Review
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World J Psychiatry. Jun 19, 2023; 13(6): 278-297
Published online Jun 19, 2023. doi: 10.5498/wjp.v13.i6.278
Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems
Lidia Torres-Rosado, Oscar M Lozano, Manuel Sanchez-Garcia, Fermín Fernández-Calderón, Carmen Diaz-Batanero
Lidia Torres-Rosado, Oscar M Lozano, Manuel Sanchez-Garcia, Fermín Fernández-Calderón, Carmen Diaz-Batanero, Department of Clinical and Experimental Psychology, University of Huelva, Huelva 21071, Spain
Oscar M Lozano, Manuel Sanchez-Garcia, Fermín Fernández-Calderón, Carmen Diaz-Batanero, Research Center for Natural Resources, Health and Environment, University of Huelva, Huelva 21071, Spain
Author contributions: Lozano OM, Sanchez-Garcia M, and Diaz-Batanero C contributed on the conception, design of study and acquisition of data; Torres-Rosado L, Lozano OM, Sanchez-Garcia M, and Diaz-Batanero C participated on the interpretation of data; Lozano OM, Sanchez-Garcia M, and Diaz-Batanero C drafted the manuscript; Torres-Rosado L, Lozano OM, and Fernández-Calderón F revised the manuscript critically for intellectual content; and all authors approved the final version of the manuscript submitted.
Supported by the “Reliable and clinical relevant change of Inventory of Depression and Anxiety Symptoms II-IDAS-II: a longitudinal clinical utility study (RELY-IDAS-II)”, project PID2020-116187RB-I00 on Proyectos I+D+i 2020 “Retos del Conocimiento” provided by Ministerio de Ciencia e Innovación (Spain) and by the grant FPU20/06606.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carmen Diaz-Batanero, PhD, Associate Professor, Department of Clinical and Experimental Psychology, University of Huelva, Campus El Carmen, Avda Fuerzas Armadas s/n, Huelva 21071, Spain. carmen.diaz@dpsi.uhu.es
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: February 20, 2023
Revised: March 4, 2023
Accepted: April 20, 2023
Article in press: April 20, 2023
Published online: June 19, 2023
Processing time: 173 Days and 23.1 Hours
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.