# Transdiagnostic dimensions of psychopathology in chronic tinnitus patients with and without hearing loss

## TL;DR

Chronic tinnitus is linked to psychological vulnerability rather than specific psychiatric diagnoses, with distress tied to internalizing symptoms and substance use.

## Contribution

Identifies transdiagnostic psychopathology dimensions in tinnitus patients, linking them to distress and highlighting psychological substrates beyond hearing loss.

## Key findings

- Three transdiagnostic dimensions identified: internalizing psychopathology, harmful substance use, and fear-related perceptions.
- Internalizing psychopathology strongly predicts tinnitus-related distress.
- Hearing loss is associated with harmful substance use but not psychological distress predictors.

## Abstract

Chronic tinnitus is frequently described as occurring with psychiatric comorbidities. However, this diagnosis-based framing may obscure underlying dimensions of psychological vulnerability in individuals both with and without measurable hearing loss (HL). This study thus aimed to identify transdiagnostic dimensions of psychopathology in patients with chronic tinnitus and examine their relevance for tinnitus-related distress (TRD) in patients with or without HL. In a clinical sample of N = 678 chronic tinnitus patients, pure-tone audiometry determined HL status and self-report screeners assessed psychiatric symptom profiles. Multiple regression models tested diagnostic predictors of TRD and diagnosis × HL interactions. Tetrachoric correlations among binary ‘diagnosis pointers’ were subjected to principal axis factor analysis to derive latent dimensions, which were then conceptually linked to the Hierarchical Taxonomy of Psychopathology (HiTOP). Most patients (96%) endorsed at least one diagnosis pointer (median = 5); over half (52.1%) had no identifiable HL. Patients without HL exhibited higher rates of anxiety and substance-related symptoms. TRD was significantly predicted by diagnosis pointers for major depression, agoraphobia, health anxiety, anorexia nervosa, and psychosis. Factor analysis identified three dimensions: Internalizing psychopathology, harmful substance use, and fear-related (social) perceptions. Internalizing psychopathology predicted TRD. HL status was associated with harmful substance use but not with psychological predictors of distress. Findings suggest that chronic tinnitus indexes broad psychological vulnerability rather than discrete psychiatric comorbidities. Whilst inner ear damage may trigger tinnitus onset in patients with HL, persistence across patients—particularly those without HL—suggests a psychological substrate underlying symptom chronicity, distress, and diagnostic covariation. Clinically, the findings support a dimensional, formulation-based approach that situates tinnitus within patients’ broader emotional functioning and foregrounds transdiagnostic processes over discrete diagnoses.