The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies.

Abstract

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.

Stability of personality traits over a five-year period in Swedish patients with schizophrenia spectrum disorder and non-psychotic individuals: a study using the Swedish universities scales of personality

“…In contrast, among the MMPI personality traits analysed by Horan and collaborators over a 15-month period the majority was influenced by psychiatric symptoms [16]. In this context, the attempts to overcome shortcomings in traditional psychopathological taxonomy by incorporating personality variation, partly overlapping with aspects of psychopathology is of interest [50].…”

Repetitive negative thinking as a predictor of depression and anxiety: A longitudinal cohort study

“…In relation to clinical diagnosis, the underlying dimension of RNT shows similarity with diagnostic constructs from the DSM-5 Section III model of pathological personality traits, in particular the trait of Anxiousness (including frequent worry) and Depressivity (including pessimism about the future) (Association, 2013;Krueger et al, 2012). Also in the Hierarchical Taxonomy of Psychopathology (HiTOP) (Kotov et al, 2017) RNT could be introduced as a maladaptive trait underlying the internalizing spectrum composed of distress and fear disorders. Future studies of the diagnostic value of RNT as a dimensional construct in conjunction with other dimensional traits for various psychiatric disorders and dimensional assessments of psychopathology are needed.…”

Focusing Personality Assessment on the Person: Modeling General, Shared, and Person Specific Processes in Personality and Psychopathology

“…Models of both the basic structure of personality (e.g., the Big Five/Five-Factor Model; Costa & McCrae, 2008;Goldberg, 1990) and the emerging structure of psychopathology that dovetails with the structure of basic personality (Kotov et al, 2017; are grounded in between-person statistical analyses. As such, they readily translate to developing inventories to assess an individual's personality profile or elevated features of psychopathology, especially when considered relative to their peers.…”