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, a2 (1), 110-128

A Transdiagnostic Temperament-Phenotype Profile Approach to Emotional Disorder Classification: An Update

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A Transdiagnostic Temperament-Phenotype Profile Approach to Emotional Disorder Classification: An Update

Anthony J Rosellini et al. J Exp Psychopathol.

Abstract

Although the emotional disorders (EDs) have achieved favorable reliability in the Diagnostic and Statistical Manual of Mental Disorders (DSM), accumulating evidence continues to underscore limitations in ED diagnostic validity. In particular, taxometric, comorbidity, and other descriptive psychopathology studies of transdiagnostic phenotypes studies suggest that the EDs may be best conceptualized as dimensional entities that are more similar than different. Despite optimism that the fifth edition of the DSM (DSM-5) would constitute a meaningful shift toward dimensional ED assessment and diagnosis, most changes contribute little movement in that direction. In the present report, we summarize past and anticipate persisting (i.e., in DSM-5) limitations of a purely categorical approach to ED diagnosis. We then review our alternative dimensional-categorical profile approach to ED assessment and classification, including preliminary evidence in support of its validity and presentation of two ED profile case examples using our newly developed Multidimensional Emotional Disorder Inventory. We end by discussing the transdiagnostic treatment implications of our profile approach to ED classification and directions for future research.

Keywords: categorical versus dimensional classification; diagnostic reliability; diagnostic validity; emotional disorders; hybrid dimensional-categorical classification; internalizing disorders; multidimensional emotional disorder inventory; transdiagnostic dimensions; transdiagnostic treatments.

Conflict of interest statement

Conflicts of Interest. None to report.

Figures

Figure 1
Figure 1
Two example latent profiles adapted from “Initial Development and Validation of a Dimensional Classification System for the Emotional Disorders,” by A. J. Rosellini, 2013. Indicator means within each profile type were converted to T-Scores for presentational clarity (i.e., indicators scaled in different metrics). NT = neurotic temperament; PT = positive temperament; DM = depressed mood; AA = autonomic arousal; SOM = somatic anxiety; SEC = social evaluation concerns; IC = intrusive cognitions.
Figure 2
Figure 2
Plotted MEDI profiles from the two case examples. Average item scores within each dimension were used for presentational clarity (i.e., total scores were not used because not all dimensions were assessed using the same number of items). The MEDI uses a Likert-type scale ranging from 0 (not characteristic of me/does not apply to me) to 8 (extremely characteristics of me/applies to me very much). Using the Anxiety Disorders Interview Schedule for DSM-5, Case #1 was diagnosed with bipolar II disorder (with current depression, moderate; with anxious distress, severe), trichotillomania, excoriation disorder, social anxiety disorder, and obsessive-compulsive disorder. Case #2 was diagnosed with social anxiety disorder and persistent depressive disorder (early onset; with moderately severe pure dysthymic syndrome and melancholic features). NT = neurotic temperament; PT = positive temperament; DM = depressed mood; AA = autonomic arousal; SOM = somatic anxiety; SEC = social evaluation concerns; IC = intrusive cognitions; TRM = traumatic re-experiencing and dissociation; AVD = avoidance.

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