Motor Abnormalities and the Hierarchical Taxonomy of Psychopathology: Incorporating a Psychomotor Perspective Into a Hierarchical Dimensional Symptom Framework
Restricted accessBrief reportFirst published online 2026
Motor Abnormalities and the Hierarchical Taxonomy of Psychopathology: Incorporating a Psychomotor Perspective Into a Hierarchical Dimensional Symptom Framework
Motor symptoms have emerged as a promising target for understanding mechanisms, prognosis, and treatment in psychology. Although motor abnormalities are observed across mental-health conditions, transdiagnostic research has been limited. It is not well understood whether motor symptoms are a broad endophenotypic marker or a predictor of specific symptoms. We leverage a hierarchical dimensional symptom structure to examine transdiagnostic relationships between psychological and self-reported motor symptoms in 3,460 participants in the Multi-Site Assessment of Psychosis-Risk study. Overall motor problems (βs = 0.07–0.25), dyskinesia (βs = 0.07–0.31), and coordination (βs = 0.05–0.23) were related positively at different strengths to all symptom domains. Amount of physical activity was positively related to mania and substance use (βs = 0.08–0.09) and negatively related to detachment, fear, and distress (βs = 0.05–0.27). These results suggest that motor domains may provide utility as both a general endophenotypic marker and more specific predictor of serious mental illness; we discuss implications for research and clinical settings.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.
2.
BernsteinE. M.PutnamF. W. (1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004
3.
BielingP. J.AntonyM. M.SwinsonR. P. (1998). The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined. Behaviour Research and Therapy, 36(7), 777–788. https://doi.org/10.1016/S0005-7967(98)00023-0
4.
BurtonB. K.HjorthøjC.JepsenJ. R.ThorupA.NordentoftM.PlessenK. J. (2016). Research Review: Do motor deficits during development represent an endophenotype for schizophrenia? A meta-analysis. Journal of Child Psychology and Psychiatry, 57(4), 446–456. https://doi.org/10.1111/jcpp.12479
5.
BurtonB. K.KrantzM. F.SkovgaardL. T.BrandtJ. M.GregersenM.SøndergaardA.KnudsenC. B.AndreassenA. K.VeddumL.RohdS. B.WilmsM.TjottC.HjorthøjC.OhlandJ.GreveA.HemagerN.BlikstedV. F.MorsO.PlessenK. J.. . . NordentoftM. (2023). Impaired motor development in children with familial high risk of schizophrenia or bipolar disorder and the association with psychotic experiences: A 4-year Danish observational follow-up study. The Lancet Psychiatry, 10(2), 108–118. https://doi.org/10.1016/S2215-0366(22)00402-3
6.
CallawayD. A.PerkinsD. O.WoodsS. W.LiuL.AddingtonJ. (2014). Movement abnormalities predict transitioning to psychosis in individuals at clinical high risk for psychosis. Schizophrenia Research, 159(2–3), 263–266. https://doi.org/10.1016/j.schres.2014.09.031
7.
CarriónR. E.McLaughlinD.GoldbergT. E.AutherA. M.OlsenR. H.OlvetD. M.CorrellC. U.CornblattB. A. (2013). Prediction of functional outcome in individuals at clinical high risk for psychosis. JAMA Psychiatry, 70(11), 1133–1142.
8.
CheniauxE.AnunciaçãoL.Landeira-FernandezJ.NardiA. E. (2024). Mood or energy/activity symptoms in bipolar mania: Which are the most informative?Trends in Psychiatry and Psychotherapy, 46, Article e20220551. https://doi.org/10.47626/2237-6089-2022-0551
9.
CheniauxE.FilgueirasA.da SilvaR. A.SilveiraL. A. S.NunesA. L. S.Landeira-FernandezJ. (2014). Increased energy/activity, not mood changes, is the core feature of mania. Journal of Affective Disorders, 152–154, 256–261. https://doi.org/10.1016/j.jad.2013.09.021
10.
CowanH. R.WilliamsT. F.SchiffmanJ.EllmanL. M.MittalV. A. (2024). Mapping psychosis risk states onto the Hierarchical Taxonomy of Psychopathology using hierarchical symptom dimensions. Clinical Psychological Science, 12(1), 3–21. https://doi.org/10.1177/21677026221146178
11.
DammeK. S. F.HanY. C.HanZ.ReberP. J.MittalV. A. (2024). Motor precision deficits in clinical high risk for psychosis. European Archives of Psychiatry and Clinical Neuroscience, 274(6), 1427–1435. https://doi.org/10.1007/s00406-023-01645-3
12.
DammeK. S. F.OsborneK. J.GoldJ. M.MittalV. A. (2020). Detecting motor slowing in clinical high risk for psychosis in a computerized finger tapping model. European Archives of Psychiatry and Clinical Neuroscience, 270, 393–397.
13.
DammeK. S. F.ParkJ. S.VargasT.WaltherS.ShankmanS. A.MittalV. A. (2022). Motor abnormalities, depression risk, and clinical course in adolescence. Biological Psychiatry Global Open Science, 2(1), 61–69. https://doi.org/10.1016/j.bpsgos.2021.06.011
14.
DammeK. S. F.SchiffmanJ.EllmanL. M.MittalV. A. (2021). Sensorimotor and Activity Psychosis-Risk (SMAP-R) scale: An exploration of scale structure with replication and validation. Schizophrenia Bulletin, 47(2), 332–343. https://doi.org/10.1093/schbul/sbaa138
15.
DeLongM. R.WichmannT. (2007). Circuits and circuit disorders of the basal ganglia. Archives of Neurology, 64(1), 20–24. https://doi.org/10.1001/archneur.64.1.20
16.
EllmanL. M.SchiffmanJ.MittalV. A. (2020). Community psychosis risk screening: An instrument development investigation. Journal of Psychiatry and Brain Science, 5, Article e200019. https://doi.org/10.20900/jpbs.20200019
17.
GoldbergL. R. (2006). Doing it all bass-ackwards: The development of hierarchical factor structures from the top down. Journal of Research in Personality, 40(4), 347–358. https://doi.org/10.1016/j.jrp.2006.01.001
18.
HeinimaaM.SalokangasR. K. R.RistkariT.PlathinM.HuttunenJ.IlonenT.SuomelaT.KorkeilaJ.McglashanT. H. (2003). PROD-screen – A screen for prodromal symptoms of psychosis. International Journal of Methods in Psychiatric Research, 12(2), 92–104. https://doi.org/10.1002/mpr.146
19.
KlineE.WilsonC.EreshefskyS.DenennyD.ThompsonE.PittsS. C.BussellK.ReevesG.SchiffmanJ. (2012). Psychosis risk screening in youth: A validation study of three self-report measures of attenuated psychosis symptoms. Schizophrenia Research, 141(1), 72–77. https://doi.org/10.1016/j.schres.2012.07.022
20.
KohoutF. J.BerkmanL. F.EvansD. A.Cornoni-HuntleyJ. (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. Journal of Aging and Health, 5(2), 179–193. https://doi.org/10.1177/089826439300500202
21.
KotovR.CiceroD. C.ConwayC. C.DeYoungC. G.DombrovskiA.EatonN. R.FirstM. B.ForbesM. K.HymanS. E.JonasK. G.KruegerR. F.LatzmanR. D.LiJ. J.NelsonB. D.RegierD. A.Rodriguez-SeijasC.RuggeroC. J.SimmsL. J.SkodolA. E.. . . WrightA. G. C. (2022). The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research. Psychological Medicine, 52(9), 1666–1678. https://doi.org/10.1017/S0033291722001301
22.
LoewyR. L.BeardenC. E.JohnsonJ. K.RaineA.CannonT. D. (2005). The Prodromal Questionnaire (PQ): Preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophrenia Research, 79(1), 117–125.
23.
LoreeA. M.LundahlL. H.LedgerwoodD. M. (2015). Impulsivity as a predictor of treatment outcome in substance use disorders: Review and synthesis. Drug and Alcohol Review, 34(2), 119–134. https://doi.org/10.1111/dar.12132
24.
MattickR. P.ClarkeJ. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36(4), 455–470. https://doi.org/10.1016/s0005-7967(97)10031-6
25.
MittalV. A.DaleyM.ShiodeM. F.BeardenC. E.O’NeillJ.CannonT. D. (2010). Striatal volumes and dyskinetic movements in youth at high-risk for psychosis. Schizophrenia Research, 123(1), 68–70. https://doi.org/10.1016/j.schres.2010.08.002
26.
NuofferM. G.LefebvreS.NadesalingamN.AlexakiD.GamaD. B.WüthrichF.KyrouA.KerkeniH.KallaR.WaltherS. (2022). Psychomotor slowing alters gait velocity, cadence, and stride length and indicates negative symptom severity in psychosis. Schizophrenia, 8(1), Article 116. https://doi.org/10.1038/s41537-022-00324-x
27.
O’FarrellT. J.Fals-StewartW.MurphyM. (2003). Concurrent validity of a brief self-report drug use frequency measure. Addictive Behaviors, 28(2), 327–337. https://doi.org/10.1016/S0306-4603(01)00226-X
28.
OsborneK. J.WaltherS.MittalV. A. (2024). Motor actions across psychiatric disorders: A Research Domain Criteria (RDoC) perspective. Clinical Psychology Review, 114, Article 102511. https://doi.org/10.1016/j.cpr.2024.102511
29.
PeraltaV.CuestaM. J. (2017). Motor abnormalities: From neurodevelopmental to neurodegenerative through “functional” (neuro)psychiatric disorders. Schizophrenia Bulletin, 43(5), 956–971. https://doi.org/10.1093/schbul/sbx089
30.
PerryW.McIlwainM.KloezemanK.HenryB. L.MinassianA. (2016). Diagnosis and characterization of mania: Quantifying increased energy and activity in the human behavioral pattern monitor. Psychiatry Research, 240, 278–283. https://doi.org/10.1016/j.psychres.2016.04.078
31.
PolettiM.RaballoA. (2022). (Developmental) Motor signs: Reconceptualizing a potential transdiagnostic marker of psychopathological vulnerability. Schizophrenia Bulletin, 48(4), 763–765. https://doi.org/10.1093/schbul/sbac026
32.
SchiffmanJ. (2017). Motor issues in the clinical high risk phase of psychosis. Schizophrenia Bulletin, 43(5), 937–938. https://doi.org/10.1093/schbul/sbx086
33.
SchrijversD.HulstijnW.SabbeB. G. C. (2008). Psychomotor symptoms in depression: A diagnostic, pathophysiological and therapeutic tool. Journal of Affective Disorders, 109(1), 1–20. https://doi.org/10.1016/j.jad.2007.10.019
WaltherS.MittalV. A. (2022). Motor behavior is relevant for understanding mechanism, bolstering prediction, and improving treatment: A transdiagnostic perspective. Schizophrenia Bulletin, 48(4), 741–748. https://doi.org/10.1093/schbul/sbac003
36.
WaltherS.StegmayerK.HornH.RampaL.RazaviN.MüllerT. J.StrikW. (2015). The longitudinal course of gross motor activity in schizophrenia–Within and between episodes. Frontiers in Psychiatry, 6, Article 10. https://doi.org/10.3389/fpsyt.2015.00010
37.
WhittyP. F.OwoeyeO.WaddingtonJ. L. (2009). Neurological signs and involuntary movements in schizophrenia: Intrinsic to and informative on systems pathobiology. Schizophrenia Bulletin, 35(2), 415–424. https://doi.org/10.1093/schbul/sbn126
38.
WüthrichF.NabbC. B.MittalV. A.ShankmanS. A.WaltherS. (2022). Actigraphically measured psychomotor slowing in depression: Systematic review and meta-analysis. Psychological Medicine, 52(7), 1208–1221. https://doi.org/10.1017/S0033291722000903
39.
YoungstromE. A.FrazierT. W.DemeterC.CalabreseJ. R.FindlingR. L. (2008). Developing a 10-item mania scale from the Parent General Behavior Inventory for children and adolescents. The Journal of Clinical Psychiatry, 69(5), 831–839. https://doi.org/10.4088/jcp.v69n0517
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