Examining the role of personality functioning in a hierarchical taxonomy of psychopathology using two years of ambulatory assessed data

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) arranges phenotypes of mental disorders based on empirical covariation, ranging from narrowly defined symptoms to higher-order spectra of psychopathology. Since the introduction of personality functioning (PF) in DSM-5 and ICD-11, several studies have identified PF as a transdiagnostic predictor of psychopathology. However, the role of PF in the HiTOP classification system has not been systematically examined. This study investigates how PF can be integrated into HiTOP, whether PF accounts for transdiagnostic variance captured in higher-order spectra, and how its predictive value for affective well-being (AWB) and psychosocial impairment (PSI) compares to the predictive value of specific psychopathology. To this end, we examined two years of ambulatory assessed data on psychopathology, PF, PSI, and AWB of N = 27 173 users of a mental health app. Results of bass-ackwards analyses largely aligned with the current HiTOP working model. Using bifactor modeling, aspects of PF were identified to capture most of the internalizing, thought disorder, and externalizing higher order factor variance. In longitudinal prediction analyses employing bifactor-(S-1) modeling, PF explained 58.6% and 30.6% of one-year variance and 33.1% and 23.2% of two-year variance in ambulatory assessed PSI and AWB, respectively. Results indicate that personality functioning may largely account for transdiagnostic variance captured in the higher-order components in HiTOP as well as longitudinal outcomes of PSI and AWB. Clinicians and their patients may benefit from assessing PF aspects such as identity problems or internal relationship models in a broad range of mental disorders. Further, incorporating measures of PF may advance research in biological psychiatry by providing empirically sound phenotypes.

Development and Initial Evaluation of the German Version of the Hierarchical Taxonomy of Psychopathology Self-Report (HiTOP-SR)

“…In our study, the corresponding scales had relevant loadings on Anankastia (checking and cleaning), Thought Disorder (checking and counting) and Body-Focused Impulse-Control Problems (cleaning). Notably, the distinct relationship of obsessive-compulsive problems to the thought disorder spectrum has also been observed in other recent empirical studies (Faure & Forbes, 2021;Kerber et al, 2024).…”

“…An alternative approach to conceptualize psychopathology is being developed as part of the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium (https://www.hitopsystem.org/). The HiTOP consortium is an association of almost 200 researchers worldwide, who aim to develop a descriptive model for psychopathological phenomena based on empirical correlations (Kotov et al, 2017;Krueger et al, 2018;Zimmermann et al, 2024).…”

“…The current model is essentially based on a meta-analytically validated literature review of factor analytic studies of DSM disorders (Kotov et al, 2017;Ringwald et al, 2023). To date, there are only a few studies in which all or most parts of the model have been measured using dimensional scales and jointly factor analyzed (e.g., Forbes et al, 2023;Kerber et al, 2024;Sellbom et al, 2021), and the structure of the Englishlanguage HiTOP-SR scales has not yet been explored. In this respect, our results on the latent structure of the scales are exploring new territory.…”

Hierarchische Taxonomie der Psychopathologie (HiTOP): Ein neues Modell zur Beschreibung psychischer Probleme

“…Außerdem liegen inzwischen weitere Studien vor, die über kategoriale Diagnosen als Indikatoren hinausgehen und deren Ergebnisse mit den Spektren des HiTOP-Modells weitgehend übereinstimmen (z.B. Conway et al, 2020;Forbes, Baillie, et al, 2023;Kerber et al, 2024;Sellbom et al, 2020;Wendt et al, 2023). Relevant sind insbesondere strukturelle Analysen zur "dunklen Materie der Psychopathologie" (Kotov et al, 2021) also zu Phänomenen, deren Platzierung im HiTOP-Modell als unsicher gilt.…”

“…Bezüglich des Konzepts von Persönlichkeitsstörungen stellt sich zudem die Frage, inwiefern damit lediglich chronifizierte psychische Probleme gemeint sind oder ob darüber hinaus nicht auch Beeinträchtigungen im Funktionsniveau der Persönlichkeit berücksichtigt werden sollten, deren Platzierung im HiTOP-Modell noch unklar ist (Kerber et al, 2024;Widiger, Bach, et al, 2019;Zimmermann et al, 2023).…”