Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda

Abstract

Despite the emphasis on evidence‐based treatment for psychological disorders, to date, there has been limited research examining treatment for nine of the 10 categorical personality disorders in DSM‐5 Section 2. This is perhaps not surprising given the complex heterogeneity and co‐morbidity within personality pathology. The hierarchical taxonomy of psychopathology (HiTOP) was proposed to address limitations within the traditional categorical model of the diagnostic system. Within this system are five spectra: detachment, antagonistic externalizing, disinhibited externalizing, thought disorder and internalizing. These foundational personality traits potentially have direct and specific treatment implications. The purpose of this paper is to highlight potential psychotherapeutic and pharmacological treatment recommendations within the personality spectra. Additionally, we outline the advantages of considering the personality science found within dimensional models of psychopathology in clinical assessment and intervention to aid in treatment planning. © 2019 John Wiley & Sons, Ltd.

The clinical characterization of the adult patient with depression aimed at personalization of management

“…There is now a manualized psychotherapy for the treatment of neuroticism 145 . Techniques that help reduce neuroticism include cognitive therapy, exposure, and mindfulness 145,146 .…”

“…Persons who are high in openness will be more receptive to exploratory insight; persons who are extraverted are more likely to be comfortable and active within group therapy; and persons who are antagonistic are likely to be disruptive within inpatient settings and oppositional or argumentative within individual therapeutic sessions, whereas persons who are agreeable are more likely to be compliant 147 . There are empirically supported strategies to treat maladaptive traits: for example, goal planning to increase conscientiousness, social skills training to decrease detachment, and cognitive restructuring to decrease antagonism 146 .…”

Neurobiological Investigations of Dimensionally Conceptualized Personality Pathology: Mapping a Way Forward for the Clinical Neuroscience of Personality Disorders

“…Dimensional models are further consistent with a variety of influential initiatives including the National Institute of Mental Health Research Domain Criteria (RDoC; Insel et al, 2010), meant to explicate a dimensional organization of systems of relevance to psychopathology across units of analysis, and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al, 2017;Krueger et al, 2018), an empirically derived dimensional organizational psychopathology framework. Dimensional approaches of these sorts not only more accurately represent the nature of psychopathology, including personality pathology, but also provide more optimal biological signal for neurobiological investigations (Latzman et al, 2020;Zald & Lahey, 2017) and improved clinical utility (Mullins-Sweatt et al, 2020;Ruggero et al, 2019).…”

Maximizing the applied value of structural models of psychopathology: Introduction to a special issue of Personality and Mental Health

“…Indeed, there is strong theoretical support for personality forming the foundation of manifest psychopathology . As alluded to by Mullins‐Sweatt et al, this relationship suggests that personality should be closely intertwined with the HiTOP constructs. But empirical research into the pattern and size of those connections is in its early stages.…”

“…panic disorder, social phobia, persistent depressive disorder and borderline personality disorder). Drawing on diverse psychotherapy traditions, Mullins‐Sweatt et al provide recommendations for treatment strategies that could make the biggest impact on each of five higher‐order HiTOP constructs: internalizing, antagonistic externalizing, disinhibited externalizing, thought disorder and detachment.…”