Personality traits across the psychosis spectrum: A Hierarchical Taxonomy of Psychopathology conceptualization of clinical symptomatology

Abstract

Psychotic disorders have varied clinical presentations, diagnostic stability is poor and other mental disorders often co‐occur with the conditions. To improve the clinical and pathophysiological utility of classification systems for psychosis, it is necessary to consider how symptoms may reflect dimensions of psychopathology that extend beyond the boundaries of traditional diagnostic classifications. We examined personality deviation as a means for explaining symptom variation across individuals with serious mental illness. Participants (N = 312) with psychosis, first‐degree biological relatives and healthy controls underwent comprehensive clinical evaluations that included symptom ratings and Diagnostic Statistical Manual consensus diagnoses. They completed the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PID‐5), which provides multidimensional assessment of personality disturbances and characterizes psychosis‐relevant phenomena, and the Schizotypal Personality Questionnaire (SPQ), a widely accepted measure of schizotypal traits. PID‐5 was comparable with SPQ in differentiating between participants with and without psychosis. Greater psychotic symptomatology and higher scores on the SPQ Cognitive–perceptual dimension were associated with higher scores on PID‐5 Psychoticism. Facet‐level traits showed diverse associations with existing clinical syndromes, suggesting they have utility for quantifying separable symptom dimensions that cut across existing disorders. Yet the patient groups were similar across four of the five PID‐5 personality trait domains, indicating shared patterns of personality expression that challenge existing categorical delineations. © 2019 John Wiley & Sons, Ltd.

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

“…Detachment has a specific association with schizoid personality disorder, as well as weaker links to avoidant and schizotypal personality disorders 23,26,80,94,95 . Both traits are tightly linked to schizophrenia 24,96 . Overall, cross‐sectional data suggest that these traits underpin thought disorder and detachment spectra.…”

“…The thought disorder spectrum describes individual differences that range from conventional and uncreative thinking to perception and cognition that are only tenuously based in reality. It includes both positive symptoms and the personality trait of psychoticism, also known as positive schizotypy 22‐27 . The label “thought disorder” aims to capture these diverse elements and is distinct from formal thought disorder (i.e., incoherent thought and discourse), which is one of many symptoms in the spectrum.…”

Retiring Categorical Systems and the Biomedical Model of Mental Illness: The Why and the How—A Clinician’s Perspective

“…Dimensional models of psychopathology are becoming increasingly popular in mental health research. This has been a response to better reflect symptoms that cut across or transcend the boundaries offered by traditional diagnostic categories, and comorbidity among mental psychopathology (Longenecker et al, 2020). This new dimensional system offers a superior approach to mental health compared to traditional and dominant categorical diagnostic approaches such as those codified in the DSM and ICD systems (Conway et al, 2019).…”

“…internalizing and externalizing disorders) and the general factor of psychopathology (Lahey et al, 2017). Arguably, the Hierarchical Taxonomy of Psychopathology (HiTOP) model is the most influential thus far (Longenecker et al, 2020).…”

Maximizing the applied value of structural models of psychopathology: Introduction to a special issue of Personality and Mental Health

“…Longenecker et al furthered the discussion of the links between personality and psychopathology through a specific focus on personality traits across the psychosis spectrum, which is a relatively understudied segment of the structural psychopathology literature. Longenecker et al studied whether expressing heterogeneous psychotic symptom sets in terms of personality traits might be superior to categorical rubrics.…”