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.

Personality disorders (PDs) are among the most common and severe classes of psychopathology. From a clinical perspective, it is challenging to help individuals with personality disorders because treatment ruptures, discontinuation, reversals, and failures are relatively common. An additional clinical challenge is that the model used to diagnose personality disorders is demonstrably incorrect. Recent efforts to improve diagnosis of personality disorders apply two criteria: the first distinguishes personality disorders from other kinds of psychopathology and the second distinguishes different types of personality disorders. However, this approach has been problematic in that, as currently operationalized, it does not provide a clear demarcation for personality disorders, and it uses a framework for individual differences that is more apt as a model of variation in psychopathology in general. This article proposes that the core of personality disorders involves difficulties understanding and relating to self and others, and thus the personality disorders should be recast as the interpersonal disorders. Interpersonal dysfunction explains extreme social challenges and treatment difficulties that are characteristic of this class of psychopathology. This approach provides a clearer model for distinguishing these kinds of problems, as demonstrated by reformulating traditional personality disorder symptoms from an interpersonal perspective. Public Significance StatementPersonality disorders are among the most common and severe classes of psychopathology. Research and intervention development for personality disorders is held back by an invalid diagnostic system. Replacing the personality disorders with the interpersonal disorders would provide a more valid, ethical, useful, and clinically compelling model.

Neuroticism is a basic dimension of personality with profound implications for mental and physical health. The link between neuroticism and health problems is thought to be driven by experiencing higher average levels of negative emotion and more emotional variability. However, because of the statistical dependency between mean levels and variability of negative emotion, neuroticism’s association with emotional variability has been questioned. If adjusting for mean levels eliminates evidence for associations between neuroticism and emotional variability, this would suggest a total revision of theory and measurement. Our meta-analysis investigated conceptual and statistical shortcomings of adjusting for the mean and tested whether the simple solution of adjusting for the median or mode instead is a better approach to account for average emotion levels and overcome the mean-variance confound. We analyzed 15 ambulatory assessment studies (N=2,088 participants; 146,823 observations) and showed that: (1) the mean-variance association is largely driven by the skewed distribution of negative emotions, (2) adjusting negative emotion variability with the mean overcorrects for their association, (3) the mode was least confounded with variability, and (4) adjusting for the median or mode strengthened evidence for the role of negative emotion variability in neuroticism. Results from our meta-analysis indicate that adjusting for the mean is an overcorrection that underestimates the association between negative emotion variability and neuroticism. Instead of adjusting for the mean, we recommend using the mode to study negative emotion dynamics related to neuroticism on theoretical and empirical grounds when there is a desire to adjust for the average.

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A model of personality pathology including both general and specific components distinguishes severity of personality dysfunction from the characteristic style of its expression. This model has been proposed as an empirically-based, dimensional alternative to categorical models. In this study, we evaluated this conceptual structure by examining associations between general and specific features of personality pathology and momentary interpersonal dynamics. By assessing whether dynamic variability reflects general impairment or a specific trait style, we also sought to link existing findings of heterogeneity in behavior and affect among persons diagnosed with categorical borderline personality disorder with dimensional models. We examined these issues in a large sample of adults (N = 605) drawn from two protocols-an initial exploratory study and a pre-registered replication. Ambulatory assessment was used to measure affect and dominant and warm behavior of self and other during everyday interpersonal interactions. We examined individuals' average affects, behaviors, and perceptions of the others' behaviors, as well as variability in these constructs in relation to personality pathology using multilevel structural equation modeling. To our knowledge, this is the first study to examine maladaptive traits or general personality pathology in relation to momentary measures. Results supported the incremental validity of general and specific features and suggested that variability is most closely associated with general personality pathology.