This invited symposium focuses on connections between the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium and research on Personality Disorder (PD)
Speakers are professors Krueger, Clark, Forbes, and Rodriguez-Seijas. Professor Andrew Chanen will serve as discussant.
Individual talk abstracts are:
Krueger:
Title: Integrating Nature and Nurture to Understand Personality Disorders: Hierarchical and Dimensional Approaches
Abstract:
Efforts to ameliorate Personality Disorder (PD) represent a key priority for improving overall public health throughout the world.
Historically, there have been extensive discussions about whether PD is more attributable to aspects of a person, such as their genotype, or aspects of a person’s
experiences, such as their rearing environment. This “nature vs. nurture” dichotomy is rapidly
giving way to a more integrated perspective that can help articulate how specific genetic factors
and specific environmental experiences correlate and interact. In this presentation, I will
discuss how nature promotes mental health via nurture, and the role of dimensional and hierarchal
approaches such as HiTOP in integrating genetic and environmental risk factors. I will focus on specific
insights about how nature and nurture can be brought together, via conceptual approaches such as HiTOP, to reduce the burden of PD throughout the population.
Clark:
Title: DSM-5 Alternative Model of Personality Disorder: The Foundation of HiTOP Before it Existed
Abstract:
The modern era of dimensional conceptualization of personality pathology began in the late
1970s, with the development of the Personality Assessment Schedule (Tyrer & Alexander,
1979), but a third of a century passed before a model of personality pathology that
incorporated dimensions was formally recognized in 2013 in the DSM-5 Alternative Model of
Personality Disorder (AMPD), and almost a half-century before the first fully dimensional PD
model became official in the ICD-11. In between the two latter events, HiTOP appeared in the
literature, providing a natural home for the AMPD and the ICD-11 models. This presentation
will focus on the primary AMPD elements of personality dysfunction (Criterion A) and the
Criterion B personality traits through which this dysfunction is manifest. A sample of ~600
outpatients and community-dwelling adults who were screened in for being at high risk for
personality pathology was assessed with both self-report and interview measures of the AMPD,
as well as of the 10 DSM-5 categorical PDs. Interrelations of these two systems will be
presented, and how and where the latter fits naturally within the HiTOP framework will be
demonstrated. Advantages of approaching PD assessment from the dimensional, hierarchical
perspective that HiTOP offers will be discussed.
Forbes:
Title: Rebuilding HiTOP from the ground up: What happens to personality disorders in a
quantitative symptom-level model of the DSM-5?
Abstract:
The Hierarchical Taxonomy of Psychopathology (HiTOP) framework aims to overcome the
limitations of traditional diagnostic categories, such as those described in the Diagnostic and
Statistical Manual of Mental Disorders (e.g., DSM-5). However, much of the evidence
underpinning the dimensions in HiTOP comes from analyses of DSM constructs. What happens
if we break these constructs down to their constituent symptoms, modelling the hierarchical and
dimensional structure that accounts for the patterns in which these symptoms co-occur? Do we
see familiar DSM constructs, HiTOP dimensions, or something else entirely? This presentation
will report the results of a study that aimed to answer these questions, assessing the 664 unique
symptoms that comprise all diagnoses in the DSM-5 in a sample of 14,762 participants (57.2%
living in Australia, mean [SD] age = 38.0 [18.0], 53.4% cisgender women, 68.3% white, 83.0%
with a history of treatment for mental health). Analyses are underway using a combination of
cluster analysis and principal components analysis, and the presentation of the results will focus
on the implications for traditional personality disorder constructs—assessed here via items
adapted from the Personality Inventory for DSM-5 (PID-5) and the Schedule for Nonadaptive
and Adaptive Personality (2 nd Edition; SNAP-II).
Rodriguez-Seijas:
Title: A HiTOP-ian approach to understanding personality pathology among underrepresented
populations.
Abstract:
The Hierarchical Taxonomy of Psychopathology (HiTOP) represents an interpretable
phenotypic hierarchy that describes core domains of psychopathology. The HiTOP model
mirrors domains of maladaptive personality thought to underlie personality disorder diagnoses,
making the HiTOP model useful for understanding personality pathology. The HiTOP model can
be particularly helpful for understanding the nature of the (borderline) personality disorder
diagnosis among populations that are typically underrepresented within the personality disorder
literature. The philosophy of the HiTOP model is useful for disentangling how assumptions
about personality disorders apply to diverse populations. For instance, borderline personality
disorder is more frequently diagnosed among LGBTQ+ populations, but there are potentially
several factors that contribute to this disparity. In this presentation, I will briefly outline a
program of research that explicitly harnesses a HiTOP-congruent approach to investigating the
elevated prevalence of borderline personality disorder among LGBTQ+ persons when compared
with cisgender heterosexual persons. Using current research projects as illustrations, I will
demonstrate how a HiTOP-congruent (i.e., “HiTOP-ian”) approach undergirds our examinations
of potential bias in the provision of the borderline personality disorder diagnosis; contamination
of borderline personality disorder diagnostic criteria with extrinsic variance specific to LGBTQ+
populations; and differential associations between borderline personality disorder symptoms and
HiTOP domains of psychopathology thought to underlie the behaviors.