Preclinical psychiatric symptomatology and “Diagnostic Criterion” of pathological procrastination: A psychopathological connectome model

Background Procrastination describes irrational delays of scheduled tasks despite clear awareness of adverse consequences to do so. Although procrastination is well-known to be linked to psychiatric or pathological processes, insights into why procrastination may contribute to psychopathological outcomes has not been fully explored. The aim of the current study was to identify the criterion for "pathological procrastination" and its preclinical correlates. Methods This is a longitudinal and prospective observational study with a five-year interval. Participants ( N = 464) completed measures of trait procrastination in November 2018, with a follow-up conducted in March 2023 ( N = 267) to collect preclinical psychiatric symptoms via self-reported measures. A constrained multivariate direct gradient model (cmDGM) was built to prospectively fit procrastination to the preclinical psychiatric symptomatology that formulated by DSM-5 framework. The 2-stage psychopathological connectome model was further constructed to constitute a "diagnostic criterion" reflecting "pathological procrastination". Results Procrastination prospectively predicted severe preclinical psychiatric symptoms and unhealthy lifestyles. Preclinical bridge hubs of "failure to self-regulate delays", "failure to control adverse consequences", "useless to self-change", "out-of-control irruptions", "poor sleep quality" and "negative emotional reactions" were captured for highly local and global disruptions in the psychopathological network of procrastination, and thus constituted the 9-item pathological procrastination diagnostic criterion (3PDC) with good diagnostic performance (AUC = 0.82, p <.01). Conclusions The present study revealed the predictive rol of procrastination for preclinical psychiatric symptomatology, and further established the preclinical 3PDC to lay the foundation for the "diagnostics of pathological procrastinators" by both quantitative measurements and DSM-structured binary schemes.