A Tower Unto Heaven: Toward an Expanded Framework for Psychopathology

I respond to commentaries on my target article “An Evolutionary Life History Framework for Psychopathology.” I start by addressing criticism of my basic assumptions about life history strategies and their implications for individual differences in human behavior. Next, I examine the theoretical structure of the proposed framework and respond to the commentators’ challenges to its generality and flexibility. I show how the framework can be expanded to include multiple levels of analysis and to integrate behavioral control with neurological functionality; I also reinterpret the recent finding of a general factor of psychopathology in the context of the expanded framework. In the last section I discuss specific psychopathological conditions, namely attention deficit/hyperactivity disorder, borderline personality disorder, substance abuse, autism spectrum disorders, schizophrenia spectrum disorders, obsessive-compulsive disorder, eating disorders, and depression. For each condition, I reply to the commentators’ criticism of my life history analysis, integrate their suggestions and insights, highlight the present weaknesses of the theory, and indicate promising directions for future research.     

Psychopathology: A Simple Twist of Fate or a Meaningful Distortion of Normal Development? Toward an Etiologically Based Alternative for the DSM Approach

In this comment, I focus on a central issue that spans the entirety of Sidney Blatt's research career, namely his contributions to the development of a theoretically consistent and clinically relevant classification system of psychopathology. First, I discuss empirical evidence concerning the key assumptions underlying the currently dominant classification system of mental disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Second, I compare these assumptions with assumptions underlying Blatt's categorization of psychopathology based on his distinction between two developmental lines, that is, self-definition and relatedness, together with a discussion of recent research on these two developmental lines in the context of the development of a more etiologically based classification system of depression and other disorders. Finally, I argue that research concerning Blatt's model of normal and pathological development—aside from direct contributions—may also inform empirically derived criteria for the development of a theoretically consistent and clinically useful way of classifying psychopathology.     

How Transdiagnostic Factors of Personality and Psychopathology Can Inform Clinical Assessment and Intervention

Research suggests that many mental disorders—mood and anxiety, substance use, and personality psychopathology—are related through relatively few latent transdiagnostic factors. With regard to the comorbidity of personality disorders and common mental disorders, factor structures such as internalizing–externalizing have been replicated in numerous samples, across the life span, and around the globe. One critical feature of transdiagnostic factors is that they serve as a point of intersection between personality and psychopathology, making them particularly relevant phenomena for applied clinical work. Although numerous studies have supported the significance of transdiagnostic factors for research and classification purposes, there has been comparatively less articulation of how such factors might be of benefit to practicing assessment clinicians. Herein, we present an overview of transdiagnostic factor research findings, and we apply these findings to the clinical topics of assessment, diagnosis, and treatment. For clinicians as well as researchers, the use of transdiagnostic constructs presents positive implications for efforts to understand, characterize, and ameliorate psychopathology—including its manifestations as personality disorder—in a valid, effective, and efficient way.     

Aggression and risk‐taking as adaptive implementations of fast life history strategy

Within the evolutionary life history (LH) framework, aggression and risk‐taking are adaptive implementations of a fast LH strategy to adapt to environmental unsafety and unpredictability. Based on a longitudinal sample of 198 Chinese adolescents living in rural areas, half of whom were separated from their parents, this study tested LH hypotheses about aggression and risk‐taking in relation to safety constraints in the childhood living environments. The results showed that proxies of environmental unpredictability, including parental separation, were positively associated with aggression and risk‐taking and negatively associated with slow LH strategy, which in turn was negatively associated with aggression and risk‐taking. Children separated from their parents scored lower on slow LH strategies and higher on aggression and risk‐taking. These findings support the evolutionary assumption that human development responds to safety cues through behavioral implementations of LH strategies.     

Parent–child warmth as a potential mediator of childhood exposure to intimate partner violence and positive adulthood functioning

Background and Objectives: Links between childhood exposure to intimate partner violence (IPV) and adult functioning are clear, but less research has examined the potential underpinnings of this association, especially the long-term effects of the parent–child relationship on adult well-being. We hypothesized that (i) childhood exposure to IPV would be negatively related to parent–child warmth and positively related to symptoms of psychopathology during adulthood and (ii) the relationship between IPV exposure and positive outcomes in adulthood (i.e., high life satisfaction and low psychopathology) would be mediated by parent–child warmth. Design: Participants included 703 Swedish adults (20–24). Methods: Participants responded to a self-report survey assessing violence exposure, parental warmth in childhood, and current mental health and well-being. Using multivariate regression and path analysis, models of the relationships between IPV exposure, parent–child warmth, symptoms of psychopathology during adulthood, and life satisfaction were examined. Mediation models were considered exploratory. Results: IPV exposure was related to lower levels of parent–child warmth, higher levels of psychopathology symptoms, and lower life satisfaction. The relationship between IPV exposure and positive outcomes in adulthood was mediated by parent–child warmth. Conclusions: Warm parent–child interactions may play a key role in long-term positive functioning for those exposed to IPV during childhood.     

Psychopathology according to behaviorism: a radical restatement

This article is a radical restatement of the predominant psychopathology, which is characterized by nosological systems and by its approach towards a neurobiological conception of the so-called mental disorders. The "radical" sense of this restatement is that of radical behaviorism itself. As readers will recall, "radical" applied to behaviorism means total (not ignoring anything that interests psychology), pragmatic (referring to the practical sense of knowledge), and it also derives from the Latin word for "root" (and thus implies change beginning at a system's roots or getting to the root of things, in this case, of psychological disorders). Based on this, I introduce the Aristotelian distinction of material and form, which, besides being behaviorist avant la lettre, is used here as a critical instrument to unmask the hoax of psychopathology as it is presented. The implications of this restatement are discussed, some of them already prepared for clinical practice.     

Behavioral aspects of epilepsy in children with mental retardation

Epilepsy and mental retardation, two relatively common childhood conditions, are both associated with a wide range of behavioral disorders. This article reviews the behavioral disturbances found in children with epilepsy, mental retardation, and both conditions. The behavioral disturbances found in children with epilepsy are associated with seizure-related, cognitive, developmental, and psychosocial factors. Although children with mental retardation also demonstrate a broad spectrum of behavioral disturbances, children with specific mental retardation syndromes have better-defined patterns of psychopathology. The presence of epilepsy and mental retardation seems to increase the severity of psychopathology. Further studies are needed, however, to define better the interaction of these two conditions and how they impact the behavior of children.     

Personality and Psychopathology: An Application of the Five-Factor Model

Our review is concerned with the relationship of the five-factor model of personality to psychopathology, focusing in particular on Axis II personality disorders and depression. The five factors provide a particularly compelling model for interpreting the Axis II personality disorders as maladaptive variants of normal personality traits. However, we also discuss methodological and conceptual limitations of this application. There has been little research on the relationship of Openness, Agreeableness, and Conscientiousness to Axis I mental disorders, but considerable attention has been given to Neuroticism and Extraversion. We focus in particular on the difficulty in distinguishing between the various ways in which personality can relate to depression, either as a predisposition to, a complication of, a pathoplastic effect upon, or a spectrum variant of the mental disorder. We conclude with recommendations for future research.     

Editorial: Applications of Cognitive and Behavioral Therapy in Response to COVID-19

The corona virus (COVID-19) continues to have a devastating health, economic, and social impact on our local and international communities. Cognitive and Behavioral Therapies (CBTs), as a family of therapies that posit cognitive, behavioral, emotional, and interpersonal change processes in the understanding and successful treatment of mental health disorders, have risen to the challenge. This special issue represents contributions from CBT experts on the impact on psychopathology, new assessment methods, adaptations of integrated behavioral health, telehealth, psychology training, and discusses a public health framework. The issue includes a series of articles offering guidance for the clinician on interventions for those impacted by trauma, CBT for youth and families, and telehealth for psychotic spectrum disorders and group therapy for social anxiety.     

The subjective–agentic personality sector (SAPS): Introduction to the special issue on self,identity, and psychopathology

This special issue is predicated upon the premise that there exists a subjective–agentic personality sector (SAPS) that is crucially relevant to the understanding and treatment of psychopathology. SAPS is often overlooked by “trait” models in personality psychology. It is comprised of “hot” cognitions about one's self and identity as they unfold throughout the life span and are brought to bear on interpersonal relationships. There are four ways in which SAPS may be involved in psychopathology: (a) inherently, as a component of psychiatric disorders, (b) as a passive vulnerability dimension, namely by interacting with life stress, (c) as an active vulnerability dimension, that is, by propelling external situations that culminate in psychopathology, and (d) by constituting a central consequent of psychopathology (i.e., the scarring pattern, see below). In this Journal of Personality special issue, experts in personality and psychopathology demonstrate the centrality of SAPS in unipolar depression, anxiety disorders, bipolar spectrum disorder, eating disorders, posttraumatic stress disorder, complex trauma and borderline personality disorder, social anxiety disorder, suicidality in the context of mood disorders, and recovery from schizophrenia. A commentary by Dan McAdams, a leader in the study of self and identity, concludes this special issue.     

Dichotomous Thinking and Personality Traits: From the Viewpoints of the Big Five and HEXACO1,2

Dichotomous thinking is a feature of certain personality traits, such as the Dark Triad and Cluster B personality disorders, which commonly reflect a fast life history strategy. The Big Five and HEXACO personality models are useful for understanding the personality structure and individual differences in life history strategy. Our study aimed to shed light on the propensity for dichotomous thinking using the framework of the Big Five and HEXACO personality models. Participants (n = 229) completed the Dichotomous Thinking Inventory, the 60-item HEXACO Personality Inventory – Revised, and the Ten-Item Personality Inventory. We examined correlations between dichotomous thinking and each domain of the Big Five and HEXACO personality models, and then computed multiple correlations predicting total and dimensional scores on the propensity for dichotomous thinking with scores on the Big Five and HEXACO personality traits. Results indicated that dichotomous thinking tendency is characterized by the set of low Agreeableness and Honesty–Humility. This study suggests that dichotomous thinking has antagonistic characteristics and a linkage to the fast life history strategy.     

The joint structure of DSM-IV Axis I and Axis II disorders

The Diagnostic and Statistical Manual (4th ed. [DSM-IV]; American Psychiatric Association, 1994) distinction between clinical disorders on Axis I and personality disorders on Axis II has become increasingly controversial. Although substantial comorbidity between axes has been demonstrated, the structure of the liability factors underlying these two groups of disorders is poorly understood. The aim of this study was to determine the latent factor structure of a broad set of common Axis I disorders and all Axis II personality disorders and thereby to identify clusters of disorders and account for comorbidity within and between axes. Data were collected in Norway, through a population-based interview study (N = 2,794 young adult twins). Axis I and Axis II disorders were assessed with the Composite International Diagnostic Interview (CIDI) and the Structured Interview for DSM-IV Personality (SIDP-IV), respectively. Exploratory and confirmatory factor analyses were used to investigate the underlying structure of 25 disorders. A four-factor model fit the data well, suggesting a distinction between clinical and personality disorders as well as a distinction between broad groups of internalizing and externalizing disorders. The location of some disorders was not consistent with the DSM-IV classification; antisocial personality disorder belonged primarily to the Axis I externalizing spectrum, dysthymia appeared as a personality disorder, and borderline personality disorder appeared in an interspectral position. The findings have implications for a meta-structure for the DSM.     

心身障碍共病与慢性疼痛关联的结构模型

常见的心身障碍共病可以理解为一种新的精神疾病结构模型：情绪障碍、抑郁、焦虑及躯体化障碍等归为内化性疾病谱系的组成元素,物质滥用和反社会行为障碍归为外化性疾病谱系的组成元素。本文分析探讨评估慢性疼痛与这一模型的联系。社会心理和生物学的研究证据表明慢性疼痛与内化性障碍密切相关,提示内化-外化性疾病模型可以作为一个有效的研究架构,为探讨慢性疼痛与情感、抑郁焦虑及其他相关精神障碍的关联共病机制提供新的研究方向和新思路。     

生命早期环境不可预测性对过度进食的影响:基于生命史理论

在生命史理论的视角下, 本研究通过两个研究揭示了生命早期环境不可预测性对过度进食的影响及其作用机制。研究1招募处于生命早期阶段的91名初中生(年龄12~14岁), 采用饱食进食(Eating in the absence of hunger, EAH)范式, 结果发现生命早期环境不可预测性能够显著正向预测个体饱食状态下的高热量食物选择(即过度进食); 研究2招募新冠病毒疾病(COVID-19)暴发背景下301名武汉市居民(高死亡威胁组)和179名其他省市居民(控制组) (年龄18~60岁)为被试, 通过问卷法回溯性地测量生命早期环境不可预测性并探究其影响当前过度进食的机制, 结果发现生命早期环境不可预测性通过生命史策略的中介作用间接影响过度进食。同时, 死亡威胁(新冠病毒疫情)扩大了环境不可预测性通过生命史策略间接影响过度进食的效应, 而社会支持则能缓冲这一效应。研究结果为COVID-19背景下和灾后居民的健康进食干预提供了依据。     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

Understanding general and specific connections between psychopathology and marital distress: a model based approach

Marital distress is linked to many types of mental disorders; however, no study to date has examined this link in the context of empirically based hierarchical models of psychopathology. There may be general associations between low levels of marital quality and broad groups of comorbid psychiatric disorders as well as links between marital adjustment and specific types of mental disorders. The authors examined this issue in a sample (N = 929 couples) of currently married couples from the Minnesota Twin Family Study who completed self-report measures of relationship adjustment and were also assessed for common mental disorders. Structural equation modeling indicated that (a) higher standing on latent factors of internalizing (INT) and externalizing (EXT) psychopathology was associated with lower standing on latent factors of general marital adjustment for both husbands and wives, (b) the magnitude of these effects was similar across husbands and wives, and (c) there were no residual associations between any specific mental disorder and overall relationship adjustment after controlling for the INT and EXT factors. These findings point to the utility of hierarchical models in understanding psychopathology and its correlates. Much of the link between mental disorder and marital distress operated at the level of broad spectrums of psychopathological variation (i.e., higher levels of marital distress were associated with disorder comorbidity), suggesting that the temperamental core of these spectrums contributes not only to symptoms of mental illness but to the behaviors that lead to impaired marital quality in adulthood.     

Family Influences on the Long Term Post-Disaster Recovery of Puerto Rican Youth

This study focused on characteristics of the family environment that may mediate the relationship between disaster exposure and the presence of symptoms that met DSM-IV diagnostic criteria for symptom count and duration for an internalizing disorder in children and youth. We also explored how parental history of mental health problems may moderate this mediational model. Approximately 18 months after Hurricane Georges hit Puerto Rico in 1998, participants were randomly selected based on a probability household sample using 1990 US Census block groups. Caregivers and children (N?=?1,886 dyads) were interviewed with the Diagnostic Interview Schedule for Children and other questionnaires in Spanish. Areas of the family environment assessed include parent-child relationship quality, parent-child involvement, parental monitoring, discipline, parents’ relationship quality and parental mental health. SEM models were estimated for parents and children, and by age group. For children (4–10 years old), parenting variables were related to internalizing psychopathology, but did not mediate the exposure-psychopathology relationship. Exposure had a direct relationship to internalizing psychopathology. For youth (11–17 years old), some parenting variables attenuated the relation between exposure and internalizing psychopathology. Family environment factors may play a mediational role in psychopathology post-disaster among youth, compared to an additive role for children. Hurricane exposure had a significant relation to family environment for families without parental history of mental health problems, but no influence for families with a parental history of mental health problems.     

基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用——基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用

在积极心理学的影响下,心理健康双因素模型包含主观幸福感和精神病理学指标。研究旨在验证心理健康双因素模型在老年人中的适用性,考察老化态度在生命意义感和心理健康间的多重中介作用。采用爱丁堡幸福量表、一般健康问卷、老化态度问卷和人生意义问卷调查了283名广州市社区老年人。结果发现：（1）心理健康双因素模型较单因素模型的拟合度更优。（2）生命意义感通过老化态度的三条路径（对身体变化、心理获得和心理社会丧失的积极态度）促进心理健康,但具体机制不同。增强意义体验、意义追寻通过老化态度的完全中介作用,提高主观幸福感。增强意义体验通过老化态度的完全中介作用,减弱意义追寻通过老化态度的部分中介作用,减少精神病理学症状。研究结果扩大了心理健康双因素模型的适用年龄范围,为提升老年人的心理健康提供实证依据。     

Religiosity and the mental health of adolescents in Great Britain

Most studies show that religion is a protective factor for mental health. A few argue that it is detrimental and the remainder conclude it makes no difference. We investigate the religiosity correlates of childhood psychopathology – strength of belief, importance of being able to practice one’s religion, and worship frequency. Questions on religiosity were included in the mental health survey of children in Great Britain administered to 2992 11–19-year-olds in 2007. The Development and Well-Being Assessment was used to generate rates of clinically recognisable mental disorders. Logistic regression analysis was used to establish the magnitude of the religiosity correlates of emotional and conduct disorders. Young people with a stated religion who had weakly held beliefs or who regarded religious practice as unimportant were those with the greater likelihood of having emotional disorders. Regular attendance at religious services or prayer meetings reduced the likelihood of having a conduct disorder.