Comorbidity and heterogeneity: Two challenges for personality pathology research.

Watson, David; Clark, Lee Anna

doi:10.1037/per0000586

Cited by 8 publications

(8 citation statements)

References 85 publications

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“…However, excessive co-occurrence among psychiatric disorders diminishes the conclusions that can be drawn from standard case–control designs. Studying a group with a particular diagnosis likely means that one is actually studying individuals with a much broader array of problems (Watson & Clark, 2023), or else an extremely unrepresentative sample if comorbidity is excluded. Moreover, significant findings from case–control designs may reflect nonspecific vulnerability factors, associated features, or functional outcomes that follow from the simple presence of psychological problems—again inhibiting the development of strong theories that can be subjected to rigorous tests.…”

Section: Why Should Psychopathology Research Shift Focus To Fine-grai...mentioning

confidence: 99%

“…An understandable attempt to circumvent this problem involves using “clinical” control groups. Although an improvement, this practice can still result in the focal diagnostic group having more comorbidity and, therefore, greater implied severity than the comparison group (Watson & Clark, 2023). Group differences with regard to some phenomenon of interest, therefore, may indicate differences in severity rather than a disorder-specific process or mechanism.…”

Section: Why Should Psychopathology Research Shift Focus To Fine-grai...mentioning

confidence: 99%

“…This feature may make the disorders look more distinct than they actually are due to artifacts such as context effects (when items from the same DSM disorder are administered together), as well as items written and selected to maximize diagnostic differentiation (Forbes et al, 2021; Watts, Greene, et al, 2023). In addition, owing to challenges in obtaining relatively comprehensive symptom-level data, symptom-level analyses may end up being item-level analyses (e.g., Markon, 2010), thus encumbering researchers with the suboptimal psychometric properties of individual items as opposed to scales (Watson & Clark, 2023). Nevertheless, as advocated by Watson and Clark (2023), any efforts to (a) use measurement tools that lend themselves to more fine-grained levels of analysis and (b) report symptom-level results will have a cumulative effect on our field and thereby facilitate the transition to more sophisticated theoretical and methodological frameworks.…”

Section: How Do We Move Forward?mentioning

confidence: 99%

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To fully leverage fine-grained clinical phenomena, we have to think beyond DSM-based concepts and the presumption of diagnostic kinds.

Levin-Aspenson

2023

Journal of Psychopathology and Clinical Science

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In light of the limitations of dominant psychiatric classification systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), this special section positions fine-grained clinical phenomena as key to the future of psychopathology research. This shift is necessary given the constraints DSMbased diagnoses place on (a) the specificity of theories and models of psychopathology and (b) efforts to develop alternative paradigms. Fine-grained clinical phenomena offer comparative advantages, but transitioning to their study involves significant challenges. Chief among these challenges is the need to move beyond DSM as a source of concepts. Implicit assumptions that DSM-based disorders provide valid, circumscribed, and explanatory definitions of clinical phenomena perpetuate existing reification of diagnostic categories rather than reimagining psychopathology nosology beyond DSM, thus needlessly restricting and even undermining research efforts. Moving forward requires careful attention to consensual operationalization. Otherwise, we will continue to struggle to develop valid compositional explanations of clinical phenomena and to organize them into explanatory conceptual taxonomies. Scientific progress here depends on coordinated pluralism that incorporates different lenses into psychopathology and different approaches to data collection and analysis, with a firm grounding in construct validity and a corresponding commitment to continually reimagine rather than reify our concepts and objects of study. General Scientific SummaryThis commentary is part of a special section that focuses on limitations to classification systems such as the DSM and the comparative advantages of alternative approaches (e.g., focusing on more nuanced aspects of mental health problems). I discuss different overarching aspects of these topics in relation to the target articles, highlighting the benefits of and challenges to focusing on symptoms versus disorders. I argue for conceptualizing psychopathology beyond the constraints of DSM and emphasize that this transition requires us to pay greater attention to how we define and measure mental health problems.

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Section: Why Should Psychopathology Research Shift Focus To Fine-grai...mentioning

confidence: 99%

Section: Why Should Psychopathology Research Shift Focus To Fine-grai...mentioning

confidence: 99%

Section: How Do We Move Forward?mentioning

confidence: 99%

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To fully leverage fine-grained clinical phenomena, we have to think beyond DSM-based concepts and the presumption of diagnostic kinds.

Levin-Aspenson

2023

Journal of Psychopathology and Clinical Science

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“…Most patients with significant personality disorder have at least one other psychiatric disorder (Tomko et al, 2014; Tyrer, Mulder, et al, 2022; Watson & Clark, 2023). This is particularly true of borderline personality disorder, which has the largest levels of comorbidity.…”

Section: Choosing the Sample And Controlling For Comorbiditymentioning

confidence: 99%

Establishing efficacy and effectiveness in the treatment of personality disorders

Tyrer,

Sharp

2023

Personality & Mental Health

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Establishing efficacy and effectiveness in the treatment of personality disorders 'The consequence was, that the most sudden and visible good effects were perceived from the use of oranges and lemons', wrote James Lind in his description of the first published randomised controlled trial, one showing the prevention of scurvy (Lind, 1753) carried out in 1747 with sailors in warships patrolling the English Channel to prevent Spanish marauders. Yet it took 100 years for this evidence to be absorbed into practice. But when one contemplates the size of the difference between scurvy prevention and treatment efficacy in personality disorder, a new period of 100 years for personality disorder treatment to be similarly summarised does not seem excessive. Scurvy, caused by a simple deficiency of vitamin C, is now perceived as a simple medical disorder; personality disorder is one of the most complex.But the James Lind legacy has persisted in the universal embrace of the randomised controlled trial across the whole of therapeutics. While there are many preliminary enquiries needed before a definitive answer to a therapeutic question can be answered, the gold standard, sometimes looking a little tattered, of the randomised trial still holds sway, even for the most complex disorders. But Austin Bradford Hill, one of the pioneers of controlled trials, frequently emphasised the need for researchers to have an array of experimental data in advance to allow a precisely framed question to be tested in the context of the definitive trial. The tendency in many complex interventions is to try and test several hypotheses simultaneously, but 'to start off without thought and with all and sundry included, with the hope that the results can somehow be sorted out statistically in the end, is to court disaster' (Hill, 1966).This important observation needs to be remembered by all researchers in the psychological sciences. Because almost all the interventions we test are complex interventions, we need to have robust models, grounded in theory (Muthukrishna & Henrich, 2019) and derived from qualitative and other methodologies (Campbell et al., 2000) that enable one very precise hypothesis to be tested.

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“…Second, other descriptors not proposed as formal terminology replacements also are used as variants of standard PD terminology in contemporary research. This includes terminology such as "personality pathology," which is sometimes used to refer to PD traits dimensionally or in a general sense rather than referring to one specific PD (e.g., Cano & Sharp, 2023;Rodriguez-Seijas et al, 2023;Watson & Clark, 2023). Additionally, "characterological" terminology features less prominently in contemporary than past research based on previous DSM versions (Bliton et al, 2017), but is still used in some cases to describe relatively stable symptom experiences (e.g., "characterological depression" Fjermestad-Noll et al, 2019).…”

Section: Review Of Terminology Proposals and Terminology Used In Cont...mentioning

confidence: 99%

Understanding Broader Community Perspectives on the Scientific Accuracy and Stigma of Personality Trait Labels

Stanton,

Levin-Aspenson,

Emery

et al. 2023

Preprint

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Many labels are used within and across subfields to describe personality disorder (PD) and related interpersonally-oriented and externalizing dimensions. For example, “interpersonal disorders” is a suggested alternative label to “personality disorders” in clinical research, and “dark triad” labels commonly are used across literatures to describe traits associated with interpersonal difficulties. Terminology changes have been proposed both due to concerns about different descriptors’ validity and their usage potentially being stigmatizing. Importantly, greater terminology consensus can also unify research efforts. Toward these aims, we present data from over 900 participants who provided their opinions of terms used in PD research. This included data from 362 undergraduates, 408 adults recruited online, and 161 adults recruited from the community, and we used targeted recruitment strategies to ensure representation of individuals with significant mental health histories. All participants completed self-report questionnaires assessing their personalities and symptoms, and community participants also completed structured clinical interviews. Results indicated that participants generally viewed traditional “personality disorders” terminology favorably compared to other terms in regard to both scientific accuracy and stigma. “Interpersonal disorders” terminology was also viewed more favorably overall than many other terms, whereas “dark triad” terminology was viewed negatively overall. Participants’ own characteristics (e.g., personality, age) were mostly unrelated to their views of terminology. These results provide insight into how various descriptors may be viewed by the broader community and provide a foundation for future research investigating how different terms are perceived across contexts.

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Comorbidity and heterogeneity: Two challenges for personality pathology research.

Cited by 8 publications

References 85 publications

To fully leverage fine-grained clinical phenomena, we have to think beyond DSM-based concepts and the presumption of diagnostic kinds.

To fully leverage fine-grained clinical phenomena, we have to think beyond DSM-based concepts and the presumption of diagnostic kinds.

Establishing efficacy and effectiveness in the treatment of personality disorders

Understanding Broader Community Perspectives on the Scientific Accuracy and Stigma of Personality Trait Labels

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