The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies

by Scott Barry Kaufman, April 2, 2017 in Blog

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The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies

Roman Kotov, Robert F. Krueger, David Watson, Thomas M. Achenbach, Robert R. Althoff, R. Michael Bagby, Timothy A. Brown, William T. Carpenter, Avshalom Caspi, Lee Anna Clark, Nicholas R. Eaton, Miriam K. Forbes, Kelsie T. Forbush, David Goldberg, Deborah Hasin, Steven E. Hyman, Masha Y. Ivanova, Donald R. Lynam, Kristian Markon, Joshua D. Miller, Terrie E. Moffitt, Leslie C. Morey, Stephanie N. Mullins-Sweatt, Johan Ormel, Christopher J. Patrick, Darrel A. Regier, Leslie Rescorla, Camilo J. Ruggero, Douglas B. Samuel, Martin Sellbom, Leonard J. Simms, Andrew E. Skodol, Tim Slade, Susan C. South, Jennifer L. Tackett, Irwin D. Waldman, Monika A. Waszczuk, Thomas A. Widiger, Aidan G. C. Wright, and Mark Zimmerman

The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other consid- erations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures.

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