The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies (original) (raw)
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A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research
2018
For over a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system—the Hierarchical Taxonomy of Psychopathology (HiTOP)—that is based on empirical patterns of psychological symptom co-occurrence. We highlight key ways in which this framework can advance mental health research, and we provide a heuristic for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to reform the study of mental health problems and to accelerate efforts to assess, prevent, and treat mental illness effectively.
The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM
Clinical psychological science, 2022
We thank DeYoung and colleagues (2022) for their commentary and appreciate the opportunity to debate the validity and usefulness of the Hierarchical Taxonomy of Psychopathology (HiTOP). DeYoung and colleagues claim that HiTOP is fundamentally different from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and that it does not "group" people. In this commentary, we explain why we disagree and discuss three fundamental flaws with HiTOP. HiTOP Is Not the Empirical Structure of the Symptoms of Psychopathology HiTOP is the result of a dimensional-interpretation/ simple-structure factor-analytic procedure (Thurstone, 1947) in which items are rotated to create nonoverlapping dimensions. This simple structure does not represent the complexity of the empirical structure of the symptom data. In fact, it "has no substantive justification whatsoever. .. from an explanatory point of view, it is plainly ridiculous to suppose that latent variables are uncorrelated (i.e., if these latent variables are taken to be substantively meaningful factors that refer to objective properties outside of the model)" (Borsboom, 2017b, p. 46, see also Guttman, 1992; McGrane & Maul Gevirtz, 2020; van Bork et al., 2017). HiTOP is not a data-driven realization of the structure of the symptoms of psychopathology because it was created using an arbitrary and inadequate representation of the dimensional space
The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM
Clinical Psychological Science, 2022
In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders ( DSM). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field c...
Progress in achieving quantitative classification of psychopathology
World psychiatry : official journal of the World Psychiatric Association (WPA), 2018
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed an...
Clinical Psychological Science, 2021
The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group self-reported symptoms of mental illness (i.e., like goes with like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any, scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the Diagnostic and Statistical Manual of Mental Disorder...
World Psychiatry, 2022
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma‐related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.
Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum
World Psychiatry, 2020
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co‐occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, c...
The structure of psychopathology: Toward an expanded quantitative empirical model
Journal of Abnormal Psychology, 2013
There has been substantial recent interest in the development of a quantitative, empirically based model of psychopathology. However, the majority of pertinent research has focused on analyses of diagnoses, as described in current official nosologies. This is a significant limitation because existing diagnostic categories are often heterogeneous. In the current research, we aimed to redress this limitation of the existing literature, and to directly compare the fit of categorical, continuous, and hybrid (i.e., combined categorical and continuous) models of syndromes derived from indicators more fine-grained than diagnoses. We analyzed data from a large representative epidemiologic sample (the 2007 Australian National Survey of Mental Health and Wellbeing; N ϭ 8,841). Continuous models provided the best fit for each syndrome we observed (distress, obsessive compulsivity, fear, alcohol problems, drug problems, and psychotic experiences). In addition, the best fitting higher-order model of these syndromes grouped them into three broad spectra: Internalizing, Externalizing, and Psychotic Experiences. We discuss these results in terms of future efforts to refine emerging empirically based, dimensional-spectrum model of psychopathology, and to use the model to frame psychopathology research more broadly.
2020
ABSTRACTPsychopathology can be viewed as a hierarchy of correlated dimensions. Many studies have supported this conceptualization, but they have used alternative statistical models with differing interpretations. In bifactor models, every symptom loads on both the general factor and one specific factor (e.g., internalizing), which partitions the total explained variance in each symptom between these orthogonal factors. In second-order models, symptoms load on one of several correlated lower-order factors. These lower-order factors load on a second-order general factor, which is defined by the variance shared by the lower-order factors. Thus, the factors in second-order models are not orthogonal. Choosing between these valid statistical models depends on the hypothesis being tested. Because bifactor models define orthogonal phenotypes with distinct sources of variance, they are optimal for studies of shared and unique associations of the dimensions of psychopathology with external va...
Classification and psychopathology research
Journal of Abnormal Psychology, 2013
The classification of psychopathology appears to be at a crossroads, with a new version of the Diagnostic and Statistical Manual of Mental Disorders impending and one of the current aspirations of the National Institute of Mental Health being the development of new ways of classifying mental disorders. This article discusses what we currently know about psychopathology and the role that classification has played in psychopathology research. It is pointed out that a wide variety of etiological factors, both within and outside the individual, have been implicated in the etiology of psychopathology, and that there is no empirical or conceptual reason to privilege any particular level of explanation. The ways in which signs/symptoms and disorders may be related are discussed, including their implications for classification. The value of theory development and theory-driven research is emphasized, along with the potential perils of generating an ossified classification scheme that must be adhered to.