A meta-analysis of heart rate variability and psychopathology: An investigation guided by the hierarchical taxonomy of psychopathology framework.

Although low resting heart rate variability (HRV) is associated with various forms of psychopathology, patterns of specificity and nonspecificity in the apparent transdiagnostic nature of resting HRV have not been systematically investigated. Existing research is dominated by disorder-specific studies, limiting conclusions about whether HRV reductions reflect mechanisms unique to particular diagnoses or a broader transdiagnostic vulnerability. Using the Hierarchical Taxonomy of Psychopathology framework, this Stage 2 Registered Report synthesized evidence from 430 studies and 732 effect sizes (N = 62,264) to quantify associations between resting HRV and psychopathology at multiple levels of specificity-from individual disorders to higher order spectra and superspectra. Across the hierarchy, lower resting HRV emerged as a robust correlate of most domains of psychopathology. For example, at the disorder level, lower resting HRV was significantly associated with schizophrenia, bipolar disorder, autism, generalized anxiety, panic disorder, borderline personality, posttraumatic stress disorder, and major depression, but not with obsessive-compulsive disorder, social anxiety, and attention-deficit/hyperactivity disorder. Psychotic conditions showed the strongest associations across all levels of the hierarchy, but sensitivity analyses indicated that these associations are likely influenced by study design and sample characteristics. Together with consistent moderator effects showing stronger HRV-psychopathology associations in samples with higher symptom severity, we conclude that decrements in resting HRV represent a transdiagnostic marker of systemic dysregulation reflecting illness severity rather than disorder-specific autonomic signatures. (PsycInfo Database Record (c) 2026 APA, all rights reserved).