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

The structure of pathological personality traits and temperament in a Persian community sample

The present study examined the extent to which the currently established factor structure of the Personality Inventory for DSM-5 (PID-5; Krueger et al., 2013) generalizes to a large Persian community sample, as well as relations between the resulting PID-5 factors and two temperament measures. Cross-sectional data came from 946 adults (65% female) from western Iran. With the use of exploratory structural equation modeling (ESEM) with target rotation, we found factor loadings that showed fairly similar patterns to those found in two previous meta-analytic PID-5 studies with predominantly North American and European samples (Watters & Bagby, 2018; Somma et al., 2019). Despite slight differences in each of the target rotations, there were moderate congruence coefficients (~0.85) between loadings for the five PID-5 domains, with the weakest evidence supporting the Disinhibition factor. The resulting PID-5 factors showed meaningful associations with temperament domains assessed via the Temperament and Character Inventory (TCI; Cloninger, 1994) and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire (TEMPS-A; Akiskal et al., 2005). Overall, our findings suggest that the documented structure of personality pathology assessed by the PID-5 generalizes somewhat to this sample of Persian participants, and pathological personality traits show important overlap with temperament, although these constructs are meaningfully distinct.

Pathological personality dimensions and neurobiological emotional reactivity

BACKGROUND

The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising framework to identify the neurobiological mechanisms of psychopathology. Many forms of psychopathology are characterized by dysfunctional emotional reactivity. The late positive potential (LPP) is an event-related potential component that provides an index of neurobiological emotional reactivity. Several categorical disorders have demonstrated a similar association with the emotion-modulated LPP. It is possible that higher-order dimensional representations of psychopathology might explain the comparable results. The present study examined the association between HiTOP-consistent pathological personality dimensions across multiple levels of the hierarchy and neurobiological emotional reactivity.

METHODS

The sample included 215 18-35-year-old adults (86% female) who were oversampled for psychopathology. Participants completed the emotional interrupt task while electroencephalography was recorded to examine the LPP. Participants also completed the Comprehensive Assessment of Traits relevant to Personality Disorders to assess pathological personality.

RESULTS

At the spectra level, higher negative emotionality was associated with a larger emotion-modulated LPP, while higher detachment was associated with a smaller emotion-modulated LPP. There were no associations between higher-order psychopathology levels and the emotion-modulated LPP. Compared to categorical diagnoses, spectra-level personality pathology dimensions significantly improved the prediction of the emotion-modulated LPP.

CONCLUSIONS

The present study indicates that HiTOP spectra levels of negative emotionality and detachment demonstrate unique associations with neurobiological emotional reactivity. The study highlights the utility of examining dimensional and hierarchical, rather than categorical, representations of psychopathology in the attempt to identify the neurobiological origins of psychopathology.

Pathological personality domains and punishment-enhanced error-related negativity

The error-related negativity (ERN) is an event-related potential that is observed after the commission of an error and is hypothesized to index threat sensitivity. The ERN is associated with multiple psychiatric disorders, but it is unclear if similar results are due to higher-order dimensions of psychopathology. When errors are punished, the ERN is further enhanced, which might better isolate threat sensitivity. However, few studies have examined whether psychopathology is associated with punishment enhancement of the ERN. In a clinical sample of 170 adults, the present study examined the association between pathological personality domains and predictable vs. unpredictable punishment-enhanced ERN. Results indicated that the ERN was enhanced when errors were punished compared to not punished. Greater negative emotionality was associated with a greater predictable punishment-enhanced ERN, while greater disinhibition was associated with smaller predictable punishment-enhanced ERN. The study suggests that higher-order pathological personality domains demonstrate discriminate relationships with punishment-enhanced error-related brain activity.

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.

Personality Pathology and Momentary Stress Processes

The expression of personality pathology differs between people and within a person in day-to-day life. Personality pathology may reflect, in part, dysregulation in basic behavioral processes. Thus, a useful approach for studying maladaptive trait expression comes from literature on stress and daily hassles, which provide dynamic accounts for the relations between individual differences and maladaptive dysregulation. This study sought to integrate maladaptive traits and dynamic stress processes to further dynamic models of personality pathology. In a combined clinical/community sample (N=297) oversampled for interpersonal problems, we used ecological momentary assessment (observation N=19,968) to investigate how maladaptive traits moderated the processes of stress generation, stress reactivity, and affective spillover/inertia. Tests of our preregistered hypotheses provided a mix of supportive and null findings for stress processes identified in past research, and mixed support for the moderating role of personality. The results provide insights into the relations between everyday stressors and personality pathology.

Dimensional models of personality disorders: Challenges and opportunities

Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.

Factor analysis in personality disorders research: Modern issues and illustrations of practical recommendations

The development of factor analysis is uniquely situated within psychology, and the development of many psychological theories and measures are likewise tethered to the common use of factor analysis. In this article, we review modern methodological controversies and developments of factor analytic techniques through concrete demonstrations that span the exploratory-confirmatory continuum. Also, we provide recommendations for working through common challenges in personality disorders research. To help researchers conduct riskier tests of their theory-implied models, we review what factor analysis is and is not, as well as some dos and don'ts for engaging in the process of model evaluation and selection. Throughout, we also emphasize the need for closer alignment between factor models and our theories, as well as clearer statements about which criteria would support or refute the theories being tested. Consideration of these themes appears promising in terms of advances in theory, research, and treatment surrounding the nature and impact of personality disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).