Purpose
Research on the structure of mental disorders and comorbidity indicates that many forms of psychopathology and substance use disorders are manifestations of relatively few transdiagnostic ...latent factors. These factors have important consequences for mental disorder research and applied practice.
Methods
We provide an overview of the transdiagnostic factor literature, with particular focus on recent advances.
Results
Internalizing and externalizing transdiagnostic factors have been well characterized in terms of their structures, links with disorders, stability, and statistical properties (e.g., invariance and distributions). Research on additional transdiagnostic factors, such as thought disorder, is quickly advancing latent structural models, as are integrations of transdiagnostic constructs with personality traits. Genetically informed analyses continue to clarify the origins of transdiagnostic factor levels, and links between these factors and important environmental exposures provide promising new avenues of inquiry.
Conclusions
Transdiagnostic factors account for the development and continuity of disorders and comorbidity over time, function as the primary links between disorders and important outcomes such as suicide, mediate associations between environmental exposures and disorders, provide an empirically supported classification system, and serve as foci for efficient, broadband intervention approaches. Overall, transdiagnostic factor research indicates the paramount importance of understanding these constructs and, thereby, broadening our understanding of mental disorder in general.
Non-suicidal self-injury (NSSI) is a significant public health concern, and its primary formal link to the universe of psychopathology content in DSM diagnoses has been mostly through borderline ...personality disorder (BPD). Recent research has produced ample evidence of weaknesses of diagnoses relative to transdiagnostic psychopathology dimensions, and found that NSSI-related variables like suicidality are best predicted by transdiagnostic versus diagnosis-based variables. These findings suggest a need to characterize how NSSI may relate to different forms of psychopathology classification constructs. We examined how transdiagnostic dimensions of psychopathology relate to NSSI, focusing on how transdiagnostic (shared) variance of dimensional psychopathology spectra might differentially explained the variance in NSSI relative to traditional DSM diagnoses. In two nationally representative United States samples (Ns = 34,653 and 36,309), we modeled the common distress-fear-externalizing transdiagnostic comorbidity model and investigated questions of predictive utility of these dimensional and categorical psychopathology structures. Transdiagnostic dimensions were superior in predicting NSSI compared to common DSM-IV and DSM-5 diagnoses. These dimensions accounted for 33.6–38.7 % of NSSI variance across all analyses in both samples. DSM-IV/DSM-5 diagnoses, however, demonstrated only modest incremental prediction of NSSI over and above the transdiagnostic dimensions. These results support a transdiagnostic reconceptualization of NSSI's links with psychopathology and highlight the importance of transdiagnostic dimensions for predicting clinical outcomes relating to self-injurious behaviors. Implications for research and clinical practice are discussed.
•We compared DSM diagnoses vs transdiganostic dimensions in explaining the variance in NSSI.•Transdiagnostic dimensions consistently outperformed categorical DSM diagnoses in accounting for NSSI variance.•Incremental prediction by diagnoses, over and above the transdiagnostic dimensional variables, was modest.•Comparatively few transdiagnostic dimensions outperform DSM diagnoses in linking NSSI to psychopathology.
Objective: Sexual minority individuals display elevated rates of psychiatric and substance use disorders compared with heterosexuals. Racial/ethnic minority individuals report lower prevalence of ...disorders compared with White individuals. Research on sexual minority mental health often neglects research on racial/ethnic minority mental health and vice versa. Therefore, at the intersection of sexual and racial/ethnic minority status, the prevalence of disorders remains unclear. Method: In a nationally representative sample (N = 36,309), we compared disorder prevalence between sexual minorities and same-race/ethnicity heterosexuals. We then examined the extent to which differences in disorder prevalence between sexual minorities and heterosexuals can be attributed to differences in discrimination experiences related to sexual minority status. We next compared prevalence of disorders for Black and Hispanic with White sexual minority individuals. We examined whether these patterns of associations were reflective of transdiagnostic factor differences among groups. Results: Regardless of race/ethnicity, sexual minority individuals experience higher prevalence of disorders than heterosexuals. Controlling for discrimination experiences partially negates these disparities. At the intersection of racial/ethnic and sexual minority status, disorder prevalence is more nuanced: Although Black sexual minority individuals experience lower prevalence of disorders than Whites, Hispanic sexual minority individuals experience similar prevalence of disorders to Whites. Similar findings are observed using a transdiagnostic factors framework. Conclusions: These findings reveal important intersectional nuances in the prevalence of psychopathology often overlooked in the race/ethnicity and sexual orientation literatures. These results can inform future scholarship on risk and resilience among marginalized populations, including identifying protective factors associated with possessing certain multiple minority statuses.
What is the public health significance of this article?
The prevalence of psychiatric and substance use disorders among sexual minority individuals varies as a function of both race/ethnicity and sexual orientation, with important implications for research, prevention, and intervention. Black, Hispanic, and White sexual minorities report higher prevalence of disorder than heterosexuals. While Black sexual minorities report lower odds of disorder than White sexual minorities, Hispanic and White sexual minorities experience similar prevalence of disorders.
Transdiagnostic factors of mental disorders Krueger, Robert F.; Eaton, Nicholas R.
World psychiatry,
February 2015, 2015-Feb, 2015-02-00, 20150201, Letnik:
14, Številka:
1
Journal Article
Gender Cognition in Transgender Children Olson, Kristina R.; Key, Aidan C.; Eaton, Nicholas R.
Psychological science,
04/2015, Letnik:
26, Številka:
4
Journal Article
Recenzirano
A visible and growing cohort of transgender children in North America live according to their expressed gender rather than their natal sex, yet scientific research has largely ignored this ...population. In the current study, we adopted methodological advances from social-cognition research to investigate whether 5- to 12-year-old prepubescent transgender children (N = 32), who were presenting themselves according to their gender identity in everyday life, showed patterns of gender cognition more consistent with their expressed gender or their natal sex, or instead appeared to be confused about their gender identity. Using implicit and explicit measures, we found that transgender children showed a clear pattern: They viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender (nontransgender) control groups. These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.
Purpose
Classification is the cornerstone of clinical diagnostic practice and research. However, the extant psychiatric classification systems are not well supported by research evidence. In ...particular, extensive comorbidity among putatively distinct disorders flags an urgent need for fundamental changes in how we conceptualize psychopathology. Over the past decade, research has coalesced on an empirically based model that suggests many common mental disorders are structured according to two correlated latent dimensions: internalizing and externalizing.
Methods
We review and discuss the development of a dimensional-spectrum model which organizes mental disorders in an empirically based manner. We also touch upon changes in the DSM-5 and put forward recommendations for future research endeavors.
Results
Our review highlights substantial empirical support for the empirically based internalizing–externalizing model of psychopathology, which provides a parsimonious means of addressing comorbidity.
Conclusions
As future research goals, we suggest that the field would benefit from: expanding the meta-structure of psychopathology to include additional disorders, development of empirically based thresholds, inclusion of a developmental perspective, and intertwining genomic and neuroscience dimensions with the empirical structure of psychopathology.
Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for multiple psychiatric diagnoses. This non-specific pattern of risk may mean that ...childhood maltreatment increases vulnerability to numerous specific psychiatric disorders through diverse, specific mechanisms or that childhood maltreatment engenders a generalised liability to dimensions of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically.
We used a latent variable approach to estimate the associations of childhood maltreatment with underlying dimensions of internalising and externalising psychopathology and with specific disorders after accounting for the latent dimensions. We also examined gender differences in these associations.
Data were drawn from a nationally representative survey of 34 653 US adults. Lifetime DSM-IV psychiatric disorders were assessed using the AUDADIS-IV. Physical, sexual and emotional abuse and neglect were assessed using validated measures. Analyses controlled for other childhood adversities and sociodemographics.
The effects were fully mediated through the latent liability dimensions, with an impact on underlying liability levels to internalising and externalising psychopathology rather than specific psychiatric disorders. Important gender differences emerged with physical abuse associated only with externalising liability in men, and only with internalising liability in women. Neglect was not significantly associated with latent liability levels.
The association between childhood maltreatment and common psychiatric disorders operates through latent liabilities to experience internalising and externalising psychopathology, indicating that the prevention of maltreatment may have a wide range of benefits in reducing the prevalence of many common mental disorders. Different forms of abuse have gender-specific consequences for the expression of internalising and externalising psychopathology, suggesting gender-specific aetiological pathways between maltreatment and psychopathology.
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between ...psychopathology and normality, frequent disorder co‐occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma‐related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
Sexual- and gender-minority individuals experience minority stress, which is hypothesized to underlie the mental-health disparities affecting these populations. Drawing on advances in the ...classification of mental disorders, we argue that transdiagnostic approaches hold great promise for understanding and reducing these disparities. In contrast to traditional diagnostic approaches, which have limited construct validity and have produced a piecemeal literature, transdiagnostic approaches (a) are evidence based, (b) account for diffuse patterns of disparities and comorbidity, (c) pinpoint psychological mechanisms linking minority stress to poor mental health, (d) reduce scientific stigma, and (e) identify efficacious and efficient points of intervention for treatment of negative outcomes of minority stress.
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