Abstract
Hierarchical dimensional systems of psychopathology promise more informative descriptions for understanding risk and predicting outcome than traditional diagnostic systems, but it is unclear how many major dimensions they should include. We delineated the hierarchy of childhood and adult psychopathology and validated it against clinically relevant measures. Participants were 9987 9- and 10-year-old children and their parents from the Adolescent Brain Cognitive Development (ABCD) study. Factor analyses of items from the Child Behavior Checklist and Adult Self-Report were run to delineate hierarchies of dimensions. We examined the familial aggregation of the psychopathology dimensions, and the ability of different factor solutions to account for risk factors, real-world functioning, cognitive functioning, and physical and mental health service utilization. A hierarchical structure with a general psychopathology (‘p’) factor at the apex and five specific factors (internalizing, somatoform, detachment, neurodevelopmental, and externalizing) emerged in children. Five similar dimensions emerged also in the parents. Child and parent p-factors correlated highly (r = 0.61, p < 0.001), and smaller but significant correlations emerged for convergent dimensions between parents and children after controlling for p-factors (r = 0.09−0.21, p < 0.001). A model with child p-factor alone explained mental health service utilization (R2 = 0.23, p < 0.001), but up to five dimensions provided incremental validity to account for developmental risk and current functioning in children (R2 = 0.03−0.19, p < 0.001). In this first investigation comprehensively mapping the psychopathology hierarchy in children and adults, we delineated a hierarchy of higher-order dimensions associated with a range of clinically relevant validators. These findings hold important implications for psychiatric nosology and future research in this sample.
Highlights
1234567890():,; 1234567890():,; 1234567890():,; 1234567890():,; Introduction Traditional psychiatric nosologies define mental disorders as distinct categories[1,2], but this is at odds with extensive evidence that disorders lie on a continuum with normality and are highly comorbid[3,4,5,6,7]
The Michelini et al Translational Psychiatry (2019)9:261 recently developed Hierarchical Taxonomy of Psychopathology (HiTOP)[7,8] includes six spectra, which were identified based on extensive factor analytic literature
We further found substantial familiality of the identified psychopathology factors, largely explained by familial aggregation of the p-factor
Summary
Traditional psychiatric nosologies define mental disorders as distinct categories[1,2], but this is at odds with extensive evidence that disorders lie on a continuum with normality and are highly comorbid[3,4,5,6,7]. This comorbidity reflects underlying higher-order dimensions (or spectra) of psychopathology[4,7,8,9]. The Michelini et al Translational Psychiatry (2019)9:261 recently developed Hierarchical Taxonomy of Psychopathology (HiTOP)[7,8] includes six spectra (internalizing, somatoform, detachment, thought disorder, antagonism, and disinhibition), which were identified based on extensive factor analytic literature (for a review, see ref. 8)
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