Transdiagnostic psychopathology dimensions and cognitive functioning after traumatic brain injury: An application of the HiTOP-TBI model

Background: Psychopathology and cognitive impairment are common consequences of moderate-severe traumatic brain injury (TBI), but their interrelationships remain poorly understood. Clarifying these relationships is important for understanding how cognitive functioning may contribute to post-TBI psychopathology and for informing targeted, holistic assessment and treatment strategies. Traditional categorical approaches to psychiatric diagnosis have produced inconsistent results, potentially due to limitations in capturing the complexity of post-TBI psychopathology. The recently developed Hierarchical Taxonomy of Psychopathology Following TBI (HiTOP-TBI) model, a transdiagnostic dimensional framework, was applied to examine associations between psychopathology and cognitive functioning. Methods: Ninety-nine participants with moderate-severe TBI (mean age 50.86 years; 72% male) completed self-report psychopathology questionnaires and performance-based cognitive tasks. Linear regressions examined associations between ten hierarchically organised HiTOP-TBI dimensions (one general factor, two broad internalizing and externalizing spectra, seven lower-order factors) and cognitive measures, with false discovery rate correction applied. Results: After correction, higher scores (indicating greater psychopathology) on the HiTOP-TBI dimensions of Externalizing Problems, Rigid Constraint, and Self-Harm and Psychoticism were associated with poorer performance on the verbal encoding task. Higher scores on Rigid Constraint and Self-Harm and Psychoticism were also associated with lower scores in the episodic memory domain (encompassing both immediate and delayed recall). In comparison, General Problems, Internalizing Problems, Somatic Symptoms, Detachment, Compensatory and Phobic Reactions, Dysregulated Negative Emotionality, and Harmful Substance Use were not significantly associated with cognitive functioning after correction. Conclusions: Applying the transdiagnostic, dimensional HiTOP-TBI framework, we identified several associations between psychopathology and cognitive functioning after moderate-severe TBI, with verbal encoding and memory most consistently implicated, particularly within externalizing domains. These findings highlight the importance of holistic neuropsychological formulation and integrative interventions aimed at improving both emotional and cognitive outcomes in TBI and demonstrate the value of transdiagnostic approaches in neuropsychology research and practice.