dimensions as conceptualized in contemporary dimensional taxonomies (i.e., hierarchical taxonomy of psychopathology; HiTOP) in adults with ASD without intellectual disability operationalized by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF).

METHOD

Applying secondary analytic processes using clinical data, we cross-examined the MMPI-2-RF profiles of adults with ASD (n = 28) compared to adults with Cluster C personality disorders (CCPD; n = 28) and a control group (n = 28) by conducting nonparametric tests and assessing effect sizes.

RESULTS

The profiles of the ASD and CCPD groups evidenced to be similar, and both average clinical profiles diverged from the average control group profiles by elevated levels of demoralization, internalizing, and somatization symptomatology. There were small differences between the average profiles of adults with ASD and adults with CCPD. Additional research using dimensional measures of psychopathology could elucidate the dimensional phenotypes of ASD and CCPD.

CONCLUSIONS

Based on the results in this study, the MMPI-2-RF may not meaningfully discriminate between the two clinical presentations, with the exception of various externalizing scales.