Examining the role of personality functioning in a hierarchical taxonomy of psychopathology using two years of ambulatory assessed data

The Hierarchical Taxonomy of Psychopathology (HiTOP) arranges phenotypes of mental disorders based on empirical covariation, ranging from narrowly defined symptoms to higher-order spectra of psychopathology. Since the introduction of personality functioning (PF) in DSM-5 and ICD-11, several studies have identified PF as a predictor of transdiagnostic aspects of psychopathology. However, the role of PF in the HiTOP classification system has not been systematically examined. This study investigates how PF can be integrated into HiTOP, whether PF accounts for transdiagnostic variance captured in higher-order spectra, and how its predictive value for future affective well-being (AWB) and psychosocial impairment (PSI) compares to the predictive value of specific psychopathology beyond PF. To this end, we examined two years of ambulatory assessed data on psychopathology, PF, PSI, and AWB of N = 27,173 users of a mental health app. Results of bass-ackwards analyses largely aligned with the current HiTOP working model. Using bifactor modeling, aspects of PF were identified to capture most of the internalizing, thought disorder, and externalizing higher-order factor variance. In longitudinal prediction analyses employing bifactor-(S-1) modeling, PF explained 58.6% and 30.6% of variance in PSI and AWB when assessed across one year, respectively, and 33.1% and 23.2% of variance when assessed across two years. Results indicate that personality functioning may largely account for transdiagnostic variance captured in the higher-order components in HiTOP as well as longitudinal outcomes of PSI and AWB. Clinicians and their patients may benefit from assessing PF aspects such as identity problems or internal relationship models in a broad range of mental disorders. Further, incorporating measures of PF may advance research in biological psychiatry by providing empirically sound phenotypes.