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Compr Psychiatry. 2017 Nov;79:19-30. doi: 10.1016/j.comppsych.2017.04.006. Epub 2017 Apr 29.

Delineating the joint hierarchical structure of clinical and personality disorders in an outpatient psychiatric sample.

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Departments of Psychiatry and Psychology, University of Minnesota-Twin Cities Campus, 2450 Riverside Ave, Suite F227, Minneapolis, MN 55454, United States. Electronic address:
Department of Psychiatry, Stony Brook University, HSC, Level T-10, Room 060H, Stony Brook, NY 11794-8101, United States. Electronic address:
Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, United States. Electronic address:
Department of Psychology, 118 Haggar Hall, University of Notre Dame, Notre Dame, IN 46556, United States. Electronic address:
146 West River St, Suite 11b, Providence, RI 02904, United States.. Electronic address:
Department of Psychology, N414 Elliott Hall, University of Minnesota-Twin Cities Campus, Minneapolis, MN 55455, United States. Electronic address:



A large body of research has focused on identifying the optimal number of dimensions - or spectra - to model individual differences in psychopathology. Recently, it has become increasingly clear that ostensibly competing models with varying numbers of spectra can be synthesized in empirically derived hierarchical structures.


We examined the convergence between top-down (bass-ackwards or sequential principal components analysis) and bottom-up (hierarchical agglomerative cluster analysis) statistical methods for elucidating hierarchies to explicate the joint hierarchical structure of clinical and personality disorders. Analyses examined 24 clinical and personality disorders based on semi-structured clinical interviews in an outpatient psychiatric sample (n=2900).


The two methods of hierarchical analysis converged on a three-tier joint hierarchy of psychopathology. At the lowest tier, there were seven spectra - disinhibition, antagonism, core thought disorder, detachment, core internalizing, somatoform, and compulsivity - that emerged in both methods. These spectra were nested under the same three higher-order superspectra in both methods: externalizing, broad thought dysfunction, and broad internalizing. In turn, these three superspectra were nested under a single general psychopathology spectrum, which represented the top tier of the hierarchical structure.


The hierarchical structure mirrors and extends upon past research, with the inclusion of a novel compulsivity spectrum, and the finding that psychopathology is organized in three superordinate domains. This hierarchy can thus be used as a flexible and integrative framework to facilitate psychopathology research with varying levels of specificity (i.e., focusing on the optimal level of detailed information, rather than the optimal number of factors).

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