See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/339283673

Maximizing the applied value of structural models of psychopathology:

Introduction to a special issue of Personality and Mental Health

Article  in  Personality and Mental Health · February 2020

DOI: 10.1002/pmh.1474

CITATIONS READS

12 2,809

2 authors:

Christopher Callahan Conway Leonard J Simms

Fordham University University at Buffalo, The State University of New York
53 PUBLICATIONS   3,303 CITATIONS    100 PUBLICATIONS   7,348 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Latent Structure of Narcissistic Personality Disorder View project

MMPI-2-RF work View project

All content following this page was uploaded by Leonard J Simms on 05 November 2020.

The user has requested enhancement of the downloaded file.

Personality and Mental Health
14: 3–8 (2020)
Published online in Wiley Online Library
(wileyonlinelibrary.com) DOI 10.1002/pmh.1474

Maximizing the applied value of structural

models of psychopathology: Introduction to a
special issue of Personality and Mental Health

CHRISTOPHER C. CONWAY1 AND LEONARD J. SIMMS2, 1Department of Psychology, Fordham

University, Bronx, NY, USA; 2Department of Psychology, University at Buffalo, The State Univer-
sity of New York, Buffalo, NY, USA

ABSTRACT
Structural models of mental illness delineate the major phenotypic dimensions of psychopathology. These
evidence-based models, such as the Hierarchical Taxonomy of Psychopathology, are poised to supplement—
and even supplant—categorical diagnostic systems in research, assessment and treatment arenas. This special
issue of Personality and Mental Health explores a new wave of research into structural models’ utility for theory
testing and clinical practice. Can structural approaches advance etiological research by clarifying connections be-
tween psychopathology and social, cultural, psychological and biological vulnerability processes? Can dimen-
sional models of mental illness assimilate consensus models of temperament and personality? Can this
paradigm identify optimal treatment targets and guide treatment design and selection? The studies compiled here
all look beyond nosology to understand how structural models are changing research and clinical landscapes in
mental health disciplines. We envision this set of articles as a blueprint for further investigation into the config-
uration, research utility and clinical application of structural approaches to diagnostic classification. © 2020 John
Wiley & Sons, Ltd.

For over a century, categorical diagnoses have
been the foundation of mental health research
and practice. Now is an exciting time to study no-
sology because this categorical hegemony may be
receding. Policy changes have put the focus on al-
ternative dimensional rubrics. The American Psy-
chiatric Association published a dimensional
model of personality disorder in Diagnostic and Sta-
tistical Manual of Mental Disorders, Fifth Edition
(DSM-5), albeit in a provisional chapter.1 The
US National Institute of Mental Health launched
the Research Domain Criteria (RDoC) initiative,
which prioritizes continuously distributed neurobi-
ological correlates of mental illness, and the Na-
tional Institute on Drug Abuse and National
Institute on Alcohol Abuse and Alcoholism
followed suit with parallel phenotyping efforts for
substance misuse.2
This wave of enthusiasm for dimensional ap-
proaches is a response—some would argue a de-
layed response—to serious psychometric problems
with categorical nomenclatures. Categorical

© 2020 John Wiley & Sons, Ltd. 14: 3–8 (2020)

DOI: 10.1002/pmh
4 Christopher C. Conway and Leonard J. Simms
psychological conditions are excessively
comorbid, heterogeneous and unable to capture
the diverse range of problems encountered in the
clinic.3 These flaws, and numerous others, have
been acknowledged for decades, especially in the
personality disorder domain. The field now seems
poised to take action and supplement, or even sup-
plant, antiquated categorical nosologies with con-
temporary dimensional systems.
Structural models of mental illness are a big
part of the dimensional landscape. They define
phenotypic dimensions on the basis of a
quantitative analysis of correlations among
observed symptoms. Using factor analysis and
related tools, researchers derive the unobserved
phenotypic dimensions that form the scaffolding
for manifest psychopathology. This empirically
based, or bottom-up, method contrasts with
authoritative, often political, processes guiding
the development of modern classification systems,
such as the DSM, and, to a smaller extent,
RDoC.4
An international group of mental health re-
searchers—called the Hierarchical Taxonomy of
Psychopathology (HiTOP) consortium—recently
assembled to advance this quantitative perspec-
tive on nosology. They are working to construct
a comprehensive model of the latent dimensions
underpinning mental illness.5 The HiTOP work-
ing model is anchored by internalizing and exter-
nalizing dimensions, which initially were
described decades ago in the developmental psy-
chopathology literature. Internalizing represents
the common thread through anxiety, depression
and somatic, sexual and eating problems,
whereas externalizing is the substrate for sub-
stance misuse and antisocial behavior.5 These
fundamental constructs have been replicated
across developmental stages, demographic
groups and regions of the world.4 When a
broader array of symptoms is examined in factor
analyses of common clinical problems, other di-
mensions emerge alongside (or within) internal-
izing and externalizing, such as dimensions
reflecting somatoform, antagonistic externalizing,
© 2020 John Wiley & Sons, Ltd.
disinhibited externalizing, detachment and
thought disorder symptoms.5
The HiTOP model is hierarchical. This struc-
ture reflects the perspective that psychopathology
can be understood at various levels of breadth.
Heterogeneous constructs, such as internalizing
and externalizing dimensions, are located near
the top of the HiTOP model (Figure 1). Closer
to the bottom are more homogeneous dimensions,
such as symptom components (e.g. relational ag-
gression) and maladaptive traits (e.g. affective la-
bility). These fine-grained elements form the
building blocks of mental illness. The structure
of psychopathology therefore mirrors that of per-
sonality, which also is hierarchical. For instance,
the Big Three personality dimensions (Negative
Emotionality, Positive Emotionality and Disinhi-
bition) can be understood, in higher resolution,
as the Big Five, which in turn manifest in various
trait facets.6
The first phase of research on structural models
has concentrated on model configuration. What
are the number and nature of dimensions needed
to parsimoniously explain (co)variation in com-
mon forms of mental illness? Figure 1 presents
the current HiTOP conceptualization, which is
based on decades of factor analytic work across a
wide range of populations and assessment routines.
Despite a strong data base for this model, quantita-
tive nosology remains a work in progress. The
model probably will expand (vertically and hori-
zontally) as other symptom sets (e.g.
neurodevelopmental disorders) are incorporated.
Provisional dimensions (e.g. somatoform) might
be added or subtracted depending on performance
in future structural research.
Even as the structure of quantitative models is
solidified via iterative testing, these frameworks
face other scientific challenges. A replicable di-
mensional model of psychological problems is, in
some ways, just a starting point of a broader re-
search agenda. Structural models are not just noso-
logical tools; they have many potential uses, such
as advancing etiological research and identifying
novel treatment targets. These functions generally
14: 3–8 (2020)
DOI: 10.1002/pmh
 Structural models of psychopathology 5

Figure 1: Hierarchical Taxonomy of Psychopathology (HiTOP) consortium working model. Constructs higher in the figure
are broader and more general, whereas constructs lower in the figure are narrower and more specific. Dashed lines denote pro-
visional elements requiring further study. At the lowest level of the hierarchy (i.e. traits and symptom components), for heu-
ristic purposes, conceptually related signs and symptoms (e.g. phobia) are indicated in bold, with specific manifestations
indicated in parentheses. Abbreviations: ADHD, attention-deficit/hyperactivity disorder; GAD, generalized anxiety disorder;
IED, intermittent explosive disorder; MDD, major depressive disorder; OCD, obsessive–compulsive disorder; ODD, opposi-
tional defiant disorder; SAD, separation anxiety disorder; PD, personality disorder; PTSD, post-traumatic stress disorder
[Colour figure can be viewed at wileyonlinelibrary.com]

relate to the criterion validity and clinical translation
of the model’s component dimensions, and they
remain largely untested. This special issue of Per-
sonality and Mental Health explores these new fron-
tiers for structural models of psychopathology.
Several of the articles in this issue investigate
the utility of the HiTOP model for research prog-
ress and clinical service delivery. Laceulle et al.7
examine the longitudinal correlates of latent di-
mensions of psychopathology in an adolescent
sample. This project builds on a burgeoning line
of research that explores whether quantitative di-
mensions are superior to categorical disorders in
predicting life outcomes—in this case, a diverse
range of economic, social and clinical variables
in the Tracking Adolescents’ Individual Lives Sur-
vey. This article additionally addresses the contro-
versial general factor of psychopathology,
presumed to pervade all expressions of mental ill-
ness, at the apex of the HiTOP model.8 The con-
struct validity of this general factor is a pressing
dilemma for psychometricians, applied researchers
and clinicians alike.
Perkins et al.9 take a broader view of the
research utility of the HiTOP system in their
narrative review of HiTOP’s potential to
illuminate the psychophysiological correlates of
psychopathology. Perkins et al. argue that
empirically derived, dimensional phenotypes are
better positioned, compared to categorical diagno-
ses, to characterize the clinical expression of psy-
chophysiological vulnerabilities. More broadly,
this article tackles the important question of how
HiTOP and other structural models of mental ill-
ness can interface with, or complement, biologi-
cally oriented frameworks for mental illness, such
as RDoC.
The philosophy behind structural models has
major implications for clinical practice. For one,
the higher-order dimensional architecture of these
models suggests that treatment might be more effi-
cient if it targets broadband vulnerabilities to
mental illness, rather than particular categorical
conditions. This logic has begun to influence
treatment design.10 Transdiagnostic psychother-
apies have shown promise in initial studies.11

© 2020 John Wiley & Sons, Ltd. 14: 3–8 (2020)

DOI: 10.1002/pmh
6 Christopher C. Conway and Leonard J. Simms
These treatment packages address the latent psy-
chopathology processes underlying a range of
DSM conditions. The hypothesis is that interven-
ing on these higher-order dimensions (e.g. inter-
nalizing) will remediate the various manifest
conditions dependent on those dimensions (e.g.
panic disorder, social phobia, persistent depressive
disorder and borderline personality disorder).
Drawing on diverse psychotherapy traditions,
Mullins-Sweatt et al.12 provide recommendations
for treatment strategies that could make the big-
gest impact on each of five higher-order HiTOP
constructs: internalizing, antagonistic externaliz-
ing, disinhibited externalizing, thought disorder
and detachment.
Along these same lines, Clark and colleagues13
discuss the potential value of using evidence-
based personality profiles as targets for psycholog-
ical interventions. Using a structural model de-
rived from both personality disorder traits and
dimensions of impaired functioning, Clark et al.
identified three groups of individuals with differ-
ent profiles of scores and suggested different treat-
ment approaches thought to optimally address
each group’s pattern of personality and function-
ing deficits. Clark et al. and Mullins-Sweatt
et al. sketch the outline of a research agenda that
can test out the utility of empirically derived
treatment targets.
Another frontier for quantitative models is
structural alignment with consensus models of
personality. Decades of research confirm that
temperament and personality dimensions are
linked robustly with various mental disorders.
Indeed, there is strong theoretical support for
personality forming the foundation of manifest
psychopathology.14 As alluded to by Mullins-
Sweatt et al.,12 this relationship suggests that per-
sonality should be closely intertwined with the
HiTOP constructs. But empirical research into
the pattern and size of those connections is in its
early stages. A subset of articles in this issue ad-
vances that line of inquiry.
Watson and Clark15 review evidence establish-
ing important parallels between the general
© 2020 John Wiley & Sons, Ltd.
structure of psychopathology, personality pathol-
ogy and normal-range personality. Using data from
both normal-range and maladaptive personality
assessment models, Watson and Clark demon-
strate substantial links between these historically
separate theoretical frameworks and point to ways
to enhance the alignment of the alternative model
of personality disorder with the five-factor model.
Such data contribute to the substantial literature
showing that psychopathology and personality
can be understood within a common structural
model.
Similarly, Sellbom et al.16 examine correlations
among HiTOP dimensions—namely, internaliz-
ing, externalizing and thought disorder—and
pathological trait domains represented in the
DSM-5 alternative model of personality disorder.
They found that, in a representative sample of
Australians, personality disorder domains had ex-
pected patterns of association with quantitative
psychopathology dimensions. For instance, nega-
tive affectivity, psychoticism and disinhibition
were closely linked with internalizing, thought dis-
order and externalizing respectively. More re-
search is needed along these lines to establish the
joint architecture of personality and
psychopathology.
Longenecker et al.17 furthered the discussion of
the links between personality and psychopathol-
ogy through a specific focus on personality traits
across the psychosis spectrum, which is a relatively
understudied segment of the structural psychopa-
thology literature. Longenecker et al. studied
whether expressing heterogeneous psychotic
symptom sets in terms of personality traits
might be superior to categorical rubrics. In a
psychiatric sample, they showed that facet-level
traits had diverse associations with existing
clinical syndromes, suggesting they have utility
for quantifying separable symptom dimensions
that cut across existing diagnoses. This finding
has important implications for nosology and, as
the authors argue, for underlying mechanisms
and treatment targets in the thought disorder
domain.
14: 3–8 (2020)
DOI: 10.1002/pmh

A final paper in this special issue explored the
understudied issue of mental health disparities
and how a hierarchical, dimensional classification
system might hold promise for better understand-
ing the nature of such disparities in diverse groups
of patients. Eaton18 described the current status of
metal health disparities research, how traditional
classification approaches might limit research
progress in this domain and how dimensional clas-
sification approaches could lead to new insights
and advances.
In sum, we view this collection of articles as sig-
nalling progress in the study of dimensional
models of psychopathology. The field is
expanding. Its ideas are reaching a broader audi-
ence of researchers in a variety of substantive re-
search areas. There are indications across
subfields that a dimensional perspective is helping
researchers learn more from their data. Also, there
is growing evidence that dimensional phenotypes
are superior clinical targets, although much more
theoretical and dissemination work is needed to
determine how best to implement this model into
everyday practice. More generally, we believe this
group of articles can serve as a guide for future re-
search and clinical activity oriented around evi-
dence-based dimensional perspectives. This new
wave of research will tell us to what extent turning
to a hierarchical, dimensional model of psychopa-
thology can lead to new insights, sounder evi-
dence and more effective practice in mental
health disciplines.
References
1. American Psychiatric Association. Diagnostic and Statisti-
cal Manual of Mental Disorders, 5th Edition. Author,
2013.
2. Insel TR, & Cuthbert BN. Brain disorders? Precisely. Sci-
ence 2015; 348: 499–500.
3. Clark LA, Cuthbert BN, Lewis-Fernández R, Narrow
WE, Reed GM. Three approaches to understanding and
classifying mental disorder: ICD-11, DSM-5, and the Na-
tional Institute of Mental Health’s Research Domain
Criteria (RDoC). Psychological Science in the Public Inter-
est 2017; 18: 72–145.
© 2020 John Wiley & Sons, Ltd.
Structural models of psychopathology 7
4. Krueger RF, Kotov R, Watson D, Forbes MK, Eaton NR,
Ruggero CJ et al. Progress in achieving quantitative clas-
sification of psychopathology. World Psychiatry 2018; 17:
282–93.
5. Kotov R, Krueger RF, Watson D, Achenbach TM,
Althoff RR, Bagby RM et al. The Hierarchical Taxon-
omy of Psychopathology (HiTOP): a dimensional alter-
native to traditional nosologies. Journal of Abnormal
Psychology 2017; 126: 454–77.
6. Markon KE, Krueger RF, Watson D. Delineating the
structure of normal and abnormal personality: an integra-
tive hierarchical approach. Journal of Personality and So-
cial Psychology 2005; 88: 139–57.
7. Laceulle OM, Vollebergh WAM, Chung JM, Ormel J.
The wide-ranging life outcome correlates of a general
psychopathology factor in adolescent psychopathology.
Personality and Mental Health This issue.
8. Lahey BL, Krueger RF, Rathouz PJ, Waldman ID,
Zald DH. A hierarchical causal taxonomy of psychopa-
thology across the life span. Psychological Bulletin 2017;
143: 142–86.
9. Perkins ER, Latzman RD, Patrick CJ. Interfacing neural
constructs with the Hierarchical Taxonomy of Psychopa-
thology: “why” and “how”. Personality and Mental Health
This issue.
10. Ruggero CJ, Kotov R, Hopwood CJ, First M, Clark LA,
Skodol AE et al. Integrating the Hierarchical Taxonomy
of Psychopathology (HiTOP) into clinical practice. Jour-
nal of Consulting and Clinical Psychology 2019; 87: 1069.
11. Barlow DH, Farchione TJ, Bullis JR, Gallagher MW,
Murray-Latin H, Sauer-Zavala S et al. The unified proto-
col for transdiagnostic treatment of emotional disorders
compared with diagnosis-specific protocols for anxiety
disorders: a randomized clinical trial. JAMA Psychiatry
2017; 74: 875–84.
12. Mullins-Sweatt SN, Hopwood CJ, Chmielewski M,
Meyer NA, Min J, Helle AC. Treatment of personality
through the lens of the Hierarchical Taxonomy of Psy-
chopathology. Personality and Mental Health This issue.
13. Clark LA, Nuzum H, Shapiro JL, Vanderbleek EN, Daly
EJ, Simons AD et al. Personality profiles as potential tar-
gets for specific interventions: identification and replica-
tion. Personality and Mental Health This issue.
14. Clark LA. Temperament as a unifying basis for personal-
ity and psychopathology. Journal of Abnormal Psychology
2005; 114: 505–21.
15. Watson D, & Clark LA. Personality traits as an organiz-
ing framework for personality pathology. Personality and
Mental Health This issue.
16. Sellbom M, Carragher N, Sunderland M, Calear A,
Batterham P. The role of maladaptive personality do-
mains across multiple levels of the HiTOP structure. Per-
sonality and Mental Health This issue.
14: 3–8 (2020)
DOI: 10.1002/pmh
8 Christopher C. Conway and Leonard J. Simms

17. Longenecker JM, Krueger RF, Sponheim SR. Personality Address correspondence to: Christopher C. Con-
traits across the psychosis spectrum: a HiTOP conceptu- way, Department of Psychology, Fordham Univer-
alization of clinical symptomatology. Personality and
Mental Health This issue.
sity, 226 Dealy Hall, 441 East Fordham Road,
18. Eaton NR. Measurement and mental health disparities: Bronx, NY 10458, USA. Email:
psychopathology classification and identity assessment. cconway26@fordham.edu
Personality and Mental Health This issue.

© 2020 John Wiley & Sons, Ltd. 14: 3–8 (2020)

DOI: 10.1002/pmh

View publication stats