The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM (original) (raw)
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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
Journal of abnormal psychology, 2017
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 considerations, 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 develop...
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...
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.
Integrating psychotherapy with the Hierarchical Taxonomy of Psychopathology (HiTOP)
2018
In this paper we present the Hierarchical Taxonomy of Psychopathology (HiTOP), an evidence-based alternative to the categorical approach to diagnostic classification with considerable promise for integrative psychotherapy research and practice. We first review issues associated with the categorical approach that may have constrained advances in psychotherapy. We next describe how the HiTOP model addresses some of these issues. We then offer suggestions regarding potentially mutual benefits of integrating HiTOP with treatment principles from the common factors literature as well as the cognitive-behavioral and relational psychotherapy traditions. We conclude by enumerating principles for psychotherapy research and practice based on the HiTOP model, which are illustrated with a case example.
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...
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...
Brazilian Journal of Psychiatry
Objective: The Hierarchical Taxonomy of Psychopathology (HiTOP) posits that psychopathology is hierarchically structured. For personality disorder (PD) traits, there are five spectra: internalizing, thought disorder, disinhibited externalizing, antagonistic externalizing, and detachment. Empirical findings suggest a sixth group, compulsivity. In this research, we tried to recover the five HiTOP spectra, plus compulsivity, specifically for PD traits. Methods: The sample was composed of 4,868 Brazilians (54.9% women, age ranging from 18 to 70; mean = 25.7; SD = 9.64). All participants answered the Dimensional Clinical Personality Inventory 2 (IDCP-2), a self-report inventory for adults, developed in Brazil, for assessment of pathological personality traits. Results: Parallel analysis yielded up to nine factors. On exploratory structural equation modeling (E-SEM), the balance between interpretability and fit index suggested the six-factor solution as the best solution. The fit indexes for the confirmatory factor analysis were slightly less adjusted in comparison to the empirical model. Conclusion: The hypothesis was confirmed, as we did find the groups proposed at the spectrum level of the HiTOP. We also found a compulsivity factor, encompassing the main traits from the conscientiousness dimension of IDCP-2, which is related to obsessive-compulsive PD. Finding the six groupings of traits in the HiTOP model contributes to the validity of this model, and confirms the existence of proposed spectra.