A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

Abstract

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 some heuristics 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 accelerate and improve research on mental health problems as well as efforts to more effectively assess, prevent, and treat mental illness.

The Heterogeneity of Mental Health Assessment

“…For example, the Research Domain Criteria (RDoC) framework from the National Institute of Mental Health (NIMH) has been developed to provide an arena in which researchers can focus on the neurobiological and neurophysiological markers of psychiatric function and dysfunction, without needing to be aligned to a particular disorder taxonomy and provides a classification structure based around causal mechanisms at multiple levels of genetics, physiology and neuroscience based on data from animals and humans (149)(150)(151). In parallel, the Hierarchical Taxonomy of Psychopathology (HiTOP) takes learnings from the dimensional nature of psychopathology and is based on a hierarchical model of mental dysfunction, dominated by externalizing, internalizing and thought disorder spectra (152,153). It is also affiliated with the development of a single transdiagnostic factor of psychopathology, or "p", as a way of encapsulating an individual's propensity to develop all forms of psychopathology (154).…”

Why do depression, conduct, and hyperactivity symptoms co-occur across adolescence? The role of stable and dynamic genetic and environmental influences

“…However, to date, the etiology of heterotypic continuity has not been explored for the relationships between internalizing and externalizing psychopathology in this age group. Understanding how genetic and environmental influences contribute to the co-occurrence of internalizing and externalizing symptoms across development might provide clinically relevant insights in the context of growing interest in transdiagnostic interventions, for example by informing research efforts to identify common treatment targets [40][41][42]. It also directly informs the theoretical models of associations between internalizing and externalizing psychopathology, by estimating the extent of the etiological overlap between these symptoms across adolescence.…”

New approach to mental disorders systematics: starting point or point of view?

“…Так, транснозологическая парадигма [15] и концепция консорциума HierarchicalTaxonom yOfPsychopathology (HiTOP) (https://medicine. stonybrookmedicine.edu/HITOP) [8] опираются на выделение общих феноменологических конструктов психических расстройств и оценку из взаимосвязи и взаимовлияния, т.е., в первую очередь, на феноменологические характеристики с учетом их коморбидности. Наличие более одного психического заболевания у индивида -крайне частое явление.…”

“…Это ставит под сомнение целесообразность использования концепции коморбидности психических заболеваний с акцентом на фенотипические (клинические) показатели в формировании принципиально новых подходов к систематике психических расстройств. Вместе с тем, именно на фенотипической коморбидности базируются концепции трансдиагностики [15] и HITOP [8].…”