Journal of psychopathology and clinical science最新文献

This article contends that many of the chief complaints about the Diagnostic and Statistical Manual of Mental Disorders can be obviated by a set-theoretic, combinatorial approach. Arbitrary cutoffs, polythetic criteria, and category heterogeneity can be avoided by using a data-driven approach that assesses whether particular symptom combinations represent sufficient conditions for clinical benchmarks at an acceptable level of conditional probability. Using data from the National Comorbidity Survey-Replication, this study employed generalized anxiety disorder, major depressive disorder, posttraumatic stress disorder, and the union of major depressive disorder and generalized anxiety disorder as exemplars and set a target probability threshold of p ≥ .90 for sufficiency. All possible symptom combinations were generated for each subsample, with sample sizes of N = 1,948, N = 2,285, N = 777, and N = 3,129, respectively. Sufficient sets were identified for diagnosis, clinical distress, and functional impairment. Establishing sufficiency reduced the number of possible symptom combinations by at least 94% (M = 98.7%, SD = 1.79%). Finally, in a large, randomly split-halved subsample (N = 6,656), sufficient sets were identified at p ≥ .90 and tested in the holdout data. Results yielded an average conditional probability of .91 (SD = .03), reinforcing the robustness and generalizability of the current methods. These results suggest that a large amount of the heterogeneity in symptom combinations in internalizing disorders may be nested and reducible. Thus, much of the combinatorial information in the symptom presentations of these disorders may be overlapping and there may be core features of psychopathology that are sufficient to produce fidelity without requiring additional complexity. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Anxiety and shame are central, elevated emotions in body dysmorphic disorder (BDD) that are implicated as risk factors for suicide in suicide theories and are associated with suicide risk in cross-sectional BDD studies. Given that emotions are transient and suicide risk can increase quickly, risk prediction in BDD may be enhanced by measuring momentary anxiety and shame. In 87 adults with moderate to severe, clinician-diagnosed BDD, we collected ecological momentary assessment-rated anxiety and shame 3 times daily for two 14-day periods (28 days). We used generalized linear mixed models to estimate associations of concurrent or next-observation ecological momentary assessment-rated (a) intensity of desire to die by suicide and (b) intention (absent/present) to attempt suicide, above baseline clinician-assessed suicide ideation (SI) severity (Columbia-Suicide Severity Rating Scale). Higher within-person deviations from one's average anxiety and shame were significantly related to greater concurrent and next-observation suicide desire and concurrent intent, above baseline clinician-assessed SI severity. Only baseline clinician-assessed SI predicted next-observation suicide intent. Altogether, results showed that our ability to detect and predict suicide risk in BDD was improved beyond baseline clinician assessment when a person's current anxiety and shame levels were also considered. When someone with BDD experiences elevated anxiety or shame compared to their own norm, these elevations are associated with concurrent and short-term increases in suicide desire and concurrent suicide intent. This is the first prospective study of shame and anxiety as risk factors for SI in BDD. Results underscore the importance of these emotions as assessment and intervention targets. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The generalizability of psychopathology constructs across human populations is often assumed, but most evidence comes from the Western contexts. The "Majority World" (Africa, Asia, Latin America, and the Middle East) is underrepresented in psychopathology research. Current efforts to reorganize mental disorder classifications provide an opportunity to better integrate evidence from these undersampled contexts. This study tested how the hierarchical structure of psychopathology replicates and deviates among a community sample of young adults in Kenya, Namibia, and South Africa. Using confirmatory and exploratory models, we investigated the structure and measurement invariance of common mental health symptoms. Our results provide limited support for the internalizing and externalizing distinction across these contexts. In the confirmatory models, the two spectra were nearly perfectly correlated. Exploratory models similarly indicated a single higher-order general distress spectrum across countries. At a lower-order level, three dimensions consistently emerged across countries: disinhibited negative affect, dysregulated sleep and stress, and harmful substance use. Attention-deficit/hyperactivity and anger symptoms showed substantial variation in loading patterns, suggesting cultural differences in symptom expression. Exploratory analyses revealed considerable variability in symptom structures across the three African countries, likely reflecting demographic, cultural, and semantic influences. This variability was further underscored by exploratory models, which identified low-loading and varying symptoms that confirmatory approaches often fail to detect. These results show how universal and culture-specific aspects shape psychopathology and emphasize the need for data from diverse global samples to better understand these differences. We advocate for a more inclusive, culturally sensitive approach to investigating mental health globally. (PsycInfo Database Record (c) 2025 APA, all rights reserved).