Bottom-Up and Top-Down Paradigms for Psychopathology: A Half-Century Odyssey

Abstract

Bottom-up paradigms prioritize empirical data from which to derive conceptualizations of psychopathology. These paradigms use multivariate statistics to identify syndromes of problems that tend to co-occur plus higher-order groupings such as those designated as internalizing and externalizing. Bottom-up assessment instruments obtain self-ratings and collateral ratings of behavioral, emotional, social, and thought problems and strengths for ages 1½–90+. Ratings of population samples provide norms for syndrome and higher-order scales for each gender, at different ages, rated by different informants, in relation to multicultural norms. The normed assessment instruments operationalize the empirically derived syndromes and higher-order groupings for applications to clinical services, research, and training. Because cross-informant agreement is modest and no single informant provides comprehensive assessment data, software compares ratings by different informants. Top-down paradigms prioritize conceptual representations of the nature and structure of psychopathology, as exemplified by psychodynamic, DSM/ICD, and HiTOP paradigms. Although these paradigms originated with observations, they tend to prioritize conceptual representations over empirical data.

A Hierarchical Taxonomy of Psychopathology (HiTOP) Primer for Mental Health Researchers

“…First, informant reports are known to have incremental validity and, for some outcomes, superior predictive utility, relative to a proband's own account of mental health problems. Indeed, Achenbach's seminal work on dimensional models of child psychopathology relied in large part on collateral sources such as parents, caregivers, and teachers (reviewed in Achenbach, 2020). This trend continues in current HiTOP-informed research (see, e.g., Boudreaux, South, & Oltmanns, 2019).…”

“…This may well manifest as noninvariance in dimensional models of psychopathology throughout development (cf. the varying structure of the ASEBA inventories by age group; Achenbach, 2020). Studies that have examined the structure of psychopathology longitudinally-and across multiple developmental periods-have tended to converge on dimensions represented in the HiTOP model (Caspi et al, 2020;see Forbes et al, 2016, for a review).…”

Hierarchical dimensional models of psychopathology: yes, but…

“…How could I do otherwise? I have been developing and advocating such models for over half a century 2,3 . But God (or the devil, if you prefer) is in the details.…”

The Five-Factor Model of Personality and the Structure of Psychopathology in Adolescence

“…So even when different models of the structure of psychopathology have been found, the factors that systematically emerge in all empirical studies are internalizing and externalizing factors (Eaton et al, 2013;Hicks, et al, 2004;Krueger et al, 2007). This structure seems to remain stable over time (Hatoum et al, 2018), and persists across different age and gender groups, and when using symptom scales, symptom counts of psychiatric diagnostic categories or categorical diagnoses (Achenbach 2020;Mezquita et al, 2015).…”

“…It is noteworthy that the HiTOP model is a recent taxonomy proposed by previous empirical studies, but needs further research. The HiTOP model has not been empirically obtained, but constructed from interpreting the results of different empirical works in which the structure of psychopathology has been studied from a limited group of symptoms (Achenbach, 2020). Thus, changes in the structure may very likely occur depending on the amount and heterogeneity of symptoms that each researcher chooses to analyze.…”