Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems

Abstract

Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

Keywords: Externalizing disorders; Measurement; Diagnostic and Statistical Manual of Mental Disorders; International Classification of Diseases; Hierarchical Taxonomy of Psychopathology; Psychopathology

Core Tip: Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases have evolved as a clinical tool but with several limitations associated to the operational definition for measuring externalizing disorders. Approaches such a Hierarchical Taxonomy of Psychopathology improve the conceptualization giving a general framework for psychopathology, although providing a more complex solution for clinicians. Present review shows a lack of measurement instruments integrating new theoretical advances and clinical utility.