Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high ...comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility.
What is the public health significance of this article?
Redefining a taxonomy of psychopathology according to data results in dimensions, not categories, that can be organized hierarchically-with at least six higher level spectra near the top of the model and more specific lower level components and traits at the bottom. This approach may improve case conceptualizations and align more closely with transdiagnostic treatments, while also specifying more narrow targets for intervention. A case illustration shows how the HiTOP model can be used in clinical practice today, although additional research is needed to fully assess the utility of this approach for providers and patients.
This study investigated emotion regulation (i.e., emotional integration, suppression and dysregulation) as a transdiagnostic process underlying adolescents’ internalizing and externalizing symptoms. ...Basic psychological need experiences were investigated as a possible underlying mechanism explaining this association. A heterogeneous sample of non-clinical and clinically-referred adolescents reported upon emotion regulation, basic psychological needs (i.e., need satisfaction and frustration), and both internalizing and externalizing problems. Results indicated that dysfunctional emotion regulation was positively linked to internalizing as well as externalizing problems. Need frustration was a partial mediator in this relation between emotion regulation and psychopathology. The findings suggest that both emotion regulation and basic psychological needs may play a transdiagnostic role in adolescents’ internalizing and externalizing symptoms.
This study proposes and tests an alternative methodology to conceptualize and assess aberrant personality tendencies at work beyond the dark triad. A sample of college alumni (N= 247) were ...administered the NEO PI‐R prior to entering the labor market and 15 years later when their professional careers had unfolded. Drawing on the dimensional perspective on personality functioning, 6 five‐factor model (FFM) aberrant compounds were computed as indicators of aberrant personality tendencies. As expected, FFM aberrant personality tendencies were highly stable across time, with test–retest correlations ranging from .61 (Narcissistic) to .73 (avoidant). With regard to predictive validity, borderline, schizotypal, and avoidant tendencies were negatively associated with extrinsic and intrinsic career outcomes. The obsessive‐compulsive tendency was largely unrelated to career outcomes, whereas individuals with antisocial and narcissistic characteristics tended toward higher hierarchical and financial attainment. In addition, relative importance analyses indicated that (a) FFM aberrant personality tendencies showed incremental validity in the prediction of career outcomes beyond FFM general traits, and that (b) both FFM general and FFM aberrant personality tendencies are important predictors when considered jointly. It is concluded that FFM aberrant personality tendencies suggest interesting avenues for personnel psychologists to form new linear combinations of FFM facets, complementing FFM general domains.
Emotional dysregulation in childhood has been associated with various forms of later psychopathology, although no studies have investigated the personality related adolescent outcomes associated with ...early emotional dysregulation. The present study uses a typological approach to examine how the child behavior checklist-dysregulation profile (CBCL-DP) predicts DSM-5 pathological personality traits (as measured with the personality inventory for the diagnostic and statistical manual of mental disorders 5 or PID-5 by Krueger et al. (Psychol Med
2012
)) across a time span of 4 years in a sample of 243 children aged 8–14 years (57.2 % girls). The results showed that children assigned to the CBCL-DP class are at risk for elevated scores on a wide range of DSM-5 personality pathology features, including higher scores on hostility, risk taking, deceitfulness, callousness, grandiosity, irresponsibility, impulsivity and manipulativeness. These results are discussed in the context of identifying early manifestations of persistent regulation problems, because of their enduring impact on a child’s personality development.
Antecedents of personality disorder in childhood and adolescence have been a neglected area in official taxonomies of mental disorders such as the International Classification of Diseases or the ...different editions of the Diagnostic and Statistical Manual of Mental Disorders. An evolving research field, however, underscores the importance of antecedents for understanding psychopathology and personality pathology in adulthood. The current article summarizes the history, updates reviews, and incorporates new research findings into an integrative scheme for conceptualizing personality pathology in childhood and adolescence. Implications of this model for assessment, future research, and intervention are discussed.
This study examines 5 types of personality continuity-structural, mean-level, individual-level, differential, and ipsative-in a representative population (
N
= 498) and a twin and sibling sample (
N
...= 548) of children and adolescents. Parents described their children on 2 successive occasions with a 36-month interval using the Hierarchical Personality Inventory for Children (
I. Mervielde & F. De Fruyt, 1999
). There was evidence for structural continuity in the 2 samples, and personality was shown to be largely differentially stable. A large percentage had a stable trait profile indicative of ipsative stability, and mean-level personality changes were generally small in magnitude. Continuity findings were explained mainly by genetic and nonshared environmental factors.
The present contribution reviews evidence that supports the relevance of childhood antecedents of personality disorders, and advocates that the validity of a Five‐Factor Model framework for ...describing general trait differences in childhood can be extended towards the field of developmental personality difficulties. In addition, we suggest that several traditional childhood Axis I conditions include a substantial trait component that may be responsible for the recurring finding that childhood Axis I disorders are predictive for adult Axis II disorders. Given the valuable information provided by a trait assessment, we further propose to integrate dimensional personality and personality pathology measures as standard tools in mental health assessments at a young age.
The inclusion of a dimensional trait model of personality pathology in DSM-5 creates new opportunities for research on developmental antecedents of personality pathology. The traits of this model can ...be measured with the Personality Inventory for DSM-5 (PID-5), initially developed for adults, but also demonstrating validity in adolescents. The present study adds to the growing body of literature on the psychometrics of the PID-5, by examining its structure, validity, and reliability in 187 psychiatric-referred late adolescents and emerging adults. PID-5, Big Five Inventory, and Kidscreen self-reports were provided, and 88 non-clinical matched controls completed the PID-5. Results confirm the PID-5's five-factor structure, indicate adequate psychometric properties, and underscore the construct and criterion validity, showing meaningful associations with adaptive traits and quality of life. Results are discussed in terms of the PID-5's applicability in vulnerable populations who are going through important developmental transition phases, such as the step towards early adulthood.
This study investigated the protective role of maternal adaptive emotion regulation in applying controlling parenting practices while assisting their toddler in completing two different ...problem-solving tasks. More specifically, the role of maternal emotion regulation was examined relative to significant situational (i.e., task difficulty) and child-related (i.e., toddlers’ temperamental negative affectivity) risk factors for controlling parenting. Results showed that (1) mothers’ integrative emotion regulation was negatively related to observed maternal control across tasks, (2) mothers were more controlling during a difficult task compared to an easy task, and (3) toddlers’ temperamental negative affectivity related positively to the use of observed maternal control, albeit only during a difficult task. These results highlight the relevance of maternal emotion regulation processes during parenting practices beyond contextual and temperamental correlates. Directions for future research and clinical implications are discussed.
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