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Conceptualizing traumatic stress and the structure of posttraumatic psychopathology through the lenses of RDoC and HiTOP

CLINICAL PSYCHOLOGY REVIEW (2022)

期刊

CLINICAL PSYCHOLOGY REVIEW

卷 95, 期 -, 页码 -

出版社

PERGAMON-ELSEVIER SCIENCE LTD

DOI: 10.1016/j.cpr.2022.102177

关键词

Traumatic stress spectrum; RDoC; HiTOP; PTSD; Models of psychopathology

类别

Psychology, Clinical

资金

National Institutes of Mental Health [5T32MH019836]

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摘要

This paper reviews the literature on categorical and dimensional conceptualizations of trauma-related symptoms, focusing on the Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. Several potential approaches for improving the representation of traumatic stress are discussed, along with the use of an integrated RDoC-HiTOP approach to reconceptualize traumatic stress.

Trauma-related psychopathology, most notably posttraumatic stress disorder (PTSD), poses unique challenges for psychiatric nosology due to the wide range of symptoms and diagnoses associated with trauma and challenges representing the impact of trauma exposure on psychopathology. In this paper, we review the literature on categorical (i.e., Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases systems) versus dimensional conceptualizations of trauma-related symptoms with an emphasis on the Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) frameworks. We identify strengths of each approach and challenges in accommodating the full range of trauma-related psychopathology and the clinical implications thereof. We discuss several potential approaches for improving the representation of traumatic stress, including the use of PTSD subtypes, trauma-related specifiers for psychiatric diagnoses, and the development of a dimension that we call the traumatic stress spectrum, which spans both adaptive and adverse reactions to trauma. These approaches to representing traumatic stress can be evaluated empirically and further refined. We also discuss how the use of an integrated RDoC-HiTOP approach to reconceptualize traumatic stress might maximize the ability to model valid and reliable trauma-related phenotypes, which would aid in the investigation of clinically relevant biological correlates.

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