A transdiagnostic, hierarchical taxonomy of psychopathology following traumatic brain injury

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a transdiagnostic framework that may better capture psychopathology in individuals with traumatic brain injury (TBI) than conventional diagnostic approaches. However, HiTOP lacks validation in the TBI population. We analyzed questionnaire data from 410 individuals with moderate-severe TBI, covering 57 homogenous symptom components and maladaptive traits within HiTOP. Using a top-down, exploratory latent variable approach, we constructed a hierarchical model of psychopathology tailored to TBI. The model encompassed broad internalizing and externalizing spectra, splitting into seven narrower dimensions: Detachment, Dysregulated Negative Emotionality, Somatic Symptoms, Compensatory and Phobic Reactions, Self-Harm and Psychoticism, Rigid Constraint, and Harmful Substance Use. The empirical structure of psychopathology after TBI largely corresponded with the established HiTOP model (e.g., a detachment spectrum), but accurate assessment necessitates considering TBI-specific experiences (e.g., the injury’s impact on social functioning). This study presents the most comprehensive empirical classification of psychopathology after TBI to date.