Modeling internalizing symptoms in United States veterans using the Hierarchical Taxonomy of Psychopathology (HiTOP) framework: Gender invariance and longitudinal stability.

Using the Hierarchical Taxonomy of Psychopathology (HiTOP) framework, we constructed hierarchical-dimensional phenotypes for internalizing disorders in a nationally representative sample of U.S. veterans that oversampled for women (N = 781, 62% women). Based on responses to the Eating Pathology Symptoms Inventory and the Expanded Form of the Inventory of Depression and Anxiety Symptoms, HiTOP models were constructed using L. R. Goldberg’s bass-ackwards method with exploratory structural equation modeling. We identified one large superordinate factor that assessed broad internalizing psychopathology, three subfactors (Eating Pathology, Fear, and Distress in women; Eating Pathology, Fear/Distress, and low Well-being in men), and six dimensional syndromes (Bulimia, Fitness Concerns, Restriction, Fear, Mixed Arousal-Distress, and low Well-being). The model demonstrated gender invariance across both time points. Factors showed evidence of measurement stability over time, as indicated by high Tucker’s congruence coefficients and low average levels of differences in the loadings across assessments. Results suggested that the HiTOP framework is a robust, longitudinally stable framework for assessing internalizing symptoms. Our findings have implications for future research seeking to improve diagnostic precision for internalizing psychopathology. Empirically based phenotypes have the potential to lead to improved treatments that target shared maintenance mechanisms underlying internalizing dimensions and, in turn, improve clinical care and treatment efficacy.