The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP)

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.

Full text

Journal of Personality. 2020;00:1–14. wileyonlinelibrary.com/journal/jopy
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© 2020 Wiley Periodicals, Inc.
Received: 29 June 2020
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Revised: 10 September 2020
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Accepted: 13 September 2020
DOI: 10.1111/jopy.12593
SPECIAL ISSUE MANUSCRIPT
The distinction between symptoms and traits in the Hierarchical
Taxonomy of Psychopathology (HiTOP)
Colin G.DeYoung1
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MichaelChmielewski2
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Lee AnnaClark3
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David M.Condon4
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RomanKotov5
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Robert F.Krueger1
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Donald R.Lynam6
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Kristian E.Markon7
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Joshua D.Miller8
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Stephanie N.Mullins-Sweatt9
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Douglas B.Samuel6
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MartinSellbom10
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Susan C.South6
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Katherine M.Thomas11
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DavidWatson3
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Ashley L.Watts12
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Thomas A.Widiger13
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Aidan G. C.Wright14
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the HiTOP Normal Personality Workgroup
1Department of Psychology, University of Minnesota, Minneapolis, MN, USA
2Department of Psychology, Southern Methodist University, Dallas, TX, USA
3Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
4Department of Psychology, University of Oregon, Eugene, OR, USA
5Department of Psychiatry and Behavioral Health, State University of New York, Stony Brook, NY, USA
6Department of Psychology, Purdue University, West Lafayette, IN, USA
7Department of Psychology, University of Iowa, Iowa City, IA, USA
8Department of Psychology, University of Georgia, Athens, GA, USA
9Department of Psychology, Oklahoma State University, Stillwater, OK, USA
10Department of Psychology, University of Otago, Dunedin, New Zealand
11Center for Therapeutic Assessment, Austin, TX, USA
12Department of Psychology, University of Missouri, Columbia, MO, USA
13Department of Psychology, University of Kentucky, Lexington, KY, USA
14Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
The HiTOP Normal Personality Workgroup consists of M. Chmielewski, L. A. Clark, D. M. Condon, C. G. DeYoung, R. Kotov, R. F. Krueger, D. R.
Lynam, K. E. Markon, J. D. Miller, S. N. Mullins-Sweatt, D. B. Samuel, M. Sellbom, S. C. South, K. Stanton, J. L. Tackett, K. M. Thomas, D. Watson, A. L.
Watts, T. A. Widiger, and A. G. C. Wright.
Correspondence
Colin DeYoung, Department of Psychology,
University of Minnesota, 75 East River Rd.,
Minneapolis, MN 55455, USA.
Email: cdeyoung@umn.edu
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and
quantitatively derived dimensional classification system designed to describe the fea-
tures of psychopathology and, ultimately, to replace categorical nosologies. Among
the constructs that HiTOP organizes are “symptom components” and “maladaptive
traits,” but past HiTOP publications have not fully explicated the distinction between
symptoms and traits. We propose working definitions of symptoms and traits and ex-
plore challenges, exceptions, and remaining questions. Specifically, we propose that
the only systematic difference between symptoms and traits in HiTOP is one of time
frame. Maladaptive traits are dispositional constructs that describe persistent ten-
dencies to manifest features of psychopathology, whereas symptoms are features of

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DEYOUNG Et al.
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INTRODUCTION
In response to the many thoroughly demonstrated flaws of
traditional categorical diagnostic systems for mental disor-
ders, researchers and clinicians are increasingly turning to
dimensional frameworks for characterizing psychopathology
(Insel et al., 2010; Kotov etal.,2017; Krueger etal.,2018;
Widiger,1993). Extensive research on comorbidity and the
distributions and covariation of signs and symptoms has re-
vealed that psychopathology is dimensional rather than cate-
gorical, such that the traditional categorical nosologies (e.g.,
Diagnostic and Statistical Manual for Mental Disorders, Fifth
Edition; DSM-5; American Psychiatric Association, 2013;
and International Classification of Diseases, 11th Revision;
ICD-11; World Health Organization,2018), in which each
disorder is a discrete entity,1 simply do not reflect real-
ity (Carragher etal.,2014; Haslam etal.,2020; Markon &
Krueger,2005; Walton etal.,2011; Widiger & Samuel,2005;
Wright etal.,2013). Continued reliance on categorical no-
sologies creates many problems in both research and clinical
practice, including poor reliability of assessment, extensive
heterogeneity within diagnostic categories, and lack of treat-
ment specificity. To solve these problems, dimensional nosol-
ogies are necessary, and shifting to a dimensional nosology
will be facilitated by a consensus model that guides research
and can also be implemented effectively in clinical settings.
The Hierarchical Taxonomy of Psychopathology
(HiTOP), depicted in Figure1, is intended to fill this role
(Kotov etal.,2017; Krueger etal.,2018; Ruggero etal.,2019;
https://medic ine.stony brook medic ine.edu/HITOP). The
HiTOP model, which has been developed, and continues to
be refined, by an international grassroots consortium of sci-
entists and clinicians, provides a hierarchical, dimensional
classification system that is being developed to encompass
features of psychopathology covering the full range of clin-
ical psychological conditions.2 At the highest levels of the
HiTOP hierarchy are several broad dimensional superspec-
tra. Underneath superspectra, the core of the system consists
of six spectra: somatoform, internalizing, thought disorder,
disinhibited externalizing, antagonistic externalizing, and
detachment. Each spectrum subsumes narrower subfactors
and syndromes, and then, near the bottom of the hierarchy,
HiTOP incorporates a large number of symptom and trait di-
mensions (Kotov etal.,2017). (Throughout, we use the term
“symptom” broadly to include externally observable signs of
psychopathology as well as subjective experiences.) Unlike
previous approaches to nosology, the structure of these di-
mensions and levels is primarily based on quantitative analy-
sis of empirical data.
By arranging clinical phenotypes into transdiagnostic
spectra and superspectra, HiTOP accommodates the perva-
sive comorbidity, nonspecific etiologies, and low-treatment
specificity that plague categorical diagnoses, while mini-
mizing heterogeneity by delineating empirically coherent
dimensions. Patients can be described more specifically and
accurately with respect to their own individual dimensional
profiles rather than being lumped into categories that misrep-
resent the true clinical picture (Ruggero etal.,2019). HiTOP’s
hierarchical structure allows systematic accounting of the
fact that different etiological factors and outcomes are asso-
ciated with clinical phenomena of varying breadth (Conway
etal.,2019; Latzman et al., 2020). Some are best described
in terms of associations with broad dimensions high in the
hierarchy, others in terms of associations with narrow dimen-
sions low in the hierarchy. HiTOP is thus a powerful tool for
improving clinical research and practice.
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SYMPTOMS VERSUS TRAITS:
A TANGLED HISTORY
One question about HiTOP that has not been clearly an-
swered by previous consortium publications is exactly how
it conceives of the distinction between symptoms and traits,
a distinction that appears in the label for the bottom level
of HiTOP depicted in Figure 1 (“Symptom Components”
and “Maladaptive Traits”; Kotov etal.,2017).3 The aim of
the present article is to provide an answer to this question.
Traditional diagnoses of mental disorder (e.g., in DSM-5)
rely in most instances on relatively short-term symptoms as
psychopathology as they are manifest during any specific time period (from moments
to days to months). This has the consequence that almost every HiTOP dimension, at
any level of the hierarchy, can be assessed as either a trait or a symptom dimension,
by adjusting the framing of the assessment. We discuss the implications of these defi-
nitions for causal models of the relations between symptoms and traits and for dis-
tinctions between psychopathology, normal personality variation, and dysfunction.
KEYWORDS
dysfunction, Hierarchical Taxonomy of Psychopathology, maladaptive traits, symptoms, traits

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DEYOUNG Et al.
criteria—requiring that they last at least 2weeks, 1month, or
6months, for example—but in some instances they rely on
traits that concern persistent features of the person evident
since childhood or at least early adulthood (most prominently
in personality disorder, but also in some other forms of psy-
chopathology, such as autism). The HiTOP model currently
lists constructs as maladaptive traits or symptom components
based primarily on how they have traditionally been con-
sidered in psychology and psychiatry (Kotov etal., 2017).
For the most part, this corresponds with their usual mode of
assessment; assessments of traits describe how the person
is “typically” or “in general” or without reference to time
frame, whereas assessments of symptoms usually specify a
time frame such as “in the last month” (known as the “recall
period”; Clarke etal.,2008). However, some constructs listed
as symptom components by Kotov etal.(2017) have been as-
sessed, in HiTOP-recommended instruments, with a standard
trait framing that does not specify a time frame—for exam-
ple, relational aggression as assessed by the Externalizing
Spectrum Inventory (Krueger et al., 2007).
The question remains, therefore, regarding the best way
for HiTOP to differentiate between a trait and a symptom. Do
they differ merely in duration (a feature in the short-term is
a symptom, and a persistent feature is a trait), or age of onset
(with traits evident at least since early adulthood, whereas
symptoms can begin at any time in life), or are there more
substantive differences between them, such that some clin-
ical constructs are inherently only symptoms or traits? The
existing clinical literature is not particularly helpful in an-
swering these questions because it is inconsistent, sometimes
explicitly distinguishing between symptoms and traits on the
basis of time frame but other times referring to constructs as
symptoms despite the fact that they are assessed using a trait
framing. This confusion is partly attributable to the fact that
dictionary definitions of the word “symptom” include any-
thing that indicates the presence of disease or disorder, and
this is the sense adopted operationally in rubrics like DSM
and ICD, in which a certain number of symptoms is neces-
sary for diagnosis. In this sense, traits are a kind of symptom
when they are indicative of disorder. Under this definition, it
is perfectly reasonable for some traits to be considered symp-
toms, but scientific usage does not, and should not, always
follow the colloquial usage found in dictionaries or the oper-
ational definitions of traditional diagnostic systems.
Not surprisingly, discussion of traits that are also symp-
toms has been most common in the literature on personality
disorders (e.g., Skodol etal., 2005), for which the official
DSM symptoms (Criterion A) are all traits. However, a shift
in that field is evident in recent decades, from describing the
traits appearing in diagnostic rubrics as the symptoms of the
disorder (per dictionary definitions of “symptom”) to explic-
itly recognizing symptoms as specific instances of experience
FIGURE 1 The Hierarchical Taxonomy of Psychopathology (HiTOP). Recent efforts by an international consortium of researchers have
produced this dimensional system for organizing psychiatric symptoms (https://renai ssance.stony brook medic ine.edu/HITOP). Figure depicts
a schematic version of the HiTOP working model with a selection of symptom components/maladaptive traits from Kotov etal.(2017, fig. 3).
Kotov etal.(2017) did not list symptom components/maladaptive traits for Sexual Problems and Eating Pathology; those are selected from the
consortium's ongoing work in measure development. HiTOP is a work in progress and will be updated on the basis of new data. Dashed lines
indicate provisional elements requiring more study. Traditional categorical diagnoses listed in the Syndromes/Disorders level are not HiTOP
constructs but are included to allow mapping of existing nosologies onto HiTOP, and those with the most prominent cross-loadings are listed in
multiple places. Minus signs indicate negative association of constructs with other dimensions in their spectrum

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DEYOUNG Et al.
or behavior and reserving the term “traits” to refer to the per-
sistent disposition to manifest these symptoms. For example,
this shift is evident in DSM-5 in the contrast between the
official diagnostic system in Section II, which was brought
forward unchanged from DSM-IV, and the Alternative Model
of Personality Disorder (AMPD), which was based on em-
pirical developments in the field and appears in Section III
(“Emerging Measures and Models”). In Section II, contents
of Criterion A for personality disorders are described at var-
ious points in the text as both “traits” and “symptoms.” In
the AMPD, however, traits are explicitly differentiated from
symptoms (e.g., “Personality traits—the dispositions to be-
have or feel in certain ways—are more stable than the symp-
tomatic expressions of these dispositions”), and it is noted
that “symptoms and traits are both amenable to intervention”
(APA, 2013, pp. 763, 774). The traits are considered to be
persistent dispositions, whereas the symptoms are the man-
ifestations of those dispositions at specific times, and this is
becoming a common approach in the field of personality-dis-
order research (e.g., Wright & Kaurin,2020).
Precisely because personality-disorder researchers are
typically dealing with indicators of psychopathology that are
by definition traits, they have needed to distinguish carefully
between short-term manifestations of the symptoms in ques-
tion and the long-term dispositions toward those symptoms
(Clark,2007; Morey & Hopwood,2013; Skodol etal.,2005).
Symptoms wax and wane from day to day or week to
week, but the general disposition to experience them may
persist over much longer periods (Wright & Simms,2016).
Distinguishing between traits and symptoms in this way is
scientifically useful; it clarifies the objects of study. Outside
of personality-disorder research, however, the labeling of
constructs as symptoms or traits still often stems merely from
whether they originated in the study of psychopathology or
the study of normal personality, without regard to time frame.
It will be useful for HiTOP to follow the lead of personal-
ity-disorder research and disentangle symptoms and traits
in the study of psychopathology as a whole. The dictionary
definition of “symptom” is certainly not invalid, but it ob-
scures a distinction that is important for clinical research and
practice.
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DEFINING SYMPTOMS AND
TRAITS IN HITOP
Table1 provides a list of our working definitions of impor-
tant terms. Given our definitions of “symptom” and “trait,”
almost any dimension at any level of the HiTOP hierarchy
may be assessed either as a trait or as a symptom dimension,
regardless of whether it was originally listed as a symptom
component or a maladaptive trait or a higher-level dimen-
sion (e.g., as a spectrum or subfactor). We recognize that the
word “symptom” in the singular typically connotes a rela-
tively specific behavior or experience; thus, when we refer to
the assessment of broader HiTOP dimensions as symptoms,
Psychological state An actual condition of the person, lasting some
specifiable amount of time, characterized by specifiable
emotional, motivational, cognitive, and/or behavioral
features
Symptom A psychological state associated with risk for
dysfunctiona
Symptom dimension A construct describing interpersonal variation in a
symptom or an aggregate of symptoms that tend to
covary between people
Dysfunction Inability to meet basic needs, to maintain an acceptable
quality of life, to operate effectively in society, and/or to
maintain adequate relationships with others
Trait A tendency or disposition to be in a particular class of
states
Maladaptive trait A tendency or disposition to be in a particular class of
states associated with risk for dysfunction (i.e., a class of
symptoms)b
Psychopathology A cause, state, or manifestation of psychological
dysfunction
Personality The relatively persistent (but not necessarily constant)
psychological features of a person
aWe use the term “symptom” to cover observable behavioral signs as well as subjective experiences.
bAlthough the term “maladaptive traits” is used to label a specific level of the HiTOP hierarchy in Figure1,
constructs at any level of the hierarchy can be manifested as maladaptive traits or symptom dimensions.
TABLE 1 Working definitions of key
terms

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DEYOUNG Et al.
we will either use the plural or refer to a “symptom dimen-
sion,” so it is clear that we are referring to the severity of
an aggregate of more specific symptoms. The assessment of
any HiTOP dimension is of a trait when it asks whether the
features of that dimension are exhibited in general or typi-
cally or with an unspecified time frame (and this applies to
all features of psychopathology, not just those traditionally
associated with personality disorders). The assessment is of
symptoms when it asks whether the features are exhibited
within a specific time frame in the past (e.g., the last hour,
day, week, or month).4
Because traits can and do change levels within individu-
als over time (Bleidorn etal., 2018; Clark, 2007; Morey &
Hopwood,2013; Roberts et al., 2008, 2017), once the time
frame for a single assessment of a symptom dimension ex-
tends beyond a certain duration, it is unlikely to differ mean-
ingfully from a trait assessment of that dimension (although
it may certainly differ simply because of transient error in
assessment, just like repeated trait assessments; Chmielewski
& Watson,2009). The two assessments should then be highly
correlated and show little incremental validity. Nonetheless,
we think it is best to rely primarily on an operational distinc-
tion based on time frame to label an assessment as being of a
trait or a symptom dimension.
Research comparing the rank-order stability of symp-
toms and traits has rarely used symptom and trait measures
of the same construct, which means that time frame is typi-
cally confounded with differences in construct content (e.g.,
Prenoveau et al., 2011). Further, measures labeled as “symp-
toms” in such studies do not always use an assessment frame
that corresponds to our definition of symptoms as states of
specified duration. However, when trait and state measures
of the same construct (e.g., anxiety) have been compared di-
rectly, trait measures have been found to be more stable than
state measures using momentary (“right now”), past week, or
daily time frames (Spielberger,1983; Watson,2000; Wright
& Simms,2016). In general, it appears that the longer the
time frame of assessment, the more stable is the measurement
over time. The question of exactly how long the time frame of
a single assessment of a symptom dimension must be before
it becomes empirically indistinguishable from a trait assess-
ment has not yet been answered, but it is probably less than
a year.
This may explain why DSM-5 requires that a maladaptive
trait indicating personality disorder has been evident for at
least one whole year if the assessment is being conducted in
individuals younger than 18years. Personality traits change
more, in their mean levels, during adolescence and sub-
sequent early adulthood than in other periods of life (Soto
etal.,2011; Roberts etal.,2006; Van den Akker etal.,2014),
but nonetheless they must by definition reflect a reasonably
persistent general tendency. Because trait levels change less
in adulthood, but still are not fixed, diagnostic interviews for
personality disorder tend to require that trait levels meeting
diagnostic criteria have been present the majority of the time
in at least the previous 5years in adults (e.g., First etal.,1997;
Pfohl etal.,1997).
The idea that constructs within HiTOP can, in principle,
be assessed as either a trait or a symptom dimension, sim-
ply by adjusting the framing of the assessment, might seem
overly simplistic. Nonetheless, it is rooted in the predominant
understanding of the nature of traits within psychological sci-
ence. Traits are best defined as descriptions of the persistent
likelihood of being in particular classes of states, and trait
scores from traditional questionnaires correspond well to the
average of repeated assessments of the corresponding state in
experience-sampling methodologies (Baumert et al., 2017;
DeYoung,2015; Fleeson,2001; Fleeson & Gallagher,2009;
Watson,2000). This correspondence has been demonstrated
not only in the context of normal variation in personality, but
also with maladaptive traits and corresponding states identi-
fied in personality disorder (Wright & Simms,2016). This
should not be surprising because the major dimensions of
personality pathology are largely equivalent to the major di-
mensions of normal personality (DeYoung & Krueger,2018;
Kotov etal.,2017; Markon etal.,2005; Stepp etal.,2012;
Suzuki et al., 2015; van Dijk et al., 2020; Widiger &
Trull,2007; Widiger, etal.,2019). Thus, what applies to nor-
mal traits generally applies to maladaptive traits.
From our perspective, the states that are involved in
maladaptive traits are “symptoms,” and there is no system-
atically coherent way, other than time frame, to distinguish
between maladaptive traits and symptom dimensions. To
say that a symptom is a “state,” is simply to say that it is
an actual condition of the person, having some specifiable
duration (sometimes states are momentary, sometimes they
are longer lasting); it is not to say that all states are symp-
toms. Only states associated with psychopathology are symp-
toms, from HiTOP’s perspective. There is a long tradition in
clinical psychology, with which our approach is consistent,
of distinguishing between traits and states of the same con-
struct (e.g., in the widely used State-Trait Anxiety Inventory;
Spielberger,1983). Figure2 illustrates the relation between
trait and symptom measures of the same HiTOP dimension.
Although measures of normal personality traits and mal-
adaptive traits generally appear to be measuring the same
underlying latent dimensions, nonetheless there are some
important differences between them stemming from the
fact that maladaptive trait measures tend to focus on more
extreme regions of the latent variable and to provide more
information about those regions (Stepp etal., 2012; Suzuki
etal., 2015; van Dijk et al., 2020). High scores on a mal-
adaptive trait measure are thus more likely to be accom-
panied by dysfunction than high scores on a normal trait
measure, even if they are measures of the same dimension
(Morey etal.,2020). Scores on normal trait measures also

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DEYOUNG Et al.
tend to be more stable than scores on measures of maladap-
tive traits (Morey & Hopwood,2013). This may be due to
the fact that the maladaptive trait measures are more focused
on the extreme of the dimension, such that regression to the
mean will make it more likely for people scoring extremely
at one measurement point to score closer to the mean at the
next (Wood & Wortman,2012). Given the typical distribu-
tions of people's states (as in the hypothetical example shown
in Figure2), which fluctuate in both directions around their
mean or typical state, extreme levels should be more difficult
to sustain over time. Additionally, because maladaptive trait
measures are more focused on the risky extremes, they may
also be more prone to evaluative consistency bias (also called
halo), in which people tend to rate targets as having more (or
less) desirable features across the board than is actually the
case, depending on their positive (or negative) feelings about
the target. In self-ratings, this bias is related to self-esteem
versus demoralization (Anusic etal.,2009; Tellegen et al.,
2006), and it could make self-ratings of maladaptive traits
less stable because biases will shift as global self-evaluations
shift, which is likely with changes in dysfunction.
According to most definitions of “personality,” any rea-
sonably persistent psychological trait is an element of per-
sonality, and this includes major dimensions of risk for
psychopathology regardless of whether they were initially
studied in personality disorder or in the disorders for-
merly known as Axis I (Baumert etal.,2017; DeYoung &
Krueger,2018; Griffith etal., 2010). Personality disorders
are less different from Axis I disorders than was once as-
sumed, in that (1) their symptoms map onto the same major
dimensions as those of other disorders, (2) their symptoms
change levels over time in ways similar to symptoms of
many other disorders, and (3) they show rates of remission
that are comparable to many other disorders (Clark,2007,
2009; Gunderson etal.,2011; Widiger, etal., 2019). Thus,
the HiTOP dimensions of psychopathology can generally be
considered personality traits, if they are expressed as per-
sistent dispositions. In contrast, there may be some relatively
narrow dimensions of personality that are not associated
with psychopathology, and these would not be included in
HiTOP. Temporally, psychopathology is a broader category
than personality, because it includes states that appear in the
short-term as well as persistent dispositions (even personal-
ity constructs conceived as less persistent than traits, such
as “characteristic adaptations,” must endure long enough
to be useful in characterizing the individual over time, in
order to be part of personality; DeYoung,2015). In terms of
constructs, however, personality is a broader category than
psychopathology, because it includes dimensions of psycho-
logical variation that have no substantial relation to psycho-
logical dysfunction, as well as those that do.
Because traits are dispositional constructs, reflecting like-
lihoods, the behaviors, and experiences that characterize the
trait do not have to be manifest at all times. It is the disposi-
tion or general tendency that is relatively stable, not the man-
ifestation of that tendency. Someone high in trait anxiety, for
example, does not experience anxiety at every moment but
does experience anxiety more often, and with more intensity,
than someone low in the trait (a fact long recognized by per-
sonality theorists; Allport,1937; Eysenck,1983). Symptoms
too can differ in expression over the course of the time frame
of assessment. Someone experiencing clinically significant
levels of anxiety over the course of a week might nonethe-
less experience periods of low anxiety within that time frame
(Wright & Simms,2016).
The fact that we are distinguishing between symptoms and
traits based primarily on time frame means that the listing of
constructs as “symptom components” or “maladaptive traits”
in the original publication of HiTOP (Kotov etal., 2017)
should be considered to reflect the way these constructs have
FIGURE 2 A hypothetical illustration of the correspondence between trait and symptom measures of the same HiTOP dimension, with
symptoms measured repeatedly over time (e.g., daily for 6months) in a single individual. The trait measure corresponds reasonably well to the
mean of the measured symptoms, but the latter, in this case, is slightly higher due to the presence of a relatively brief (e.g., 2weeks) episode of
severe symptoms, which would correspond to a time-limited episode of severe psychopathology. Nonetheless, with the exception of that episode,
the distribution of measured symptoms conforms well to the distribution implied by the trait measure

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DEYOUNG Et al.
been conceptualized historically, rather than a claim about
their status within HiTOP. In principle, they can be assessed
as either symptoms or traits simply by adjusting their mode
of measurement. Although we are suggesting this as a use-
ful perspective on HiTOP in principle, in practice some con-
structs do not translate as easily between traits and symptoms
as others, and a few symptom dimensions may not have any
corresponding trait dimension, as discussed in the following
two sections.
In some cases, the same items may be used to assess traits
and symptoms, simply with different response options. In
many other cases, however, items may need to be modified
to assess trait versus symptom time frames—for example, if
aspects of the time frame are implied by the item itself. One
type of symptom for which this is an important consideration
is symptoms that are defined by a change from the person's
usual behavior and experience, such as loss of appetite. To
assess this construct as a trait one could not simply assess
whether the person had a chronically suppressed appetite, as
that would neglect the change component. Instead, one might
ask about whether the person frequently had episodes of ap-
petite loss. Whether such trait items were in fact measuring
the same dimension as symptom assessments of appetite loss
would need to be verified empirically—for example, by using
experience-sampling methods to assess symptoms on a mo-
mentary or daily basis, and then, correlating average symp-
tom levels with the intended trait assessments.
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EPISODIC
PSYCHOPATHOLOGY
One reason that the distinction between traits and symp-
toms is important is that some cases of psychopathology are
episodic and may not appear more than once in a patient's
lifetime, whereas other cases are chronic or recurring. For
most HiTOP dimensions, both patterns are possible, which is
part of the reason that most HiTOP dimensions can be meas-
ured as both a trait and a symptom dimension. Obviously,
symptoms of psychopathology that appear as a single epi-
sode and never return do not reflect that particular person's
trait levels of those symptoms. Even during the episode, that
person would most likely score considerably lower on a trait
measure of the same construct, despite scoring high on the
corresponding symptom measure. In contrast, chronic cases
of psychopathology, in which people suffer from symptoms
on many days in any given period of time, can easily be de-
scribed in terms of trait levels.
More complicated are forms of psychopathology that are
highly episodic but recurring, in which there may be a general
disposition to certain symptoms, but the likelihood implied by
the disposition is not constant in most cases. For example, al-
though there are occasional cases of chronic mania, most are
episodic (Kotov etal.,2013). The risk for full-blown mania in
episodic cases may be trait-like when considered over a suffi-
ciently long time span, but it may nonetheless be challenging
to assess full-blown mania with a trait framing. Rather, one
would be more likely to assess a trait dimension that includes
both hypomania and mania. Hypomania comprises what are
often described as “subclinical” manifestations or features of
mania—nonetheless, hypomania itself has been considered to
encompass symptoms of disorder, as in the DSM diagnosis of
bipolar II disorder. In other words, mania is part of the same
dimension as hypomania but describes only the very upper
range of the dimension. In psychometric terms, the items
used to assess full-blown mania would have high difficulty
(i.e., very few people endorse them), such that they provide
information primarily about the high end of the dimension.
This issue in assessment reflects the nature of traits as
distributions of states. On average, people's states will tend
to fall near their trait level, but there will also be many devi-
ations from that level, falling in the tails of the distribution,
as depicted in Figure2. These deviations will depend on the
situation both externally (e.g., even extraverts are unlikely to
be voluble at a funeral) and internally (after a serious loss,
extraverts may be temporarily too depressed to generate their
typical level of activity, even in situations where they nor-
mally would do so). Someone with a relatively extreme level
of a trait (e.g., hypomania) is more likely than someone with
a less extreme level to deviate into even more extreme levels
that are more likely to cause dysfunction (full-blown mania,
in this example; Klein etal.,1996; Kwapil etal.,2000). Very
extreme levels of any particular dimension of psychopathol-
ogy in HiTOP are unlikely values of the trait in question
(i.e., exceptionally few people would have trait levels that
extreme—fewer than the number of people who merely have
an episode of symptoms at that same level). From a psycho-
metric perspective, therefore, items describing states that are
good indicators of those extreme levels may be better as-
sessed as symptoms than as traits, if they are assessed alone.
If they are part of a scale that also includes items indicating
less extreme levels, however, then, it should not be difficult
to assess them with a trait framing.
5
|
CULTURALLY SPECIFIC AND
AGE-SPECIFIC SYMPTOMS
Although the existence of forms of psychopathology con-
stituted by recurring episodes of extreme symptoms poses
some challenges to trait assessment, it does not funda-
mentally challenge the idea that the HiTOP dimensions on
which those symptoms fall can be conceived as both trait
and symptom dimensions. However, some other symptoms
may be more fundamentally difficult to conceptualize as
traits. First, there are symptoms that are culturally specific,

8
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DEYOUNG Et al.
such as marijuana problems (a symptom dimension within
the substance abuse subfactor) or phobias of specific situa-
tions that are not present in all cultures (symptoms within the
fear subfactor). Some definitions of “trait” include any per-
sistent regularity in behavior and experience (e.g., Baumert
et al., 2017). Under these definitions, smoking marijuana
regularly for years would be a trait, as would having a per-
sistent fear of elevators, or even having a long-term passion
for Starbuck's coffee (DeYoung, 2017). However, labeling
these behaviors as traits does not align well with common
usage in psychology and psychiatry, and some definitions of
traits place more restrictions on what kind of regularities can
be called traits—for example, by limiting them to variations
in universal human mechanisms that evolved in response
to classes of stimuli consistently present in human environ-
ments (DeYoung,2015).
Under the latter definition, persistent personality features
that require reference to things that are culturally specific,
such as the availability of marijuana or elevators or coffee,
are not traits but characteristic adaptations. Characteristic ad-
aptations are habits that people have learned in response to
their specific life experiences, rather than variations in traits
of which everyone has some level (DeYoung,2015). Outside
of the substance abuse and fear subfactors, no other con-
structs listed at the symptom-component/maladaptive-trait
level by Kotov etal.(2017) suggest characteristic adaptations
rather than traits, but it is certainly possible that others could
be identified as HiTOP is expanded. Although substance
abuse or specific phobia can be assessed using a trait-like
time frame (i.e., by asking about people's general tenden-
cies to abuse or to fear the thing in question; e.g., Cutshall &
Watson,2004; Krueger et al., 2007), nonetheless, under some
definitions of “trait” they may not fit the conceptual scheme
we are proposing. Such assessments would still be considered
part of personality, but they would be assessments of charac-
teristic adaptations, rather than traits.
A second group of symptoms that are difficult or impos-
sible to conceptualize as traits are those that are specific
to one age period, such as the late-life cognitive decline
associated with dementias. (HiTOP has not yet incorpo-
rated symptoms related to intellectual disability and simi-
lar cognitive dysfunctions but aspires to do so eventually.)
It would not make sense to think of late cognitive decline
as a trait because its nature as a unidirectional change at a
particular time of life prevents it from being a persistent
disposition. It could be seen as a change in a trait of cog-
nitive function, but a change in a trait is not itself a trait.
Further, late cognitive decline is clearly distinct from trait-
like cognitive problems that begin early in development.
At any rate, we can conclude that, although assessing each
HiTOP construct as a trait or a symptom dimension works
for almost every dimension in the model, there will always
be a small subset that cannot be fit into this scheme for
various reasons. Nonetheless, we are unable to identify any
other systematic difference between traits and symptoms
beyond time frame.
6
|
CAUSAL RELATIONS
BETWEEN TRAITS AND SYMPTOMS
Drawing a distinction between traits (as dispositions) and
symptoms (as time-limited states) raises the question of
how symptoms and traits are related, not just definition-
ally, but also causally. A number of models of potential
causal relations between personality traits and psycho-
pathology have been proposed (e.g., Klein et al., 2011;
Krueger & Tackett,2003; Ormel et al., 2013; Watson &
Clark,1995; Widiger & Smith,2008), but for the most part
they are based on relating traits to disorders or symptoms
as different constructs (e.g., the relation of Extraversion to
depression), so they are difficult to apply when considering
trait and symptom manifestations of the same construct.
For example, the spectrum model, in which psychopathol-
ogy is considered to be equivalent to an extreme trait level,
was developed in the context of categorical diagnosis,
where it makes sense to ask whether a diagnostic cut-off
for symptom severity might correspond to some trait level.
According to our definition, traits and symptoms certainly
can be located on the same spectrum or dimension, but this
does not imply that someone with a diagnosis must always
have high levels of the traits corresponding to the symp-
toms of the diagnosis. In an isolated episode of psychopa-
thology, the symptoms could be a temporary fluctuation
away from the person's trait level instead (as illustrated in
Figure2).
The common cause model, which states that trait levels
and symptoms share the same causes, is also not simply ap-
plicable to our model, as we would need to distinguish be-
tween causes of symptoms that are typical manifestations
of a trait versus causes of symptoms that are far from the
person's trait level. For a given HiTOP dimension, the trait
represents the disposition to manifest the specific symptoms,
and so the neural mechanisms that proximally produce the
manifestations of the trait are by definition those that pro-
duce the corresponding symptoms. When considering more
distal causes, however, we cannot assume common causes for
trait and symptom levels within the same HiTOP dimension
when a person has an episode of symptoms that do not con-
form to their typical trait distribution. This is because some
set of genetic and environmental factors during development
are likely to be responsible for a person's trait level, but a re-
cent stressor may cause the person to manifest symptoms that
are more extreme than their trait level on that same dimen-
sion. Thus, in cases of episodic psychopathology in which
the symptoms do not correspond to the person's typical trait

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9
DEYOUNG Et al.
level, one should look for additional causes of symptoms be-
yond the causes of trait levels.
In general, the vulnerability model is probably more use-
ful than the common cause or spectrum models for thinking
about the causal relations between the trait and symptoms for
a given HiTOP dimension. In the vulnerability model, trait
levels predispose people to certain symptoms, and therefore,
relatively extreme trait levels are often a precursor to the de-
velopment of more severe symptoms (i.e., more severe even
than those implied by the trait level). Because a trait reflects
a person's central tendency, but their state varies around that
tendency (as shown in Figure2), a given trait level always re-
flects some degree of risk for states/symptoms more extreme
than the trait level. Further, because traits can and do change,
a given trait level also reflects some degree of risk that the
trait itself will change to a nearby value in the maladaptive
direction. For this reason, age of onset is not a viable cri-
terion for distinguishing between traits and symptoms, from
our perspective, because trait change later in life could lead
to the onset of psychopathology that is best characterized as
a trait, rather than merely as an episode of symptoms, even
though it was not present since early adulthood.
To better understand the causal relations between traits
and symptoms, we need longitudinal research (preferably
with genetically informative designs) examining the same di-
mensions using both trait and symptom assessments. In such
studies, one could additionally assess symptoms using multi-
ple recall periods—for example, not only occasionally assess-
ing some symptom dimension in the “the past two weeks,”
but also assessing daily or momentary symptoms in that di-
mension using an experience-sampling design. Typically, in
such research, it is probably best to use brief symptom time
frames to minimize the amount of trait variance in the symp-
tom assessments. Longitudinal and experience-sampling de-
signs can be combined effectively in “measurement burst”
designs, as in one study that investigated associations be-
tween Neuroticism (corresponding to HiTOP internalizing;
Griffith etal.,2010) and daily experiences of negative affect
over 6years (Borghuis etal.,2020).
7
|
HITOP DIMENSIONS AND
DYSFUNCTION
We have noted that scientific usage may diverge from diction-
ary definitions, and we have defined symptoms as features of
psychopathology that manifest over a specifiable time frame,
which is narrower than the dictionary definition. Another
divergence from common usage is that, whereas the word
“symptom” is often taken to refer to something inherently
indicative of the presence of disorder, this does not conform
with its typical usage in psychology and psychiatry. Many
symptoms used to identify psychopathology can be found in
many healthy people, and even the DSM-5 acknowledges that
“it has not been possible to completely separate normal and
pathological symptom expressions contained in diagnostic
criteria” (APA, 2013, p. 21). (For this reason, most DSM-5
diagnoses include an additional criterion of social or occupa-
tional impairment, so that the symptoms in aggregate are in-
deed typically associated with dysfunction.) Symptoms need
not always be accompanied by dysfunction or impairment,
even if they tend to predict its presence, and this is true even
for symptoms such as hallucinations and delusions that often
signal very severe disorders (Linscott & van Os,2013).
For this reason it makes sense to separate the assessment
of symptom and trait dimensions from the assessment of ac-
companying dysfunction. The World Health Organization has
gone so far as to develop a separate taxonomy of functioning,
The International Classification of Functioning, Disability,
and Health (World Health Organization, 2001; see Üstün
& Kennedy,2009, for a comprehensive discussion of this
topic). In the present context, we are using function versus
dysfunction to refer to people's overall ability to meet their
basic needs, to maintain an acceptable quality of life, to oper-
ate effectively in society, and to maintain adequate relation-
ships with others. (We are not referring to the biological or
evolved function of specific components of the human organ-
ism; cf. Wakefield,1992.) Extremity on any HiTOP dimen-
sion, whether assessed as a symptom dimension or a trait,
is insufficient to assume the presence of dysfunction. Risk
for dysfunction increases with extremity, but dysfunction is
not an inevitable consequence of extremity. This assumption
is supported by studies that find substantial but certainly
not perfect associations of various measures of dysfunction
with maladaptive trait or symptom dimensions (Calabrese
& Simms,2014; Clark & Ro,2014; Morey etal.,2020; Ro
& Clark, 2013; Vittengl etal., 2018). Various approaches
to assessing psychopathology have similarly concluded that
dysfunction should be assessed separately from the trait or
symptom dimensions that characterize the style or particular
features of psychopathology, and this is true for psychopa-
thology in general as well as personality disorder in particular
(Bender etal.,2011; Clark,2007; Clark etal.,2017; DeYoung
& Krueger,2018; Leising & Zimmerman, 2011; Livesley &
Jang, 2005; Widiger & Mullins-Sweatt,2009).
When examining various assessment instruments, whether
dysfunction necessarily increases with extremity on mea-
sures of any given symptom or trait dimension depends on
exactly how that dimension has been measured. Sometimes
the presence of impairment or dysfunction is written into the
description of the symptom or trait itself, thereby conflat-
ing the particular feature being measured with dysfunction.
In contrast, in its ongoing process of measure development,
the HiTOP consortium is attempting to divorce the assess-
ment of its dimensions of psychopathology from the explicit
assessment of dysfunction. This means that optimal HiTOP

10
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DEYOUNG Et al.
measures should not include items that explicitly link the
feature being described to dysfunction or impairment caused
by that feature. “My impulsivity causes problems at work”
would be a suboptimal item, for example, and a better item
would be “I often act impulsively at work.”
In principle, dysfunction can be caused either by persistent
maladaptive patterns of behavior and experience (traits) or by
episodes of behavior and experience that are deviations away
from one's typical patterns (transient symptoms), but it is not
identical to those traits or symptoms. Dysfunction should be
correlated with HiTOP dimensions, in part because items that
describe high-risk traits or symptoms (e.g., “I am very de-
pressed”) are very likely to imply dysfunction even if they
do not explicitly describe dysfunction. Nonetheless, it is best,
whenever feasible, to avoid explicitly describing dysfunction
in the item.
Because of this substantive distinction drawn by the
HiTOP system between the dimensions describing features
of psychopathology, which are shown in Figure1, and dys-
function, which is not shown, dysfunction should be assessed
separately. Measuring dysfunction is an evolving area of
empirical research, less well studied than assessment of the
HiTOP spectra and their subdimensions. In addition to de-
veloping effective measures of HiTOP dimensions shown in
Figure1, members of the HiTOP consortium are also work-
ing to develop improved measures of dysfunction. Initial
research makes clear that separating assessment of dysfunc-
tion from assessment of maladaptive traits and symptoms
is a serious challenge that may be difficult to overcome
(Clark et al., 2019; Morey et al., 2020; Mullins-Sweatt &
Widiger,2010; Nuzum etal.,2019).
The AMPD attempts to separate personality dysfunction
(defined as “disturbances in self and interpersonal function-
ing”) from the assessment of maladaptive traits (APA, 2013,
p. 762), but some researchers worry that the AMPD con-
ceptualization of dysfunction may include content that more
properly belongs in its maladaptive trait dimensions and in
HiTOP spectra (Widiger etal.,2019). For example, lack of
empathy might be best conceived as a trait rather than as an
inherently dysfunctional quality, because some people with
little empathy may nonetheless be able to achieve social re-
lationships adequate to their needs. In any case, the AMPD’s
approach to defining dysfunction is intended to be specific to
“personality dysfunction,” and the HiTOP consortium is pur-
suing its own efforts to develop broader dysfunction-related
constructs and measures that can be appropriate for all forms
of psychopathology.
HiTOP does not currently specify levels at which symptom
and trait scores become of clinical concern due to their likely
association with dysfunction. This level may be different for
different dimensions, and it may also be different for symp-
tom versus trait assessments of the same dimension. Having a
persistent tendency toward an extreme state level (i.e., having
a high-trait level) may lead to dysfunction even though oc-
casionally expressing that state does not. For example, it is
normal for people to experience occasional brief periods of
extreme social withdrawal, but having a persistent trait of ex-
treme social withdrawal may be debilitating. Identifying clin-
ically relevant levels across different assessment modalities
is an important future empirical project for HiTOP and one
that we hope will be facilitated by the development of better
measures of dysfunction.
8
|
CONCLUSIONS AND FUTURE
DIRECTIONS
HiTOP constructs (expressed as either symptoms or traits)
are dimensions of psychological variation that capture fea-
tures of psychopathology, the extremes of which are typically
associated with dysfunction. Almost every construct listed
in HiTOP can be manifested both as a trait and as a symp-
tom dimension, and so HiTOP constructs can, in principle,
be measured as trait dimensions or symptom dimensions by
changing the time frame of assessment. Linking the distinc-
tion between traits and symptoms to different time frames
of assessment is consistent with current understanding of
traits in psychology and avoids dubious distinctions drawn
on the basis of tradition or outmoded beliefs about the nature
of traits. Although dictionary definitions of “symptom” tend
to allow for overlap, such that some traits can be considered
symptoms, it is useful scientifically to distinguish them more
cleanly, and researchers in clinical psychology have been
moving slowly in this direction in recent decades.
When considering existing research, however, the fact that
a construct is described as a “symptom” in a scientific re-
port is no guarantee that it was assessed as a symptom from
the HiTOP perspective. Researchers should be very careful
to check how a construct was measured in a given study be-
fore making any inferences about differences between symp-
toms and traits based on its results. For example, measures
of “symptoms” or “symptom counts” based strictly on the
criteria for personality disorders in DSM-IV or Section II of
DSM-5 should be considered measures of traits rather than
symptoms, from the perspective of our working definition,
given that they include a criterion of being “stable and of
long duration,” “beginning by early adulthood and present in
a variety of contexts” (APA, 2013, pp. 647–678).
Clearly and consistently distinguishing between symptoms
and traits should improve future studies of psychopathology,
encouraging researchers to measure the same constructs in
both ways. Especially in longitudinal and genetically infor-
mative studies, this practice will facilitate research on the
causal relations among traits and symptoms. Additionally, re-
searchers would be wise to distinguish dimensional features
of psychopathology from dysfunction or impairment, which

|
11
DEYOUNG Et al.
may be measured separately from symptoms and traits. Much
like HiTOP’s consensus model of dimensions of psychopa-
thology depicted in Figure1, a consensus approach to dis-
tinguishing symptoms and traits could help psychopathology
research to be more effective and cumulative.
ORCID
Colin G. DeYoung https://orcid.
org/0000-0001-5621-1091
Joshua D. Miller https://orcid.org/0000-0003-1280-2863
Douglas B. Samuel https://orcid.
org/0000-0003-3592-1523
Aidan G. C. Wright https://orcid.
org/0000-0002-2369-0601
ENDNOTES
1 In ICD-11, the diagnosis of personality disorder has been shifted to a
dimensional model, but the other mental disorders remain categorical.
2 Although HiTOP is not yet fully comprehensive, for example, not
yet encompassing symptoms of autism, development of the system to
include all clinical phenomena is ongoing.
3 Using the term “maladaptive traits” to refer to HiTOP dimensions is
something of a misnomer because it is only the extreme ranges of the
dimensions that are maladaptive. Per the field's conventions, how-
ever, we use the term to refer to trait dimensions that are associated
with risk for psychopathology and that are typically assessed with a
focus on the maladaptive range, even though they cover normal-range
variance as well.
4 A third type of assessment not discussed here is lifetime assessment.
This has typically been conducted to determine whether someone
has ever met the criteria for a diagnosis, even if they do not cur-
rently. Lifetime assessments can be accommodated in HiTOP by
assessing whether and for how long someone has ever reached a
given level of the relevant trait and/or symptom dimensions. This
form of assessment can also be adapted in HiTOP to more complex
assessments of individual histories of psychopathology, which are
particularly important for highly episodic problems or in cases for
which one wants to be sure that trait level has been reasonably
consistent over long periods of time, as in traditional diagnoses of
personality disorder.
REFERENCES
Allport, G. W. (1937). Personality: A psychological interpretation.
Henry Holt and Company.
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Author.
Anusic, I., Schimmack, U., Pinkus, R. T., & Lockwood, P. (2009). The
nature and structure of correlations among Big Five ratings: The ha-
lo-alpha-beta model. Journal of Personality and Social Psychology,
97(6), 1142–1156. https://doi.org/10.1037/a0017159
Baumert, A., Schmitt, M., Perugini, M., Johnson, W., Blum, G.,
Borkenau, P., & Jayawickreme, E. (2017). Integrating personal-
ity structure, personality process, and personality development.
European Journal of Personality, 31(5), 503–528. https://doi.
org/10.1002/per.2115
Bender, D. S., Morey, L. C., & Skodol, A. E. (2011). Toward a model
for assessing level of personality functioning in DSM-5, part 1: A
review of theory and methods. Journal of Personality Assessment,
93, 332–346.
Bleidorn, W., Hopwood, C. J., & Lucas, R. E. (2018). Life events and
personality trait change. Journal of Personality, 86, 83–96.
Borghuis, J., Bleidorn, W., Sijtsma, K., Branje, S., Meeus, W. H., &
Denissen, J. J. (2020). Longitudinal associations between trait
Neuroticism and negative daily experiences in adolescence. Journal
of Personality and Social Psychology, 118(2), 348–363. https://doi.
org/10.1037/pspp0 000233
Calabrese, W. R., & Simms, L. J. (2014). Prediction of daily ratings of
psychosocial functioning: Can ratings of personality disorder traits
and functioning be distinguished? Personality Disorders: Theory,
Research, and Treatment, 5(3), 314–322. https://doi.org/10.1037/
per00 00071
Carragher, N., Krueger, R. F., Eaton, N. R., Markon, K. E., Keyes, K.
M., Blanco, C., Saha, T. D., & Hasin, D. S. (2014). ADHD and the
externalizing spectrum: Direct comparison of categorical, contin-
uous, and hybrid models of liability in a nationally representative
sample. Social Psychiatry and Psychiatric Epidemiology, 49, 1307–
1317. https://doi.org/10.1007/s0012 7-013-0770-3
Chmielewski, M., & Watson, D. (2009). What is being assessed and why
it matters: The impact of transient error on trait research. Journal
of Personality and Social Psychology, 97(1), 186–202. https://doi.
org/10.1037/a0015618
Clark, L. A. (2007). Assessment and diagnosis of personality disor-
der: Perennial issues and an emerging reconceptualization. Annual
Review of Psychology, 58, 227–257. https://doi.org/10.1146/annur
ev.psych.57.102904.190200
Clark, L. A. (2009). Stability and change in personality disorder.
Current Directions in Psychological Science, 18(1), 27–31. https://
doi.org/10.1111/j.1467-8721.2009.01600.x
Clark, L. A., Cuthbert, B., Lewis-Fernández, R., Narrow, W. E., & Reed,
G. M. (2017). Three approaches to understanding and classifying
mental disorder: ICD-11, DSM-5, and the National Institute of
Mental Health’s Research Domain Criteria (RDoC). Psychological
Science in the Public Interest, 18(2), 72–145.
Clark, L. A., Daly, E. J., Ellickson-Larew, S. A., Nuzum, H., Kingsbury,
T., Shapiro, J. L., Allen, X., & Ro, E. (2019). Personality dysfunc-
tion and trait extremity: Conceptually but not empirically distinct?
In D. B. Samuel & D. R. Lynam (Eds.), Using basic personality
research to inform personality disorders (pp. 137–152). Oxford
University Press.
Clark, L. A., & Ro, E. (2014). Three-pronged assessment and diagno-
sis of personality disorder and its consequences: Personality func-
tioning, pathological traits, and psychosocial disability. Personality
Disorders: Theory, Research, and Treatment, 5(1), 55–69. https://
doi.org/10.1037/per00 00063
Clarke, P. M., Fiebig, D. G., & Gerdtham, U. G. (2008). Optimal re-
call length in survey design. Journal of Health Economics, 27(5),
1275–1284. https://doi.org/10.1016/j.jheal eco.2008.05.012
Conway, C. C., Forbes, M. K., Forbush, K. T., Fried, E. I., Hallquist,
M. N., Kotov, R., Mullins-Sweatt, S. N., Shackman, A. J., Skodol,
A. E., South, S. C., Sunderland, M., Waszczuk, M. A., Zald, D. H.,
Afzali, M. H., Bornovalova, M. A., Carragher, N., Docherty, A. R.,
Jonas, K. G., Krueger, R. F., … Eaton, N. R. (2019). A Hierarchical
Taxonomy of Psychopathology can transform mental health re-
search. Perspectives on Psychological Science, 14(3), 419–436.
https://doi.org/10.1177/17456 91618 810696

12
|
DEYOUNG Et al.
Cutshall, C., & Watson, D. (2004). The phobic stimuli response
scales: A new self-report measure of fear. Behaviour Research
and Therapy, 42, 1193–1201. https://doi.org/10.1016/j.
brat.2003.08.003
DeYoung, C. G. (2015). Cybernetic Big Five theory. Journal of Research
in Personality, 56, 33–58. https://doi.org/10.1016/j.jrp.2014.07.004
DeYoung, C. G. (2017). A cybernetic perspective on integrating person-
ality structure, personality process, and personality development.
European Journal of Personality, 31, 538–539.
DeYoung, C. G., & Krueger, R. F. (2018). A cybernetic theory of psy-
chopathology. Psychological Inquiry, 29, 117–138. https://doi.
org/10.1080/10478 40X.2018.1513680
Eysenck, H. J. (1983). Cicero and the state-trait theory of anxiety:
Another case of delayed recognition. American Psychologist, 38(1),
114–115. https://doi.org/10.1037/0003-066X.38.1.114
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin,
L. S. (1997). Structured clinical interview for DSM-IV axis II per-
sonality disorders, (SCID-II). American Psychiatric Association.
Fleeson, W. (2001). Toward a structure- and process-integrated view
of personality: Traits as density distributions of states. Journal of
Personality and Social Psychology, 80, 1011–1027. https://doi.
org/10.1037/0022-3514.80.6.1011
Fleeson, W., & Gallagher, P. (2009). The implications of Big Five
standing for the distribution of trait manifestation in behavior:
Fifteen experience-sampling studies and a meta-analysis. Journal
of Personality and Social Psychology, 97, 1097–1114. https://doi.
org/10.1037/a0016786
Griffith, J. W., Zinbarg, R. E., Craske, M. G., Mineka, S., Rose, R. D.,
Waters, A. M., & Sutton, J. M. (2010). Neuroticism as a common
dimension in the internalizing disorders. Psychological Medicine,
40, 1125–1136. https://doi.org/10.1017/S0033 29170 9991449
Gunderson, J. G., Stout, R. L., McGlashan, T. H., Shea, M. T., Morey,
L. C., Grilo, C. M., & Ansell, E. (2011). Ten-year course of border-
line personality disorder: Psychopathology and function from the
Collaborative Longitudinal Personality Disorders study. Archives of
General Psychiatry, 68(8), 827–837. https://doi.org/10.1001/archg
enpsy chiat ry.2011.37
Haslam, N., McGrath, M. J., Viechtbauer, W., & Kuppens, P. (2020).
Dimensions over categories: A meta-analysis of taxometric research.
Psychological Medicine, 50(9), 1418–1432. https://doi.org/10.1017/
S0033 29172 000183X
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K.,
Sanislow, C., & Wang, P. (2010, July). Research Domain Criteria
(RDoC): Toward a new classification framework for research on
mental disorders. AJP, 167(7), 748–751. https://doi.org/10.1176/
appi.ajp.2010.09091379
Klein, D. N., Kotov, R., & Bufferd, S. J. (2011). Personality and de-
pression: Explanatory models and review of the evidence. Annual
Review of Clinical Psychology, 7, 269–295. https://doi.org/10.1146/
annur ev-clinp sy-03221 0-104540
Klein, D. N., Lewinsohn, P. M., & Seeley, J. R. (1996). Hypomanic
personality traits in a community sample of adolescents. Journal
of Affective Disorders, 38, 135–143. https://doi.org/10.1016/0165-
0327(96)00005 -5
Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R.
R., Bagby, R. M., Brown, T. A., Carpenter, W. T., Caspi, A., Clark,
L. A., Eaton, N. R., Forbes, M. K., Forbush, K. T., Goldberg, D.,
Hasin, D., Hyman, S. E., Ivanova, M. Y., Lynam, D. R., Markon,
K., … Zimmerman, M. (2017). The Hierarchical Taxonomy of
Psychopathology (HiTOP): A dimensional alternative to traditional
nosologies. Journal of Abnormal Psychology, 126(4), 454–478.
https://doi.org/10.1037/abn00 00258
Kotov, R., Leong, S. H., Mojtabai, R., Erlanger, A. C. E., Fochtmann,
L. J., Constantino, E., Carlson, G. A., & Bromet, E. J. (2013).
Boundaries of schizoaffective disorder: Revisiting Kraepelin. JAMA
Psychiatry, 70(12), 1276–1286. https://doi.org/10.1001/jamap sychi
atry.2013.2350
Krueger, R. F., Markon, K. E., Patrick, C. J., Benning, S. D., & Kramer,
M. D. (2007). Linking antisocial behavior, substance use, and per-
sonality: An integrative quantitative model of the adult externalizing
spectrum. Journal of Abnormal Psychology, 116(4), 64–666.
Krueger, R. F., Kotov, R., Watson, D., Forbes, M. K., Eaton, N.
R., Ruggero, C. J., Simms, L. J., Widiger, T. A., Achenbach, T.
M., Bach, B. O., Bagby, R. M., Bornovalova, M. A., Carpenter,
W. T., Chmielewski, M., Cicero, D. C., Clark, L. A., Conway,
C., DeClercq, B., DeYoung, C. G., … Zimmermann, J. (2018).
Progress in achieving quantitative classification of psychopa-
thology. World Psychiatry, 17, 282–293. https://doi.org/10.1002/
wps.20566
Krueger, R. F., & Tackett, J. L. (2003). Personality and psychopathol-
ogy: Working toward the bigger picture. Journal of Personality
Disorders, 17(2: Special issue), 109–128.
Kwapil, T. R., Miller, M. B., Zinser, M. C., Chapman, L. J., Chapman,
J., & Eckblad, M. (2000). A longitudinal study of high scorers on
the Hypomanic Personality Scale. Journal of Abnormal Psychology,
109, 222–226. https://doi.org/10.1037/0021-843X.109.2.222
Latzman, R. D., DeYoung, C. G. & The HiTOP Neurobiological
Foundations Workgroup. (2020). Using empirically-derived di-
mensional phenotypes to accelerate clinical neuroscience: The
Hierarchical Taxonomy of Psychopathology (HiTOP) frame-
work. Neuropsychopharmacology, 45(7), 1083–1085. https://doi.
org/10.1038/s4138 6-020-0639-6
Leising, D., & Zimmermann, J. (2011). An integrative conceptual frame-
work for assessing personality and personality pathology. Review
of General Psychology, 15(4), 317–330. https://doi.org/10.1037/
a0025070
Linscott, R. J., & van Os, J. (2013). An updated and conservative sys-
tematic review and meta-analysis of epidemiological evidence on
psychotic experiences in children and adults: On the pathway from
proneness to persistence to dimensional expression across mental
disorders. Psychological Medicine, 43, 1133–1149. https://doi.
org/10.1017/S0033 29171 2001626
Livesley, W. J., & Jang, K. (2005). Differentiating normal, abnormal,
and disorders of personality. European Journal of Personality, 19,
257–268.
Markon, K. E., & Krueger, R. F. (2005). Categorical and continuous
models of liability to externalizing disorders: A direct comparison in
NESARC. Archives of General Psychiatry, 62, 1352–1359. https://
doi.org/10.1001/archp syc.62.12.1352
Markon, K. E., Krueger, R. F., & Watson, D. (2005). Delineating the
structure of normal and abnormal personality: An integrative hierar-
chical approach. Journal of Personality and Social Psychology, 88,
139–157. https://doi.org/10.1037/0022-3514.88.1.139
Morey, L. C., Good, E. W., & Hopwood, C. J. (2020). Global personal-
ity dysfunction and the relationship of pathological and normal trait
domains in the DSM-5 Alternative Model for Personality Disorders.
Journal of Personality, 1–13. https://doi.org/10.1111/jopy.12560
Morey, L. C., & Hopwood, C. J. (2013). Stability and change in person-
ality disorders. Annual Review of Clinical Psychology, 9, 499–528.
https://doi.org/10.1146/annur ev-clinp sy-05021 2-185637

|
13
DEYOUNG Et al.
Mullins-Sweatt, S. N., & Widiger, T. A. (2010). Personality-related
problems in living: An empirical approach. Personality Disorders:
Theory, Research, and Treatment, 1(4), 230–238. https://doi.
org/10.1037/a0018228
Nuzum, H., Shapiro, J. L., & Clark, L. A. (2019). Affect, behavior, and
cognition in personality and functioning: An item-content approach
to clarifying empirical overlap. Psychological Assessment, 31(7),
905–912. https://doi.org/10.1037/pas00 00712
Ormel, J., Jeronimus, B. F., Kotov, R., Riese, H., Bos, E. H., Hankin,
B., Rosmalen, J. G. M., & Oldehinkel, A. J. (2013). Neuroticism
and common mental disorders: Meaning and utility of a complex
relationship. Clinical Psychology Review, 33(5), 686–697. https://
doi.org/10.1016/j.cpr.2013.04.003
Pfohl, B., Blum, N., & Zimmerman, M. (1997). Structured interview for
DSM-IV personality: SIDP-IV. American Psychiatric Association.
Prenoveau, J. M., Craske, M. G., Zinbarg, R. E., Mineka, S., Rose, R. D.,
& Griffith, J. W. (2011). Are anxiety and depression just as stable
as personality during late adolescence? Results from a three-year
longitudinal latent variable study. Journal of Abnormal Psychology,
120(4), 832–843. https://doi.org/10.1037/a0023939
Ro, E., & Clark, L. A. (2013). Interrelation between psychosocial func-
tioning and adaptive- and maladaptive-range personality traits.
Journal of Abnormal Psychology, 122, 822–835.
Roberts, B. W., Luo, J., Briley, D. A., Chow, P. I., Su, R., & Hill, P.
L. (2017). A systematic review of personality trait change through
intervention. Psychological Bulletin, 143(2), 117–141. https://doi.
org/10.1037/bul00 00088
Roberts, B. W., Walton, K. E., & Viechtbauer, W. (2006). Patterns of
mean-level change in personality traits across the life course: A
meta-analysis of longitudinal studies. Psychological Bulletin, 132,
1–25. https://doi.org/10.1037/0033-2909.132.1.1
Roberts, B. W., Wood, D., & Caspi, A. (2008). The development of per-
sonality traits in adulthood. In O. P. John, R. W. Robins, & L. A.
Pervin (Eds.), Handbook of personality: Theory and research (3rd
ed., pp. 375–398). Guilford Press.
Ruggero, C. J., Kotov, R., Hopwood, C. J., First, M., Clark, L. A.,
Skodol, A. E., Mullins-Sweatt, S. N., Patrick, C. J., Bach, B. O.,
Cicero, D. C., Docherty, A., Simms, L. J., Bagby, R. M., Krueger, R.
F., Callahan, J. L., Chmielewski, M., Conway, C. C., De Clercq, B.,
Dornbach-Bender, A., … Zimmermann, J. (2019). Integrating the
Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical
practice. Journal of Consulting and Clinical Psychology, 87(12),
1069–1084. https://doi.org/10.1037/ccp00 00452
Skodol, A. E., Gunderson, J. G., Shea, M. T., McGlashan, T. H., Morey,
L. C., Sanislow, C. A., Bender, D. S., Grilo, C. M., Zanarini, M. C.,
Yen, S., Pagano, M. E., & Stout, R. L. (2005). The collaborative lon-
gitudinal personality disorders study (CLPS): Overview and impli-
cations. Journal of Personality Disorders, 19(5), 487–504. https://
doi.org/10.1521/pedi.2005.19.5.487
Soto, C. J., John, O. P., Gosling, S. D., & Potter, J. (2011). Age dif-
ferences in personality traits from 10 to 65: Big Five domains and
facets in a large cross-sectional sample. Journal of Personality
and Social Psychology, 100(2), 330–348. https://doi.org/10.1037/
a0021717
Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory.
Consulting Psychologist Press.
Stepp, S. D., Yu, L., Miller, J. D., Hallquist, M. N., Trull, T. J., &
Pilkonis, P. A. (2012). Integrating competing dimensional mod-
els of personality. Personality Disorders: Theory, Research, and
Treatment, 3, 107–126.
Suzuki, T., Samuel, D. B., Pahlen, S., & Krueger, R. F. (2015). DSM-5
alternative personality disorder model traits as maladaptive extreme
variants of the Five-Factor model: An item-response theory anal-
ysis. Journal of Abnormal Psychology, 124, 343–354. https://doi.
org/10.1037/abn00 00035
Tellegen, A., Ben-Porath, Y. S., Sellbom, M., Arbisi, P. A., McNulty, J.
L., & Graham, J. R. (2006). Further evidence on the validity of the
MMPI-2 Restructured Clinical (RC) scales: Addressing questions
raised by Rogers, Sewell, Harrison, and Jordan and Nichols. Journal
of Personality Assessment, 87, 148–171.
Üstün, B., & Kennedy, C. (2009). What is “functional impair-
ment”? Disentangling disability from clinical significance. World
Psychiatry, 8(2), 82–85. https://doi.org/10.1002/j.2051-5545.2009.
tb002 19.x
Van den Akker, A. L., Deković, M., Asscher, J., & Prinzie, P. (2014).
Mean-level personality development across childhood and ad-
olescence: A temporary defiance of the maturity principle and
bidirectional associations with parenting. Journal of Personality
and Social Psychology, 107(4), 736–750. https://doi.org/10.1037/
a0037248
van Dijk, I., Krueger, R. F., & Laceulle, O. M. (2020). DSM–5 alterna-
tive personality disorder model traits as extreme variants of five-fac-
tor model traits in adolescents. Personality Disorders: Theory,
Research, and Treatment. Advance online publication. https://doi.
org/10.1037/per00 00409
Vittengl, J. R., Clark, L. A., Thase, M. E., & Jarrett, R. B. (2018).
Relations of shared and unique components of personality and
psychosocial functioning to depressive symptoms. Journal of
Personality Disorders, 32(5), 577–602. https://doi.org/10.1521/
pedi_2017_31_313
Wakefield, J. C. (1992). Disorder as harmful dysfunction: A conceptual
critique of DSM-III-R's definition of mental disorder. Psychological
Review, 99, 232–247. https://doi.org/10.1037/0033-295X.99.2.232
Walton, K. E., Ormel, J., & Krueger, R. F. (2011). The dimensional
nature of externalizing behaviors in adolescence: Evidence from a
direct comparison of categorical, dimensional, and hybrid models.
Journal of Abnormal Child Psychology, 39, 553–561. https://doi.
org/10.1007/s1080 2-010-9478-y
Watson, D. (2000). Mood and temperament. Guilford Press.
Watson, D., & Clark, L. A. (1995). Depression and the melancholic tem-
perament. European Journal of Personality, 9(5), 351–366. https://
doi.org/10.1002/per.24100 90505
Widiger, T. A. (1993). The DSM-III-R categorical personality disorder
diagnoses: A critique and an alternative. Psychological Inquiry,
4(2), 75–90. https://doi.org/10.1207/s1532 7965p li0402_1
Widiger, T. A., Bach, B. O., Chmielewski, M., Clark, L. A., DeYoung,
C., Hopwood, C. J., Kotov, R., Krueger, R. F., Miller, J. D., Morey,
L. C., Mullins-Sweatt, S. N., Patrick, C. J., Pincus, A. L., Samuel,
D. B., Sellbom, M., South, S. C., Tackett, J. L., Watson, D., Waugh,
M. H., … Thomas, K. M. (2019). Criterion A of the AMPD in
HiTOP. Journal of Personality Assessment, 101, 345–355. https://
doi.org/10.1080/00223 891.2018.1465431
Widiger, T. A., & Mullins-Sweatt, S. N. (2009). Five-factor model of
personality disorder: A proposal for DSM-V. Annual Review of
Clinical Psychology, 5, 197–220. https://doi.org/10.1146/annur ev.
clinp sy.032408.153542
Widiger, T. A., & Samuel, D. B. (2005). Diagnostic categories or di-
mensions? A question for the Diagnostic and Statistical Manual of
Mental Disorders—Fifth Edition. Journal of Abnormal Psychology,
114(4), 494–504. https://doi.org/10.1037/0021-843X.114.4.494

14
|
DEYOUNG Et al.
Widiger, T. A., Sellbom, M., Chmielewski, M., Clark, L. A.,
DeYoung, C. G., Kotov, R., Krueger, R. F., Lynam, D. R., Miller,
J. D., Mullins-Sweatt, S., Samuel, D. B., South, S. C., Tackett,
J. L., Thomas, K. M., Watson, D., & Wright, A. G. C. (2019).
Personality in a hierarchical model of psychopathology. Clinical
Psychological Science, 7, 77–92. https://doi.org/10.1177/21677
02618 797105
Widiger, T. A., & Smith, G. T. (2008). Personality and psychopathol-
ogy. In O. P. John, R. Robins & L. A. Pervin (Eds.), Handbook
of personality: Theory and research (3rd ed., pp. 743–769).
Guilford.
Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the clas-
sification of personality disorder: Shifting to a dimen-
sional model. American Psychologist, 62, 71–83. https://doi.
org/10.1037/0003-066X.62.2.71
Wood, D., & Wortman, J. (2012). Trait means and desirabilities as
artifactual and real sources of differential stability of person-
ality traits. Journal of Personality, 80, 665–701. https://doi.
org/10.1111/j.1467-6494.2011.00740.x
World Health Organization. (2001). International Classification of
Functioning, Disability and Health (ICF). https://www.who.int/
class ifica tions/ icf/en/
World Health Organization. (2018). International classification of dis-
eases for mortality and morbidity statistics (11th Revision). https://
icd.who.int/brows e11/l-m/en
Wright, A. G., & Kaurin, A. (2020). Integrating structure and function in
conceptualizing and assessing pathological traits. Psychopathology,
53(3–4), 189–197. https://doi.org/10.1159/00050 7590
Wright, A. G. C., Krueger, R. F., Hobbs, M. J., Markon, K. E., Eaton, N.
R., & Slade, T. (2013). The structure of psychopathology: Toward
an expanded quantitative empirical model. Journal of Abnormal
Psychology, 122, 281–294. https://doi.org/10.1037/a0030133
Wright, A. G., & Simms, L. J. (2016). Stability and fluctuation of
personality disorder features in daily life. Journal of Abnormal
Psychology, 125(5), 641–656. https://doi.org/10.1037/abn00 00169
How to cite this article: DeYoung CG, Chmielewski
M, Clark LA, et al. The distinction between symptoms
and traits in the Hierarchical Taxonomy of
Psychopathology (HiTOP). J Pers. 2020;00:1–14.
https://doi.org/10.1111/jopy.12593