Clinical utility of categorical and dimensional perspectives on personality pathology: A meta-analytic review.

Bornstein, Robert F.; Natoli, Adam P.

doi:10.1037/per0000365

Cited by 72 publications

(65 citation statements)

References 67 publications

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“…Overall, existing data strongly support clinical utility of the dimensional approach 319,320 . Nevertheless, it is important to expand studies of clinical utility to include frank psychosis and also compare diagnostic systems on objective criteria, such as fostering better treatment outcomes.…”

Section: Utility Evidencementioning

confidence: 97%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

et al. 2020

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The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis‐related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

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Section: Utility Evidencementioning

confidence: 97%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

et al. 2020

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“…Using case vignettes as well as data obtained from actual patients, these studies evaluate the clinical utility of dimensional and categorical frameworks across various dimen sions of utility (e.g., ease of use, utility in communicating with other health professionals, usefulness in formulating a therapeu tic intervention, and usefulness in treatment planning). Recent ly, Bornstein and Natoli 365 summarized this literature and found that dimensional models of PD are rated more positively than categorical models with respect to most areas of clinical utility.…”

Section: Clinical Utilitymentioning

confidence: 99%

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

et al. 2021

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The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within disorders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

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“…Aspects of clinical utility include user acceptability and utility, professional communication, interrater reliability, subtlety of diagnosis, and clinical decision-making [26]. The evidence for the clinical utility of the AMPD is just beginning to be accumulated, with evidence that clinicians prefer the emphasis on dimensional assessment [27].…”

Section: Comparison Of the Ort Model With The Ampdmentioning

confidence: 99%

An Object Relations Model Perspective on the Alternative Model for Personality Disorders (DSM-5)

2020

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The Alternative Model of DSM-5 combines dimensional ratings of self-functioning, interpersonal functioning, and traits with categorical classification. The object relations model has a long tradition pre-dating the Alternative Model and, in part, has been incorporated into the Alternative Model. The object relations model provides a theoretical background (generally missing in the Alternative Model) that enhances the clinical assessment of personality pathology and its relationship to treatment planning.

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Clinical utility of categorical and dimensional perspectives on personality pathology: A meta-analytic review.

Cited by 72 publications

References 67 publications

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

An Object Relations Model Perspective on the Alternative Model for Personality Disorders (DSM-5)

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