Examining the Factor Structure of the Transdiagnostic DSM-5-TR Level 1 Cross-Cutting Symptom Measure in Real World Psychiatric Outpatients

The DSM-5-TR Level 1 Cross-Cutting Symptom Measure (DSM-XC) is a 23-item transdiagnostic assessment tool, but its underlying dimensional structure in clinical populations remains understudied. Previous research has been limited by small sample sizes and non-clinical populations.

Here, we examine the factor structure of the DSM-XC using a large real-world psychiatric outpatient sample (N = 2,157).We employ both exploratory and confirmatory factor analysis to identify and validate potential factor solutions, while also testing a theoretically-derived three-factor model based on Caspi's p-factor framework.Our analysis reveals three distinct solutions: a six-factor general model representing traditional symptom clusters, a five-factor bifactor model that includes a general factor for overall symptom burden, and a three-factor hierarchical model incorporating a higher-order general psychopathology factor with first-order factors (internalizing, externalizing, and thought disorder).

All models demonstrate acceptable fit indices, suggesting the DSM-XC successfully captures both overall symptom burden and distinct areas of dysfunction. This finding supports a dimensional, transdiagnostic approach to understanding psychopathology in clinical populations.

Using a real-world sample of predominantly female (66%) and Caucasian (84%) outpatients with a mean age of 38.6 years, we demonstrate the DSM-XC's potential as a comprehensive assessment tool. Further validation with larger, more diverse samples could enhance our understanding of psychopathology's dimensional nature and improve the measure's clinical utility.