The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.

New approaches to deep phenotyping in addictions.

“…Also, HiTOP has begun to incorporate popular constructs in laboratory paradigms, such as delay discounting, into its assessment battery. An added benefit of translating between the constructs outlined in NIDA PhAB and HiTOP is that doing so offers the opportunity for reverse translation between constructs studied in preclinical nonhuman animal models and in human laboratory paradigms, which will likely increase consilience between siloes of addiction science (Kotov et al, 2022).…”

New approaches to deep phenotyping in addictions

“…Also, HiTOP has begun to incorporate popular constructs in laboratory paradigms, such as delay discounting, into its assessment battery. An added benefit of translating between the constructs outlined in NIDA PhAB and HiTOP is that doing so offers the opportunity for reverse translation between constructs studied in preclinical nonhuman animal models and in human laboratory paradigms, which will likely increase consilience between siloes of addiction science (Kotov et al, 2022). Externalizing and its subforms.…”

Parsing genetically influenced risk pathways: genetic loci impact problematic alcohol use via externalizing and specific risk

“…Externalizing generally refers to a broad liability towards behavioral disinhibition and dysregulation. The externalizing spectrum includes disorders such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder, substance use disorders, and antisocial behavior personality disorder, as well as personality traits like impulsivity and sensation seeking [ 10 – 12 ]. Prior research estimates that the majority of the genetic variance for AUD is shared with other externalizing disorders with a much smaller proportion of genetic variation specific to alcohol use outcomes [ 8 ].…”