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 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.
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 and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinical practice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 17 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Network analysis is quickly gaining popularity in psychopathology research as a method that aims to reveal causal relationships among individual symptoms. To date, four main types of psychopathology networks have been proposed: (1) association networks, (2) regularized concentration networks, (3) relative importance networks, and (4) directed acyclic graphs. We examined the replicability of these analyses based on symptoms of major depression and generalized anxiety between and within two highly similar epidemiological samples (i.e., the National Comorbidity Survey – Replication [n = 9282] and the National Survey of Mental Health and Wellbeing [n = 8841]). While association networks were stable, the three other types of network analysis (i.e., the conditional independence networks) had poor replicability between and within methods and samples. The detailed aspects of the models—such as the estimation of specific edges and the centrality of individual nodes—were particularly unstable. For example, 44% of the symptoms were estimated as the “most influential” on at least one centrality index across the six conditional independence networks in the full samples, and only 13–21% of the edges were consistently estimated across these networks. One of the likely reasons for the instability of the networks is the predominance of measurement error in the assessment of individual symptoms. We discuss the implications of these findings for the growing field of psychopathology network research, and conclude that novel results originating from psychopathology networks should be held to higher standards of evidence before they are ready for dissemination or implementation in the field.
are acknowledged for their thoughtful feedback during the early stages of this project. Special thanks is also offered to Christian Luhmann for his valuable insight and constructive critiques of this work. Limited previews of this study's hypotheses and results were presented on two occasions. First, preliminary findings were discussed with HiTOP coauthors at the 2017 HiTOP meeting in Denver, Colorado. Second, some preliminary results were discussed in an APS conference presentation led by Roman Kotov. None of the results reported herein have been posted on any websites, listserves, or manuscript publications.
Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability in daily practice, high co-morbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimension-based approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. To this end, the present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. We review potential advantages and limitations for clinical utility, including case conceptualization and treatment planning. We illustrate what a HiTOP approach might look like in practice relative to traditional nosology. Finally, we discuss common barriers to using HiTOP in real-world healthcare settings and how they can be addressed.
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