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Transdiagnostic dimensional models for personality pathology, such as PID-5 and HiTOP, have emerged as a research effort to rectify some long-held concerns with the categorical classification of mental disorders. These transdiagnostic dimensions, as compared to discrete personality disorders, represent arguably superior targets for research and treatment. However, widespread clinical implementation of such a dimensional approach requires further evidence of its clinical utility. Thus, the current study aims to investigate the relationships between dimensional personality domains and outcome trajectories of evidence-based psychological treatment with natural clinical data.

Obsessive-compulsive disorder (OCD) is a clinical syndrome characterised by recurrent intrusive thoughts (obsessions) and repetitive mental or behavioural acts (compulsions), typically performed in response to obsessions or related anxiety. OCD generally has a stable symptom pattern throughout life but nevertheless is well known for its heterogeneity, as symptomatic presentations and comorbidity patterns differ widely among patients. A number of other psychiatric and neurological disorders may share similar phenomenological characteristics with OCD or are sometimes conceptualised as atypical OCDs. These heterogeneous aspects of the disorder have led to a search for OCD subtypes that might be associated with different aetiologies or treatment responses.

Classical psychopathology highly valued the interaction between clinician and patient, and recent findings have provided preliminary evidence of an association between categorical psychiatric diagnosis and the clinician's subjective experience during the first clinical assessment. To extend these findings, the present study examined the relationship between psychopathological dimensions and clinicians' subjective experiences. The study involved 45 clinicians and 783 patients in several psychiatric inpatient and outpatient units. When they saw a new patient, the clinicians completed the Assessment of Clinician's Subjective Experience questionnaire (ACSE) and the 24-item Brief Psychiatric Rating Scale (BPRS). Scores on five core psychopathological dimensions supported by meta-analytic evidence (Affect, Positive Symptoms, Negative Symptoms, Activation, Disorganization) were derived from the BPRS. Multivariate analysis revealed that each psychopathological dimension was characterized by a distinct pattern of independent associations with certain aspects of Clinician's Subjective Experience, as measured by the ACSE. This study provided preliminary evidence of significant and theoretically consistent relationships between major psychopathological dimensions and the psychiatrist's subjective experience during the first clinical evaluation. Improving the understanding of intersubjective processes may have important implications for theory, practice, research, and training.

Introduction: Current psychiatric classification systems underestimate the part played by anger and aggressiveness in unipolar depression. This study was designed to assess the relevance of anger, irritability, aggressiveness, hostility, and psychomotor activation in major depressive disorder. Methods: A total of 222 newly admitted consecutive outpatients with major depressive disorder (mean age 48.9 years, 64.4% females) were enrolled in the study. They had no comorbid axis I or II DSM-IV disorder, and they received no treatment with antidepressants in the preceding 2 months. They were assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. Principal component analysis was performed on SVARAD items. Results: We obtained a three-factor solution accounting for 47.4% of total variance. The factors were interpreted as ‘anger/irritability’, ‘depression’, and ‘anxiety’, respectively. The anger/irritability dimension was clinically relevant in 23% of patients. Anger/aggressiveness was especially frequent (21.6%), whereas psychomotor activation was infrequent (0.9%). Discussion: In depressive disorders, there are psychopathological dimensions other than depressed mood and anxiety that deserve greater clinical recognition and research. Our study suggests that one of these symptom clusters includes anger, irritability, aggressiveness, and hostility. The relevance of this dimension was not related to concurrent pharmacological treatment. Misdiagnosis of bipolar II disorder is also unlikely to explain our findings. Possibly, personality factors might at least partly explain the occurrence of anger and aggressiveness in several depressed patients. Attachment theory suggests that anger might also be conceived as part of the protest-despair-detachment reaction to a loss, either actual or symbolic.