Delineating the joint hierarchical structure of clinical and personality disorders in an outpatient psychiatric sample

Abstract

Background A large body of research has focused on identifying the optimal number of dimensions—or spectra—to model individual differences in psychopathology. Recently, it has become increasingly clear that ostensibly competing models with varying numbers of spectra can be synthesized in empirically derived hierarchical structures. Methods and Materials We examined the convergence between top-down (bass-ackwards or sequential principal components analysis) and bottom-up (hierarchical agglomerative cluster analysis) statistical methods for elucidating hierarchies to explicate the joint hierarchical structure of clinical and personality disorders. Analyses examined 24 clinical and personality disorders based on semi-structured clinical interviews in an outpatient psychiatric sample (n = 2900). Results The two methods of hierarchical analysis converged on a three-tier joint hierarchy of psychopathology. At the lowest tier, there were seven spectra—disinhibition, antagonism, core thought disorder, detachment, core internalizing, somatoform, and compulsivity—that emerged in both methods. These spectra were nested under the same three higher-order superspectra in both methods: externalizing, broad thought dysfunction, and broad internalizing. In turn, these three superspectra were nested under a single general psychopathology spectrum, which represented the top tier of the hierarchical structure. Conclusions The hierarchical structure mirrors and extends upon past research, with the inclusion of a novel compulsivity spectrum, and the finding that psychopathology is organized in three superordinate domains. This hierarchy can thus be used as a flexible and integrative framework to facilitate psychopathology research with varying levels of specificity (i.e., focusing on the optimal level of detailed information, rather than the optimal number of factors).

Testing structural models of psychopathology at the genomic level

“…However, in the current analyses, eating disorders loaded most strongly on the Thought Problems factor, perhaps suggesting that this factor is characterized by disturbed cognitions found across disparate psychopathological disorders. The placement of eating disorders on this factor is also consistent with previous studies that have found substantial covariation between eating disorders and OCD (52,53), which also loaded on the Thought Problems factor in the current study.…”

Delineating and validating higher-order dimensions of psychopathology in the Adolescent Brain Cognitive Development (ABCD) study

“…First, it was limited to one assessment system, thus generalizability of the findings needs to be tested with other measures. Nevertheless, the hierarchy is largely consistent with previous studies using different measures 21, 23, 30, 53 suggesting at least partial generalizability. Second, only one parent completed both the CBCL about the child and the ASR about themselves, which may have inflated the similarity between childhood and adult psychopathology structures due to rater biases.…”

“…To map the hierarchical structure, we correlated factor scores on adjacent levels of the hierarchy to describe transitions between levels using Goldberg’s hierarchical method, 29 in line with previous work. 30, 48, 49 The paths between levels in the hierarchical model reflect correlations ≥.55 between the factor scores where a ≥ shift of at least two primary loadings was observed between levels.…”

“…Simpler and more complex architectures may be integrated as different levels of a single hierarchy: from a p-factor at the apex to progressively more specific nested factors. 29, 30 Consequently, models with different numbers of dimensions (one, two, three etc.) can co-exist and be studied simultaneously.…”

“…can co-exist and be studied simultaneously. Initial studies have identified a hierarchy of higher-order dimensions, 22, 23, 30–32 but were largely limited to personality pathology and focused on adults. Importantly, developmental studies suggest that there may be progressive differentiation in psychopathology and emergence of additional dimensions over development 14, 33 which underscores the importance of studying children samples as well.…”