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 cognition’s role in post-TBI psychopathology and for informing targeted, holistic assessment and treatment strategies. Traditional categorical approaches to psychiatric diagnosis have produced inconsistent results. 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 adults with moderate-severe TBI participated (Mage = 50.86 years; 72% male; Mtime post-injury = 14.6 years,SD = 8.2; MGCS = 8.03; MPTA = 24.3 days). Psychopathology was assessed using self-report questionnaires completed predominantly online (96%). Cognitive performance was assessed via telephone-administered tasks. Linear regressions examined associations between ten hierarchically organizedHiTOP-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 verbal encoding and 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 notsignificantly 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. Verbal encoding and memory were most consistently implicated, particularly within externalizing domains. 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.