Classification Of Psychopathology Research Articles

A Transdiagnostic, Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI).

Psychopathology, including depression, anxiety, and post-traumatic stress, is a significant yet inadequately addressed feature of moderate-severe traumatic brain injury (TBI). Progress in understanding and treating post-TBI psychopathology may be hindered by limitations associated with conventional diagnostic approaches, specifically the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD). The Hierarchical Taxonomy of Psychopathology (HiTOP) offers a promising, transdiagnostic alternative to psychiatric classification that may more effectively capture the experiences of individuals with TBI. However, HiTOP lacks validation in the TBI population. To address this gap, we administered a comprehensive questionnaire battery, including 56 scales assessing homogeneous symptom components and maladaptive traits within HiTOP, to 410 individuals with moderate-severe TBI. We evaluated the reliability and unidimensionality of each scale and revised those with psychometric problems. Using a top-down, exploratory latent variable approach (bass-ackwards modeling), we subsequently constructed a hierarchical model of psychopathological dimensions tailored to TBI. The results showed that, relative to norms, participants with moderate-severe TBI experienced greater problems in the established HiTOP internalizing and detachment spectra, but fewer problems with thought disorder and antagonism. Fourteen of the 56 scales demonstrated psychometric problems, which often appeared reflective of the TBI experience and associated disability. The Hierarchical Taxonomy of Psychopathology Following Traumatic Brain Injury (HiTOP-TBI) model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. This study presents the most comprehensive empirical classification of psychopathology after TBI to date. It introduces a novel, TBI-specific transdiagnostic questionnaire battery and model, which addresses the limitations of conventional DSM and ICD diagnoses. The empirical structure of psychopathology after TBI largely aligned with the established HiTOP model (e.g., a detachment spectrum). However, these constructs need to be interpreted in relation to the unique experiences associated with TBI (e.g., considering the injury's impact on the person's social functioning). By overcoming limitations of conventional diagnostic approaches, the HiTOP-TBI model has the potential to accelerate our understanding of the causes, correlates, consequences, and treatment of psychopathology after TBI.

Meta-Analytic Review of Temperamental Correlates of the Five-Factor Model and Hierarchical Taxonomy of Psychopathology Domains.

There is little and heterogeneous knowledge on the links between the temperamental predispositions of psychopathology and the contemporary dimensional models of psychopathology, such as the Hierarchical Taxonomy of Psychopathology (HiTOP) classification system, which can be aligned with the five-factor model (FFM) of personality. This meta-analysis seeks to expand the temperamental theoretical basis of the HiTOP model by incorporating associations of temperament traits of two temperamental theories measured, respectively, by the Temperament and Character Inventory (TCI) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) with (a) the FFM's personality domains and (b) HiTOP's five psychopathological spectra. A systematic search was done on Web of Science, Scopus, PubMed, ProQuest, Cochrane Database, and Google Scholar for all articles published in English from January 1990 to August 2020. Because of heterogeneity in the results of almost 70% of studies, pooled estimates of correlation coefficients were calculated using the random-effects method. Risk of bias (low-quality studies) and publication bias are reported. The pooled correlations obtained from the analysis of 35 studies showed that the temperamental profile associated with each FFM domain and HiTOP spectra is distinct. Specifically, TCI-harm avoidance (HA) and all TEMPS temperaments were more strongly related to neuroticism/internalizing, extraversion/low detachment, and conscientiousness/disinhibition. In contrast, TCI-novelty seeking was more strongly related to both disinhibited/antagonistic externalizing and thought disorder. A large body of research supports maladaptive variants of all FFM domains and some psychopathological spectra of HiTOP related to the abnormal-range temperaments.

Construct and criterion validity of the HiTOP spectra to predict dimensional and categorical somatization in a large non-western sample

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a phenotypic data-driven framework for the classification of psychopathology. We tested the construct and criterion validity of the HiTOP spectra measured by the Personality Inventory for DSM-5 (PID-5) using exploratory structural equation modeling (ESEM) and hierarchical regressions both to predict somatic symptom and related disorders (SSRD) and a somatization factor. The case–control study used hierarchical logistic regressions to distinguish 257 cases with SSRD from 1007 healthy controls by both the maladaptive and the temperament factors. The extracted factors were also used in hierarchical linear regressions to predict the dimensional somatization factor. The seven temperament factors explained more variance above and beyond the five maladaptive factors when predicting SSRD (pseudo R2 = 0.169 to 0.266 versus 0.125 to 0.196; change in pseudo R2 = 0.055 to 0.087 versus 0.011 to 0.017). The temperament factors also explained more variance above and beyond the maladaptive factors when predicting the somatization factor (R2 = 0.392 versus 0.269; change in R2 = 0.146 versus 0.023). Although the HiTOP spectra measured by PID-5 are significant structures related to the categorical and dimensional measurements of somatoform, our findings highlight potential problems with both the construct and criterion validity of the HiTOP spectra.

The structure of antagonism: A hierarchical model of self- and interview-rated psychopathology.

Recent initiatives in the empirically based classification of psychopathology, namely, the Hierarchical Taxonomy of Psychopathology (HiTOP), have made significant strides in addressing the limitations of traditional taxonomies (i.e., Diagnostic and Statistical Manual of Mental Disorders, International Classification of Diseases). The current study aimed to extend this work by helping to clarify the lower order structure of an understudied dimension of psychopathology-antagonism (i.e., HiTOP antagonistic externalizing spectrum)-a core feature of many externalizing disorders and related to important outcomes such as interpersonal problems, childhood conduct problems, and incarceration. We examined the hierarchical structure of several measures of antagonistic externalizing features across both self-report and clinical interview ratings for 2,279 community participants with a diverse range of personality pathology (~75% with a personality disorder) and antagonistic behaviors (~30% with intermittent explosive disorder). Exploratory structural equation modeling was used to account for the shared variance between variables within self-report and interview methods. Results revealed an optimal lower order structure consisting of six factors labeled Antisociality, Anger, Hostility, Narcissism, Mistrust, and Attention Seeking. Factor scores yielded expected relations with self-report and interview ratings of psychopathology, personality, and childhood trauma. Implications for future research in classification and treatment of psychopathology are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Diversity and the Hierarchical Taxonomy of Psychopathology (HiTOP)

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology that was created in response to the limitations of traditional, categorical psychiatric classification frameworks. The HiTOP model has become increasingly popular in clinical psychology and psychiatry since its publication in 2017. In this Review, we consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations. We first review the philosophy underlying psychopathology research in general to understand the impact of scientific norms on the inclusion of diverse populations within the research canon. We then review the HiTOP approach to modelling psychopathology, and how diverse populations have been included within HiTOP-related research to date. We conclude by highlighting ways for future research to increase the applicability of the HiTOP framework to diverse populations. Seriously engaging with the HiTOP model’s suitability for diverse, underrepresented and epistemically excluded populations is imperative in order to achieve the HiTOP consortium’s goal of delineating a fully empirical classification of psychopathology, and to provide a model that can guide the field of psychopathology research and training to increase representation. The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based, hierarchical model of the structure of psychopathology. In this Review, Rodriguez-Seijas et al. consider the applicability of the HiTOP model to diverse, underrepresented and epistemically excluded populations.

Heterotypic patterns, psychopathology beyond symptomatology, and the legacy constructs of the DSM-ICD.

This article extends the ideas expressed in a special section on theories of psychopathology by expounding on heterotypic patterns in which different arrangements of symptoms appear over time. With heterotypic continuity, the different arrangements are somewhat predictable; with discontinuity, they are not. Among the reasons the articles in the special section give for heterotypic patterns are the lack of central controllers for producing symptom clusters, the importance of transdiagnostic factors, and the dynamics of gene-environment correlations. The articles also consider what more there is to psychopathology than symptoms-largely by modeling normal, adaptive psychology as flexible and maladaptive psychology too rigid or too pliable. The articles espouse a variety of views on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) legacy disorders moving forward, with some of them seeking to eliminate DSM-ICD categories from the classification of psychopathology and others seeing the DSM-ICD constructs as having continued roles to play. I use Lakatos' notion that elimination of a theory requires that an alternative theory demonstrate competitive superiority to account for why legacy constructs have not been eliminated. I examine a debate about the existence or not of basic emotions and apply it to psychopathology to identify a common ground or potential point of agreement between those who want to eliminate DSM-ICD categories and those who believe DSM-ICD constructs can continue to be useful moving forward. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Linking non-suicidal self-injury to psychopathology: The utility of transdiagnostic and DSM-based models

Non-suicidal self-injury (NSSI) is a significant public health concern, and its primary formal link to the universe of psychopathology content in DSM diagnoses has been mostly through borderline personality disorder (BPD). Recent research has produced ample evidence of weaknesses of diagnoses relative to transdiagnostic psychopathology dimensions, and found that NSSI-related variables like suicidality are best predicted by transdiagnostic versus diagnosis-based variables. These findings suggest a need to characterize how NSSI may relate to different forms of psychopathology classification constructs. We examined how transdiagnostic dimensions of psychopathology relate to NSSI, focusing on how transdiagnostic (shared) variance of dimensional psychopathology spectra might differentially explained the variance in NSSI relative to traditional DSM diagnoses. In two nationally representative United States samples (Ns = 34,653 and 36,309), we modeled the common distress-fear-externalizing transdiagnostic comorbidity model and investigated questions of predictive utility of these dimensional and categorical psychopathology structures. Transdiagnostic dimensions were superior in predicting NSSI compared to common DSM-IV and DSM-5 diagnoses. These dimensions accounted for 33.6–38.7 % of NSSI variance across all analyses in both samples. DSM-IV/DSM-5 diagnoses, however, demonstrated only modest incremental prediction of NSSI over and above the transdiagnostic dimensions. These results support a transdiagnostic reconceptualization of NSSI's links with psychopathology and highlight the importance of transdiagnostic dimensions for predicting clinical outcomes relating to self-injurious behaviors. Implications for research and clinical practice are discussed.

Variables predicting the association between autistic traits and externalizing symptoms among young adults

PurposeConsidering the high comorbidity of autism spectrum disorder (ASD) with externalizing disorders and that ASD is considered as a continuum, which implies the identification of it features in the whole population, the purpose of this paper is to know the characteristics of the association of externalizing symptoms in the population with ASD traits.Design/methodology/approachOne hundred and seventeen postsecondary students participated in the study, providing responses to a battery of self-reported tests.FindingsThe existence of a significant association between ASD and attention deficit hyperactivity disorder (ADHD) (0.519; p < 0.01) was proved. Regression analyses showed that problems in executive functioning, working memory deficits and difficulties in the use of emotion regulation strategies predicted the presence of ADHD traits (F = 36.757, R2 = 62.3%, p < 0. 01) and impulsivity behavior (F = 18.249, R2 = 45.1%, p < 0.01).Research limitations/implicationsExternalizing symptomatology in people with higher ASD traits is extended to the general population. Future research should study other problematic behaviors, such as aggression or self-harm, to continue generating appropriate interventions.Originality/valueThe results reported reinforce the study of ASD as a dimensional disorder, in line with the latest advances in the classification of psychopathology. Considering which variables are behind the problematic behaviors allows interventions to be focused on these factors, contributing to their reduction and to the improvement of professional practices.

Building a replicable and clinically-impactful immunopsychiatry: Methods, phenotyping, and theory integration

Immunopsychiatry is a subfield of psychoneuroimmunology that integrates immunological and psychopathological processes with promise for improving the classification, identification, and treatment of psychopathology. Using research on the relationship between inflammation and depression as a running example, this mini-review will discuss three areas of work that should be emphasized in future research to maximize the replicability and clinical impact of the field: 1) methodology with respect to planning data collection and statistical analyses with measurement properties and conceptually important sources of variance in mind, 2) characterizing inflammatory phenotypes of psychopathology, and 3) the integration of inflammatory processes into robust, extant psychosocial theoretical frameworks of psychopathology risk. Consistent, parallel growth in all three areas will ensure immunopsychiatry research is replicable, contributes to understanding of how (and for whom) the immune system is associated with psychiatric symptoms, and increases the flexibility and power of personalized treatment planning.

Developing Preliminary Scales for Assessing the HiTOP Detachment Spectrum.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical-based classification of psychopathology. Detachment is one of the six spectra in the current HiTOP working model. The aim of this study was to develop preliminary scales for the HiTOP Detachment spectrum that can be used in the next phase of developing a comprehensive measure of HiTOP. We had 456 participants from MTurk (Sample 1) and 266 university students (Sample 2) complete an online survey including a pool of 247 Detachment items assessing 15 consensually defined low-order constructs. Using a stepwise procedure involving factor analyses and ant colony optimization methods, we developed seven 8-item scales that capture unipolar facets of Detachment: anhedonia, suspiciousness, social withdrawal, intimacy avoidance, unassertiveness, risk aversion, and restricted affectivity. Three other 8-item scales emerged that tapped into a Maladaptive Extraversion construct (attention-seeking, thrill-seeking, and domineering), which was mostly unrelated to unipolar Detachment in factor analyses. The 10 scales were unidimensional, reliable, and showed some evidence of convergent and discriminant validity. We discuss challenges of assessing Detachment when moving forward with developing a comprehensive measure of HiTOP.

Alternative Models of Psychopathology: The Diagnostic and Statistical Manual of Mental Disorders, the Hierarchical Taxonomy of Psychopathology, Research Domain Criteria, Network Analysis, the Cambridge Model, and the Five-Factor Model

Wilshire, Ward, and Clark (this issue, p. 323) critiqued the classification of psychopathology in the Diagnostic and Statistical Manual of Mental Disorders, offering as an alternative a “Cambridge model” that focuses on symptoms rather than syndromes. They compared their model with additional alternatives, such as the Research Domain Criteria, the Hierarchical Taxonomy of Psychopathology, and network analysis. In this commentary, I offer further comparisons, considering as well the five-factor model alternative to the DSM syndromal classification of personality disorder.

Massively Multiplayer Online Role-Playing Game (MMORPG) Player Profiles: Exploring Player’s Motives Predicting Internet Addiction Disorder

Background: Due to the increasing spread of massively multiplayer online role-playing games (MMORPGs) and their addictive potential, scholars assert that understanding the factors underpinning Internet gaming disorder (IGD) is crucial, considering the psychopathological classification. Objectives: This study aimed to explore the motives predicting IGD in MMORPG players with different personality risk profiles. Materials and Methods: An online survey was conducted among 202 MMORPG players (mean age = 27.85 years, SD = 6.49). A cluster analysis was performed to classify the samples, according to the substance use risk profile scale (SURPS), distinguishing a sensation seeking (SS) group from a group prone to negative emotions (PNE), including anxiety, hopelessness, and impulsivity. Also, the gaming motives, which were determined using the Motives for Online Gaming Questionnaire (MOGQ), were considered as independent variables in analyses. The regression analyses indicated different combinations of gaming motives, predisposing the two groups to IGD. Results: The escapism motive and male gender were the main risk factors for SS players, whereas the sociability motive predicted addiction tendencies in the PNE group. Also, the competition motive was a strong predictor of IGD in both groups; this motive was found to be associated with the male gender and the specific game genre. Moreover, the PNE players were significantly more addicted to MMORPGs and were less satisfied with their life, compared to the SS group. Conclusions: Based on the present results, clustering gamers in terms of personality traits allowed us to understand the mechanisms underlying IGD for overcoming a reductive approach, which considers MMORPG players as a uniform group.

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.

Somatization disorders of affective and neurotic registers during the COVID-19 pandemic (analysis of clinical cases)

The COVID-19 coronavirus pandemic has added additional difficulties to the differential diagnostic evaluation of the status of patients with disorders of affective and neurotic registers. In such conditions, the works describing and analyzing specific clinical cases are of considerable interest. The paper describes three clinical cases of somatization mental disorders manifesting themselves during the COVID-19 pandemic, with an account of their history, somatic and mental status, psychopathological classification of the condition, and a rationale for the therapy regimen. Itching, dysuria, and hyperventilation without a somatic basis come to the fore in the clinical picture. These somatic symptoms developing in the pattern of mental disorders of the affective and neurotic registers substantially make the diagnosis, specialized care provision, and medical routing of patients difficult. An integrated psychosomatic approach to clinically evaluating psychopathological disorders that are partially realized in dermatological, urological, and pulmonological spheres, contributes to their adequate diagnosis and effective therapy.

Rethinking Categories and Dimensions in the DSM.

This paper addresses the role of categories and dimensions in the classification of psychopathology. While psychopathology does not sort itself out neatly into natural categories, we do find rough, symptom-based groupings that, through refinement, become diagnostic categories. Given that these categories suffer from comorbidity, uncertain boundaries, and excessive "unspecified disorder" diagnoses, there has been a move toward refining the diagnoses with dimensional measures. The paper traces efforts both to improve the diagnostic categories with validators that allow at least partial validity and to introduce dimensional measures into the diagnostic manual. Drawing from the philosophical pragmatism of Charles Sanders Peirce, William James, and John Dewey, which emphasizes the practical, effect-sensitive consequences of a theory along with an emphasis on empirical evidence and the progressive, probabilistic character of knowledge, the paper argues that these efforts must be guided both by scientific validity and clinical utility.

Una presentación no tan atípica: autismo en mujeres

A pesar del conocimiento que tenemos en la actualidad de la amplia variedad de sintomatología y fenotipos de pacientes que engloban los Trastornos del Espectro Autista, algunos de estos fenotipos siguen sin estar claramente descritos en las clasificaciones psicopatológicas. Se propone un caso clínico de una paciente adolescente que consulta por sintomatología depresiva, descubriéndose tras la evaluación y durante la evolución un Trastorno del Espectro Autista subyacente que había pasado desapercibido.

Developmental Psychopathology and the Research Domain Criteria: Friend or Foe?

Developmental psychopathology (DP) is a conceptual approach to the study of the origins and course of individual patterns in the development of psychopathology across the lifespan. The Research Domain Criteria (RDoC) framework aims to study dimensions of neurobiology and behavior to construct a new classification of psychopathology that will advance the understanding and treatment of mental disorders. In this commentary, we describe aspects of overall convergence and divergence between these two approaches. Developmental psychopathology and RDoC overlap, in that they both (a) study the full range of variation from normality to psychopathology, (b) aim to understand the origins and mechanisms underlying psychopathology, (c) use multiple units of analysis to study salient domains of functioning, and (d) emphasize the importance of using reliable and valid measurement. There also are several differences between these perspectives. For example, RDoC is exclusively dimensional, whereas DP studies both continuities and discontinuities. According to RDoC, mental disorders are brain disorders and neurocircuitry is primary, whereas DP asserts that the development of psychopathology results from dynamic transactions among neurobiology, psychology, and social contexts. We conclude by identifying ways to leverage the DP and RDoC perspectives to advance progress in both, particularly regarding research and intervention for children and adolescents.

Transtorno dissociativo de identidade: aspectos diagnósticos e implicações clínicas e forenses

O transtorno dissociativo de identidade ou TDI (historicamente conhecido como “transtorno de múltiplas personalidades”) compreende uma classificação psicopatológica controversa em relação à sua validade transcultural. Ao longo da história, aquilo que chamamos de TDI adquiriu facetas muito diferentes conforme a época analisada, indo desde a possessão demoníaca até o diagnóstico de histeria e múltiplas personalidades no século XIX. No Brasil, poucos casos de TDI foram reportados na literatura científica. Contudo, tem-se observado, ainda que informalmente, um significativo aumento no interesse pelo tema e no número de relatos veiculados pela imprensa brasileira nos últimos anos. O presente artigo tem como propósito apresentar, para o público brasileiro, as controvérsias teóricas em torno do diagnóstico de TDI, bem como suas implicações clínicas e forenses. O texto avalia a metodologia dos estudos nessa área, a validade transcultural do TDI e os modelos teóricos existentes. O artigo conclui com recomendações para investigações futuras e sugestões de ordem prática para os profissionais de saúde mental (psiquiatras, psicólogos clínicos e forenses) e profissionais do Direito.

Unresolved–Disorganized Attachment is Associated With Smaller Hippocampus and Increased Functional Connectivity Beyond Psychopathology

Loss and abuse in children can lead to unresolved–disorganized (UD) attachment. How this condition relates to brain structure and functional connectivity (FC) is unknown. We therefore aimed to investigate gray matter volume (GMV) and resting state functional connectivity (RSFC) correlates of UD attachment in adolescents. Based on previous neuroimaging studies of trauma effects, we hypothesized that the structure of the amygdala and hippocampus and the FC of the latter would be linked to UD attachment. Anatomical and RSFC data were collected from a mixed group of adolescents (N = 74) with symptoms of posttraumatic stress disorder (PTSD) related to childhood sexual abuse (CSA), anxiety/depressive symptoms, and without psychiatric disorder as part of the Emotional Pathways’ Imaging Study in Clinical Adolescents (EPISCA). Bilateral volumes of the amygdala and hippocampus were measured using the FMRIB Software Library, and RSFC of the hippocampus was assessed using seed‐based correlation. UD attachment was measured using the Adult Attachment Interview. Hierarchical regression and correlation were used to assess the associations between UD status (continuous and categorical), brain structure, and FC, adjusting for a general psychopathology factor, puberty stage, gender, age, and IQ. UD attachment was associated with a smaller left hippocampal volume, R 2 = .23, and a higher level of FC between the hippocampus and the middle temporal gyrus and lateral occipital cortex. The associations among UD attachment, specific brain structure, and FC across psychopathological classifications shows promise for dimensional complements to the dominant classificatory approach in clinical research and practice.

Measurement and mental health disparities: Psychopathology classification and identity assessment.

Mental health disparities research compares groups of individuals with regard to their mental health status, and numerous studies have reported significant and burdensome disparities across populations. This literature is based almost entirely on traditional mental disorder constructs (e.g. major depressive disorder and borderline personality disorder) as defined by official nosologies, but these disorders are associated with numerous problems of reliability and validity. Advances in psychopathology classification research have converged on an alternative conceptualization of mental disorder structure, which comprises a set of transdiagnostic dimensions that cut across traditional diagnostic boundaries and overcome the limitations of traditional diagnoses. The application of these dimensions, particularly those of the hierarchical taxonomy of psychopathology model, holds great promise for mental health disparities research. Measurement considerations associated with these transdiagnostic dimensions, as well as participants' intersecting identities, are discussed. Incorporation of these measurement advances with statistical advances allows for the generation and testing of unique hypotheses related to minority stressors that may give rise to observed disparities. © 2019 John Wiley & Sons, Ltd.