The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM

Abstract

In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders ( DSM). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field closer to a more valid and useful taxonomy.

A Developmentally Informed Systematic Review and Meta-Analysis of the Strength of General Psychopathology in Childhood and Adolescence

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Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles

“…However, these new models, although highly inspiring to overcome classic categorical approach, are currently hardly implemented in common clinical practice ( 32 , 38 ), where categorical approach remains the most used, even though work groups are working on implementing dimensional approaches ( 32 , 39 ). Finally, these models are also not free of criticisms, either on their overall utility [e.g., for HiTOP ( 40 )] or on their representativeness of the clinical complexity of patients [e.g., for AMPD/ICD-11 ( 41 )].…”

Intraindividual phenotyping of depression in high-risk youth: An application of a multilevel hidden Markov model

“…Phenotypes that target intraindividual heterogeneity may have clinical utility. Whereas contemporary literature on depression has promoted dimensional conceptualizations of psychopathology (Forbes et al, 2016), sophisticated categorical classification systems may remain efficient for practitioners' decision making (Haeffel et al, 2022). For example, intraindividual phenotypes can represent clinically relevant states that can signal when a particular intervention may be especially helpful for a particular individual.…”