#1095 Robert Krueger: Classification of Mental Disorders, and Mental Wellbeing

00:00 Ricardo Lopes: Hello, everyone. Welcome to a new episode of the Center. I'm your host, as always, Ricardo Labs, and today I'm joined by Doctor Robert Kruger. He is distinguished McKnight University professor in the Department of Psychology at the University of Minnesota. And today, we're going to talk about the classification of disorders in psychiatry, the hierarchical taxonomy of psychopathology, personality, uh, subjective well-being, and other related topics. So, Doctor Kruger, welcome to the show. It's a pleasure to everyone.

00:34 Robert Krueger: Yeah, thanks again for inviting me.

00:38 Ricardo Lopes: So, let's start by talking a little bit about nosology, psychiatric nosology or how the classification of mental disorders is done in psychiatry. So, what do you think of the way psychiatric nosology works today?

00:55 Robert Krueger: Um, SO I suppose we could start with the sort of um official noseologies, I guess that's where you're headed with this question. So, you know, descriptive psychiatry has a rich history, um, and has functioned historically in a way that's similar to how medicine is functioned, which is to say that clinical observation is the bedrock of the classification system, right? So clinicians encounter patients. They see patients who have similar features and then based on that they start to describe criteria for You know, patients who present with similar kinds of complaints or features and You know, throughout the history of medicine, that kind of approach has been fairly productive, especially during the 20th century. Because many of those syndromes were fairly tight in their organization and had an ideology that was fairly circumscribed, right? So for example, you can encounter patients who have similar features. You can use 20th century style technology to, you know, examine potential correlates, right, like for instance looking at blood samples under a microscope and so on and find a key pathogen, right, or some sort of specific factor that then leads to this, you know, presentation of symptoms. And I don't mean to oversimplify, you know. Semantic medicine, because there are many things in that realm that are considerably more complicated in terms of their ideology and pathophysiology. But, you know, to make a long story short, that that's the paradigm, right, that has influenced psychiatric classification in a way that's similar to medicine, in as much as psychiatry is in fact a branch of medicine. So that has, you know, that results in the kinds of classification systems that most people are familiar with that are issued by authoritative bodies, most notably the American Psychiatric Association's, you know, diagnostic and Statistical Manual, or PSM and the very similarly organized um international classification of Disease, which is published by the World Health Organization. Right, and so in those systems, diagnoses are arranged into categories, um, and those categories are delineated by criteria, um. And the idea basically is that these things exist in nature as categories and based on the presence or absence of a fixed number of criteria from a more extensive set, right, for example, there may be 9 criteria and the threshold for diagnosis having 5. Using that kind of rubric, right, the clinicians. Meant to utilize that kind of system to arrive at an appropriate diagnosis. And then comparing potential diagnostic labels, the clinician is meant to engage in the process of differential diagnosis, right? So there may be similar presentations but subtle differences, right? And the process of diagnosis is to determine what the most optimal and, and generally speaking singular, right, um, diagnostic label would be for any given clinical presentation. So that that's the system that sort of exists um in psychiatry, and that system has wide influence over all mental health disciplines.

04:08 Ricardo Lopes: So one highly debated question has to do with what a mental disorder is. Uh, SO, what is it? I mean, what is your approach to this question? What are your thoughts about it?

04:25 Robert Krueger: Maybe you could say a little more specifically, my thoughts about what specifically, maybe.

04:31 Ricardo Lopes: Uh, I, I mean, the question of what a mental disorder is, what it means.

04:38 Robert Krueger: That's a very deep question. It's hard to answer it in a succinct manner because many brilliant people have written about this issue and tried to come up with an internally consistent definition, um. Uh, THANKS to the prompting of my colleague and friend Colin DeYoung, it is something that I've tried to think about and write about more recently, and Colin and I have a perspective on this that we call the cybernetic perspective, um, and the idea there basically is that when Uh, an organism that's goal directed like, like a human being, right, um, encounters circumstances that Uh, are incompatible with their goals, they often experience a sense of distress or misalignment, and then, you know, it's that kind of process of encountering things that are incompatible with one's goals that leads to the kind of distress, right? That might be the essence of You know, um, not feeling well in a psychological sense, um. And then psychopathology from that perspective emerges when the uh person, you know, people as an example here, right? Like when the person is unable to generate novel strategies or approaches um to realize a different set of goals or to realize a different way of approaching their goals. And so I think that's that's kind of how we've started to think about it. So similar to other people's, you know, definitions. There's, you know, the symptom presentation per se, but that's not, you know, sufficient to say that psychopathology is present. There also has to be a thwartedness about it, right? So I guess that that's been our perspective, but most perspectives have key similarities, right? So a typical definition is not just that there are symptoms present, but also that those symptoms are debilitating, right? So there has to be, for instance, social and occupational dysfunction. It goes along with the sense of um. With the presentation of problematic, you know, psychiatric symptoms.

06:39 Ricardo Lopes: So, you mentioned, uh, Doctor Colin the Young. I met him on the show twice and we talked a lot about personality traits, for example, and their relationship to psychopathology. So, uh, do individual differences have any bearing on how we understand and study psychopathology, and if so, what is the relationship here?

07:08 Robert Krueger: Right, so I guess your question is generally about the relationship between personality and psychopathology. Again, you picked a very deep topic on which there's a tremendous literature. Um, I guess my thinking about it is that these are very closely related concepts because we sort of know this um from a number of different angles, right? So um based on just phenotypic presentation we could call it, right? So we could say that's the literature on personality, the literature on psychopathology. These literatures have evolved somewhat independently, um, and the assessments that have been developed from both perspectives are. Uh, PUTTING people into individual difference, you know, rankings in a way that's very similar, right? So a personality questionnaire that's meant to get at a neuroticism trait often has, you know, items on it that are very similar to the items on something like a symptom checklist for anxiety and depression. So it, it may be the case that the, the sort of de facto distinction has to do with something like time scale, right? So personality traits are often thought of as Reasonably consistent and enduring, um. And psychopathology is often thought of as having more um time varying features, right, so that it's not typical for a person to be continually in an episode of psychopathology, but rather people sort of wax and wane in their presentation over time based on what's happening in their lives. So that's probably the kind of key distinction, something about the time scale, but You know, speaking, you know, kind of clinically, uh, it's, it's very difficult for me to think about a patient, you know, or a client. In a way that doesn't recognize their dispositional features. Uh, EVEN if their current functioning is somewhat different from their typical functioning, right? It, it, their symptom profile, the way in which they're presenting with things is embedded in their dispositions. So there's a very intimate relationship um between personality and psychopathology and the way I tend to think about it, and this is, I think, well supported by the evidence is that personality is kind of the organizing structure. For the presentation of symptoms, um, but I don't want to go as far as to say the concepts are entirely fungible or interchangeable because there are some important distinctions historically between the concepts. Um, SO hopefully that kind of addresses your question in a succinct way.

09:40 Ricardo Lopes: Mhm. So could you tell us about the hierarchical taxonomy of psychopathology project? I mean, what is it, what is it about, uh, how did it start and what are its goals exactly?

09:57 Robert Krueger: Right, so the high top, you know, the hierarchical taxonomy psychology project started, um. Almost a decade ago now, um. And the way it got started really was that, um, my, you know, colleague and and friend Roman Kotov, right, had this idea that plenty of people were doing this work on, um, trying to figure out kind of the structure of psychopathology. And, and that work kind of had to do with figuring out if there was consistency to patterns of comorbidity that were shown among DSM defined entities. Um, SO going back to our discussion of, you know, the DSM and categorical classification. In spite of the sort of basic underlying premise that you can choose the most optimal, you know, single categorical descriptive label for any given patient. You know, literature had emerged showing that that's very difficult to do practically speaking, um, Particularly in psychiatric epidemiology, where the goal is to figure out You know, the prevalence of different kinds of categorical diagnosis in the general population. So those studies um did away with the attempts to have very strict hierarchical exclusionary rules among the categories because it's very hard to apply them in a way that makes conceptual or clinical sense. Um, SO instead you kind of assign the diagnostic labels that seem appropriate for the person's, um, You know, complaints or presentation or endorsement of, you know, criteria in an interview. And so you get these patterns of comorbidity, um, we could talk a little bit about comorbidity, right? What does that term really mean? Um. It's a little bit of a misnomer in my way of thinking about it because comorbidity just, you know, means that you have to, you know, diagnoses at the same time. Given whatever time frame it is you're considering the comorbidity in terms of, this could happen just because two things have very high base rates, right? So, um, you know, plenty of people who meet criteria for depression are also myopic because these are commonly observed conditions. You can figure out the prevalence of the joint condition just from the product of the base rates of the two conditions, right? So the base rate of A multiplied by the base rate of B gives you. The probability that someone's gonna have both things if they're not correlated with each other. But the phenomenon right in psychiatric epidemiology that had been observed is more um that these diagnoses are correlated with each other. So that means that they're co-occurring at rates that are greater than would be predicted simply from the product of the base rates. So what you see in those kinds of psychiatric epi data is persons who have um diagnosis, uh well I should say like, you see that there's um correlations essentially among diagnoses. So you have many more people with multiple conditions than you would get if you just worked out all the base rate products, right? And it's those patterns of correlation that kind of gave rise to the um To the structural literature that was the initial inspiration for the high top consortium where it, it becomes clear if you start to study this stuff that there are patterns that are both um hierarchical in terms of the sort of organization of individual differences and psychopathological propensities as well as dimensional, right? So let's, we can work through those two concepts a little bit here if you want, right? So, um. The idea of hierarchy is very familiar to researchers and individual differences in areas like personality and mental abilities, um, and it's basically that if you look at patterns of correlations, a good way to model them is from very fine-grained individual difference variables. So in in the world of psychopathology that could be particular symptom cluster is right like anhedonia, for example, like something that's pretty specific, but then those things have patterns of correlation that are pretty psychologically meaningful. And and the psychological meaning of those correlations is distinctive from the DSM's organizational structure. That gets really interesting, right back to the question about personality and psychopathology. So to make a long story short, if you start to look at patterns of correlation among psychopathological experiences, you get a structure that's very similar to the structure of human personality. Um, MAYBE seen through a darker lens, right, because you're asking about the maladaptive aspects of personality expressions. But you kind of see something similar to the well-known big five, just the maladaptive aspects of those big five tendencies. So there's pretty good evidence now that that's the structure of psychopathology, right? It's not what the DSM imposes, right, or claims, um, which would be something more like this kind of linear organization of categories and these computerly separate chapters that are studied in these distinctive literatures. Rather, the patterns, right, of correlation among mental disorder diagnoses look a lot like the patterns of personality that you see in the general population. So, again, getting back to high top, the the way that that effort came about. WAS to say that, OK, like a bunch of us were doing this work, um, we, we knew each other and we're publishing productively kind of independent groups, but it made sense to bring everybody together in a consortium, particularly to, to, um, articulate a more comprehensive and empirically based classification system that wasn't constrained by the traditions of the DSM, right? So in DSM basically through fiat, right, like by definition. Just because that's how authorities have put together the manual, these things are supposed to be categories. But they might not be. So that's the hierarchical part, right? These things tend to be organized from very narrow specific sent clusters all the way up to broad individual difference variables that you might think of as a spectrum of interrelated conditions. And in addition, there's a, there's a related literature that tries to ask, OK, if we have these patterns of symptoms. What kind of a model would fit the patterning we're observing in data? This stuff gets a little technical, but But basically there's ways to compare models that um Have the underlying distribution as more categorical or um discrete would be maybe a better word for it, right, that there are discrete groupings of probability masses in the underlying distribution. Versus that it's more continuous and smooth. So that's another strong empirical basis for the perspective that is um sort of underlying the high top effort, right? So, you know, to make a long story short, you can formally compare dimensional and categorical models of psychopathological variation. When you do this formal comparison, there's a substantial literature showing that things are generally better fit by dimensional models than they are fit by more discrete or categorical kinds of models. So those two robust empirical observations, right, the things tend to be dimensional in the world of psychopathology, and that they're pretty well organized into a hierarchy, form the basis for the high top effort and provide an empirically based approaches to classification of psychopathology. Um, THAT'S an alternative to the constraints, right, that exists primarily by tradition and, you know, psychiatric methodology. Maybe one, go ahead.

18:01 Ricardo Lopes: No, no, go ahead, yes, just finish what you're going to

18:04 Robert Krueger: say. Well, I was just gonna say like how has evolved? High has evolved into a situation where there are sort of Well, there are, there are two related efforts, right? There's the high top um research consortium, right, which is people working on particular topics inspired by the high top model. There are work groups, for instance, on genetics and And neuroscience and so on and so forth, right, where the idea is to take those fields and merge them with the high top perspective on phenotypic organization of psychopathology. And that's the consortium part, but there's also a society that's formed now, um, right, so a scientific society where the idea is that there will be annual meetings and people pay dues and they, you know, come to the meetings and present their research, um, and I would encourage people to go to the high top web page. Um, I'm sure we can put the URL into the show notes or something like this, but if you're interested in this kind of thing, it's possible to get involved in. Either or both, the society, right, which is again like a scientific organization. Um, OR the consortium, which is, you know, a, a more of a group focused on the science and scholarship, um. So the new members are always welcome and I would encourage people who are interested in what I'm talking about here to think about joining. That's my point.

19:26 Ricardo Lopes: So in this taxonomy, what are symptoms and how do you deal with them and what are the differences between symptoms and treats?

19:39 Robert Krueger: Yeah, that's an excellent question. I think that's challenging in the way that we were discussing earlier in this conversation, but in, in short, um, that distinction is pretty fuzzy. It probably has something to do with the time scale on which these things are presented. But both kinds of constructs are sitting within the high top hierarchy, right? So traits again are more like a disposition to engage in a behavior over time, right, kind of a, a probability, right, that a person's gonna be in a given state at any given point in time over some aggregate amount of time, um, whereas symptoms might be thought of as more like things that change more from time to time. So classic examples, right, are things like um self-harm, right? So. Self-harm tends not to be um entirely trait-like, although some people can be very persistent in their self-harming tendencies. There's more variation over time and how intensely people are engaging in that specific and circumscribed set of, you know, very troubling behaviors. Whereas the disposition, right, to want to harm oneself, um, is coming from, you know, neuroticism and distress and, you know, qualities like that that the person might have as a disposition over longer chunks of time. Um, SO that I think is kind of the distinction within high top, right? Symptoms are more like things that come and go and traits are more like things that are more consistent over time, but they're meaningfully related to each other, because the probability of having a symptom emerges from the position that one has on a, you know, trait like construct. And the key to moving this discussion forward is um fine-grained longitudinal data, um, which many people involved in Hightop are very interested in, challenging data to collect, but kind of the key to unraveling these time scales. That makes sense? So like if you really want to understand in in an empirically based way the different time scales of different human propensities to different behaviors, you got to study people in an intensive longitudinal fashion. And you got to study them closely over long over, you know, both shorter time frames and longer time frames to figure out what things are, what kind of behaviors tend to be like this, right? Like they come and go, and what kind of behaviors are more consistent. And that gets um. It's very important, but it's very challenging because you can imagine that different people, right, are gonna have different patterns and so there's just a lot of different possibilities within that space, and it's an active area of research at this time.

22:18 Ricardo Lopes: Mhm. And how do you approach etiology and um causal influences including genetic and environmental influences in this model of psychopathology?

22:32 Robert Krueger: So ideology specifically, is that what you're thinking about here? Like, yeah, so that, that's um. You you really hit on kind of the key topics and the most challenging areas, but sure, like we can try to get some um purchase here on the concept of etiology, right? So when I think about, you know, ideology, I'm thinking about it in terms of more distal causes and also more proximal causes. Um, AND I think that that distinction between things that are further in the past and things that are more, you know, close by in the person's, you know, history. Um, IT'S pretty important. So when I think about the distal etiology, um, I'm often thinking about, well, genomics, right? Um, I think there's, you know, plenty of evidence that, um, A key part of the distal etiology of psychopathology is sitting in the human genome, um, which absent something terrible happening to people like a radiation, right, is gonna be consistent through your life, um. And those um You know, causal factors can be studied now given modern molecular genetic technologies, um. And so that's a key part of the distal ideology of psychopathology, right, is the complement that a person has of um genomic variants that In a very complex and multifaceted way, right? So we know that from genomics too, right, that none of these causes are very discrete and specific. Rather, there's a bunch of different segments of DNA, oftentimes at the level of even single nucleotide polymorphisms, they kind of add up to give a person a position on a trait like, you know, kind of dimension. Um, THAT is probably a key part of the distal ideology, but that's of course, only part of the equation because it's not just DNA as, you know, the only driving force behind a person's propensities to experience psychopathology. It also, um, Obviously has a lot to do with environmental experiences that are often correlated with, right, so this gets tricky too, right? BECAUSE the environment is not necessarily completely independent of the genome. People are exposed to environments that are correlated with their genomes. Um, SO the gene environment correlation active also, as well as the potential for gene environment interactions, right? So the exposures might be, um, such that the person's genetic propensity is enhanced or um kind of suppressed by environmental exposures like stress experiences and so on and so forth, right? Um, SO that all gets kind of carrying complicated, but that's unfortunately the nature of the material we're dealing with, right? Psychopathology is not simple to study. It's multifaceted in its ideology. It has both distal and proximal components. Right, so things that are further in the past and things that are more proximal and to develop a realistic empirically based model of how genes and environments come together to influence psychopathological propensities. IS obviously the holy grail, right, in terms of understanding the ideology of psychopathology, but pretty difficult to accomplish in a kind of Um, tractable, manageable, replicable, scientific way. Um, NEVERTHELESS, I think that's the task in front of us. IS to combine technologies that are coming from genomics with an intensive understanding of exposures, right, as an epidemiologist might call them, right? So environmental experiences to articulate more um evidence-based models of how genes and environments come together to influence what a person's. Particular symptom profile might be like at any given point in time.

26:23 Ricardo Lopes: So, uh, let me ask you a different kind of question now. How would the classification of mental disorders look like within the framework of a hierarchical taxonomy?

26:38 Robert Krueger: Right, so kind of what's the diagnostic process given a high top type of model, is that kind of what you're asking? Yes. Yeah, so I think that the key distinction to appreciate between um classical. DSM style differential diagnosis as the clinical task and the sort of high top classification scheme as the clinical task. Is that in the high top scheme things are both dimensional and multi-dimensional, right? So we could start with the classic paradigm in the way that you're sort of taught to do this, um, when you're being trained clinically, right, is You know, interview the patients, take a good history, and try to figure out based on the clinical data available to you, the best diagnostic label. Right, best being defined as, OK, consider the hundreds and hundreds of categories that are sitting in something like the DSM. Consider a careful differential diagnosis kind of um approach, right? Like, so is this closer to You know, something like major depression with recurrent episodes, there's a closer to something like generalized anxiety disorder, even though those, you know, syndromes have overlapping features. Which they clearly do in terms of the, you know, criteria for the disorders, but you're supposed to consider things like, well, how, what's the balance between, you know, sort of low mood experiences and more activated, you know, kind of anxiety experiences and, and you can try to do this, but with real people, it doesn't work well. It's something I've often, I've been very interested in as a clinician, right? So the way I got to a lot of what I'm interested in is trying to do this, right? Working with patients. Trying to be, um, you know, A good student of the of the psychiatric classification type system, right? Trying to use it effectively to find the right diagnosis and finding that it's very difficult to pick the one right optimal diagnostic label. So then turning to the more hierarchical, you know, high top kind of approach, it's more like a profile. Um, SO instead of saying that you belong in this category and not these nearby ones, it's more like, all right, let's look at the key dimensions that um have been identified in people and position the person based on the assessment data within those dimensions. So you end up more with like a profile, uh, and that that handles problems of comorbidity and differential diagnosis much more deftly in my view than the differential diagnosis paradigm. So you would have a, a pattern right across the major, you know, spectra, right, that have been developed in high top. You could think about the presentation of different levels of resolution, right? That's the hierarchical part, right? Where's the person on these big broad spectrums. And clinically often you want to know more like the fine-grained elements cause that's more clinically useful, right, to have some fine grain information and you don't have to. Deal with the differential diagnosis problem, which is often frustrating and has been a, a thorn in the side of psychiatric classification for as long as people have tried to do it. Right, so there are these interstitial right in between psychiatric categories that have a checkered history and anybody trying to make sense of them. Um SCHIZOAFFECTIVE disorder is a classic example of this, right? When What do you do when a person is not very clearly mood disordered versus very clearly having a psychotic type of, you know, episode. And DSM handles this by having lots of different categories having to do with the time course and relative balance of those experiences. That is hard, right, because people don't fit neatly into those categories. You still end up with people who have prominent mood disorder symptoms and prominent um reality testing type symptoms. And then what we can see you're not really supposed to use schizoaffective very often cause it's an uncomfortable thing where you're not really making a clear decision. In something like high top, there's no need for such, you know, hand wringing about the right diagnostic category. Rather, you have people with different balances of mood problems and psychotic problems, and it just falls naturally into the possibility that people may be elevated in two different spectrums simultaneously. And and that's much closer to what the phenotypes, right, the clinical presentations look like in data, right? That's the empirical basis for the high top approach. And I could go further and say, you know, the evidence from genetic research, certainly from the twin studies, right? And now emerging also from the molecular studies, is that these things aren't highly discreet and and separable in the way that's implied by the classical, you know, categorical classification system. Um, So, but it requires a change of focus, right? It requires the clinician to be thinking more about dimensional profiles and less about optimal, you know, categories. If that makes sense. Mhm.

31:42 Ricardo Lopes: So in your work, I also read about the general factor of psychopathology or how to go from individual symptoms up to a general factor of psychopathology. So, what is it? What what is a general factor of psychopathology?

32:00 Robert Krueger: This is a concept, um. That emerges from the evidence that everything that has historically been called psychopathology is positively correlated with everything else. Different degrees, right? So the degrees of correlation is what gives you evidence for the hierarchy, right? Not everything is correlated with the same degree. So this gets again sort of technical and statistical, but maybe I can describe it verbally, you know, a little bit. If it were the case that all the psychopathology symptoms. Right, like everything that's in the criteria of the DSM we're all correlated with each other to the same degree. Then you would say, well, OK, it it's a parsimonious way to describe that data matrix by saying there's one thing. And it manifests in lots of different ways, but there's really kind of like one thing that's driving all of this. Whereas, um, what you really see in data are that they're correlated all positively, right? They, they're not, they're rarely negatively correlated or zero correlated because everything is correlated at least a little bit with everything else in psychopathology. But there are denser groups of correlations, and it's that patterning of the density versus sparsity if you will, right of, of different patternings that gives rise to the hierarchy. But nevertheless, at the highest level of the hierarchy, right, you can posit the existence of a general propensity to experience all of psychopathology because there is evidence that everything is positively correlated with everything else. So this is a long way of saying that what it's not nonsensical to think about a general propensity given that kind of data structure. But it's very abstract, right? Because you're talking about everything being correlated with everything else. I think the key to getting your head around this, right, is that there's a hierarchy. It doesn't consist of just one general factor. It consists of factors arranged in this hierarchical kind of arrangement. And why that's important is because, well, it's important for every possible reason, right? Like if you want to understand the etiology of these things or their pathophysiology or how to describe a patient who presents clinically, you're gonna have to think about the whole hierarchy. It's not super clinically useful to say a person has a lot of psychopathology. Like what are you gonna do with that practically speaking, but nevertheless, there is some evidence that you can think about a general factor because everything's correlated with everything. So, again, to make a long story short, potential ideologic factors, right, like underlying genomic factors or whatever. ARE going to be located in different parts of that hierarchy, um, and there's, you know, evidence for that. And not a difficult thing is like I can give you an example of how this would work, right? Like there's propensity to experience externalizing kinds of problems, right? So acting out, doing things that would be grounds for arrest, acting impulsively, um, acting in a way that's um antagonistic to other people, right? Those things tend to coalesce into this broad externalizing spectrum. But, you know, people with an externalizing propensity are at a higher risk of developing substance use problems than people at a lower externalizing propensity. But the specific substance is gonna have a lot to do with the ability to metabolize specific substances. Um, SO, right, there are ideologic factors at different levels, like a person with a high externalizing propensity who's attracted to substances because of that propensity, presumably, right? Might not be able to develop alcohol dependence, right, as opposed to dependence on some other substance because they can't metabolize alcohol like another person who is able to metabolize large amounts of alcohol, you know. Uh, BECAUSE of metabolic factors that have nothing to do with the externalizing propensity but are sort of separate and at a lower level of the hierarchy. So that that's the key to understanding this, right, that there are ideologic factors at different levels of, of, you know, breath or extraction. And so you can't really think about alcoholism relevant genes. As separate from externalizing relevant genes, although there are going to be things within there, right, that have different positions within the hierarchy. Um, SO I don't know, that's a, that's a pretty complicated set of things to try to describe briefly and, you know, verbally, but hopefully I've done an OK job with it because Again, there's a, there's a literature, right, a scientific literature that supports what I'm saying here that, you know, the interested listener might want to get into, um, but that, that's basically how that seems to work, right? I think there's fairly good evidence for what I've tried to articulate. Mhm.

36:58 Ricardo Lopes: So let me ask you now a question specifically about personality disorders. So, what do you make of the way they are currently understood and classified?

37:12 Robert Krueger: Well, right, so this, this question is a very, um, it's sort of like a specific subfield of the general stuff we've been talking about, right? So, historically. Personality disorders, um, and their classification have emerged from clinical observation. And so there's a, you know, historical psychiatric literature based on observing certain kinds of patients, finding that some have very significant interpersonal challenges, right, that go beyond just Mood symptoms or psychotic symptoms or whatever, um. And it's kind of that observation that some people's psychopathology manifests itself in very interpersonal ways that gives rise to this putatively separate group of conditions called the personality disorders. Um, AND you know, the DSMs, um, at least up through DSM-4, talk about this in terms of categories, right? So DSM-4 posits 10 discrete categories, personality disorder as well as personality disorder not otherwise specified. And says, you know, based on this basic paradigm like find the right one, right? So is this person more like schizoty personality disorder, right? So having odd or eccentric beliefs and being sort of socially withdrawn versus more like borderline personality disorder which is emotional dysregulation, um, interpersonal dysregulation, um. Transient stress-related association, like a whole host of different things that are supposed to be relevant to borderline, and you gotta pick the right label basically, as the clinician. So that doesn't work, right? Um, IN the same way that generally speaking, classical categorical approaches don't work cause you see persons who you might think of as having significant personality pathology, you try to put them in these boxes and it doesn't really work because they have presentations that intermingle all the different features of the different 10 disorders. Um, AND that's what led to these alternatives, um, that are now, you know, kind of the main focus of the personality disorders literature, the DSM-5's alternative model of personality disorders and the ICD 11 personality disorder system, which is very similar. And those, you know, look like what we were talking about before, right? They say there are these broad dimensions, right, that are very similar to a darker version of the of the big five. Um, AND, and when you think about a person, you want to think about kind of their position within those dimensions. Um, THEY have the added element of the overall, uh, kind of constructive personality disorder, you know this criteria A in the alternative model, um, which has to do with self and other, um. You know, functioning, right, like you have a clear and consistent conception of who you are from time to time and place to place, and do you relate to other people in a way that might be considered adaptive, um. And it's the combination of those things that kind of defines personality disorder in these modern classification systems. And so the approach is very similar to what we've been discussing overall, right? How much interpersonal and self dysfunction is there, right? That's criterion A. And then what's the patterning across major dimensions of personality, that's criterion B again in the AMPD approach. And that's, you know, a prominent approach now cause it works better, right? Like that's a much more, I I would say clinically useful way to describe real patients, um, versus trying to put them into these um categories that just don't capture actual clinical presentations.

40:52 Ricardo Lopes: So, let me ask you now about one last topic that is very different from what we've been talking about. What is subjective well-being?

41:04 Robert Krueger: Well, again, like a substantial literature exists, right, talking about what subjective well-being is. Um, I mean, I, I have been influenced by Carol Griff's conceptualization of, of what she has called psychological well-being, um, because Carol is a close colleague and she and I worked together on the midlife in the United States study, right, the big MA study. I've worked with a lot of those measures and data, um, and there's many elements to it, but if you had to succinctly describe the essence of well-being, it's a sense that things are going well for you and your place in the world is secure, right? I guess if I had to put it in one quick phrase, um. And of course that's something that all human beings strive toward, right? Everybody would like to have a sense of psychological well-being. Um, AND there's just different ways that it can be manifest, um, so I think that's another one of these higher and multi-dimensional kinds of situations similar to psychopathology. Um, RIGHT, it's, it's a sense that you're Doing well. I mean we could talk about it in terms of varieties of happiness too, right, to bring that construct into play, right? So there's um Eudaimonic, um, and hedonic versions of well-being, right? Hedonic being I feel good, right? I have pleasant emotional experiences, um, and eudaimonic, my, my life has a sense of meaning and purpose. Um, I think that it's the combination of those two things that, that, you know, sort of epitomize human flourishing, right? That's the, that's the stuff that you'd like to achieve as a human being, right, that you're generally in a positive mood idonically and also. That you have a sense that life is is meaningful, right? That you have pursuits and goals and things that you're trying to do that bring you um joy and engagement with life in spite of all of its multifaceted challenges.

43:02 Ricardo Lopes: Uh, SO you mentioned eymonic and hedonic well-being. What about social well-being? Yeah,

43:09 Robert Krueger: that's a good point, right? Um, CONNECTIONS with important others is, is certainly. A key element of well-being also, um. And one could think about sort of a three dimensional kind of structure that or that recognizes the social aspects as potentially separate or separable, but these things tend to be pretty correlated with each other, right? And they tend to be reciprocal in their relationship with each other. So for example, people who have a disposition toward positive moods. Right, it, it could be argued that that disposition, that tendency to be in a good mood, regardless of what's going on, right, promotes extroverted behavior. So right, you can think about extroversion, the personality trait like being outgoing and friendly and engaged with other people and enjoying social interactions as having a positive emotional core. Um, AND that's how, you know, many, many theorists at the intersection of personality and mood, like, you know, David Watson and Leanna Clark and people like that have talked about it based on evidence, right? That, you know, extroverted behaviors have a positive emotional core. People who are in a good mood like to engage with other people because that's a normal human thing to do when you're in a good mood. Well, you could go on a podcast and have, you know, conversations about interesting topics, right? Like it requires a certain amount of Positive mood, right, being in a good frame of mind to want to engage socially. So I guess what I'm trying to say is like, yeah, you can think about different manifestations in the social world, in the, in the subjective, you know, sort of world too, right? Like there's a difference between like how am I perceiving myself subjectively and what am I doing interpersonally. But they tend to be reciprocal, right, correlated with each other because they have this, you know, sickly kind of aspect to them where they kind of bounce off each other and mutually reinforce a kind of sense of well-being in the world.

45:03 Ricardo Lopes: So, one last question then, is there any relationship between subjective well-being and personality traits?

45:11 Robert Krueger: Oh, absolutely, yeah. And when I think about that, they, they tend to want to be located in that extroversion kind of space. OK, so I think there's there's, you know, a literature on this, right, but. That the mood space and the personality space are closely related to each other, um, right, so the different, different mood dispositions, um, can be thought of as having something to do with the extroversion neuroticism space, right, and are closely related to each other. Um, So I guess that's how I would think about that, um. You know, right, that that that there's a um an effective basis for a lot of what is considered personality because what those personality dispositions are driven by is affective dispositions. Um, SO just the tendency to be in certain kinds of mood states, if you think about them over time, right, can be thought of as personality dispositions, um, and they have You know, intrapersonal and interpersonal manifestations, um. And that's kind of the essence of what's going on with, you know, extroversion and neuroticism, right, that those big trait domains have a lot to do with a person's um mood dispositions.

46:31 Ricardo Lopes: Right. So, so I, I mean, does that mean then that if someone scores high on extroversion, then they tend to also have higher subjective well-being and if someone scores high on neuroticism, uh, it's the opposite then.

46:51 Robert Krueger: Uh, THE way you said it makes it sound like there's sort of one dimension, but they're kind of, um, orthogonal dimensions, right? So, OK, so the key thing to sort of recognize there is that a person can have simultaneous propensities toward. This regulated mood and positive mood. It, it's a little, it's maybe sounds a little hard to put together psychologically, but if you think about it a little bit, it kind of maybe makes more sense. So, and it makes sense, uh I wanna say like phylogenetically, like when you think about, you know, systems in the brain and their origins, right, in evolutionary history and things like this, right? There are systems for dealing with the potential for threat. And there are systems for dealing with the potential for reward, and there are separable systems. So you can imagine a human organism that has high levels of both, right? And that would be a person who is outgoing, friendly, um, engaged, and also anxious and worried. Um, THAT'S not too difficult of a person to imagine. I can imagine people like this and I've known people like this, right? They want to engage with people. They're very excited. They're extroverted and outgoing, but they're also very worried and concerned and a lot of anxiety and like those things can happen simultaneously in a person's personality, I guess it's the point I'm trying to make. And that's consistent with the structure of personality and mood, right, that those are separable dimensions.

48:16 Ricardo Lopes: Mhm. Right. So, just before we go, where can people find you and your work on the internet?

48:25 Robert Krueger: In the usual scholarly resources, I guess, right? So you could have a Google Scholar page, right? I'm not, I'm not particularly engaged with social media because I find that to be kind of um. Difficult and distracting, right, when I'm trying to sort of concentrate on. Academic work, one could spend a lot of time, and many people do, on academic um social media, right, arguing about things or engaging with colleagues, and I've never loved that just in terms of how I want to spend my time, although I understand that there are potential implications for me interacting with the world by not being super active on social media. But I like to think about these things in a more um Maybe old fashioned way, right? Like that that my scientific publications are more thought through. Um, THEN, you know, me firing off some social media posts, um, in response to some provocation, right? So I don't think I would do well with the dynamic aspects of social media. So I don't really have a presence there. Um, BUT yeah, you can find my web page at the University of Minnesota, you can find my Google Scholar profile. I don't mind emails, right? Like I, I don't, I have an easier time responding one on one to people when I know the context of the conversation, right, than broadcasting something to the whole world. The social media often feels to me like yelling into a void, and maybe some people are listening, but everybody's yelling, right? And it just, I, it's hard for me to conceptualize it as bringing together communities based on well thought out, you know, kinds of ideas. Because everything's so spontaneous and sudden, but maybe I'm just old fashioned that way, and I should get with the times and be more engaged with it, but currently I don't really do much of that kind of activity.

50:14 Ricardo Lopes: Yeah, no, that's fair enough and interesting insights on social media. So, but I will be leaving then links to your university page and your Google Scholar page in the description of the interview. And thank you so much for taking the time to come on the show. It's been really nice to talk with you.

50:34 Robert Krueger: No, I really appreciate your very thoughtful questions. You certainly hit on things that are very deep. Right, not easy to deal with succinctly, so hopefully I did OK. It felt, it felt a bit like a final examination, not for decades. But that's OK. I think those are really kind of the key questions that you were asking. So hopefully, um, your listeners know a little bit more about it and know where to find me if they want to converse further.

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