Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co‐occurrence in the modal case, heterogeneity of presentation within dis­orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and “Cluster B” personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self‐assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

Answering Questions About the Hierarchical Taxonomy of Psychopathology (HiTOP): Analogies to Whales and Sharks Miss the Boat

“…This approach maximizes coherence of constructs and distinctiveness between them. Moreover, extensive evidence indicates that such constructs capture information about common genetics, risk factors, biomarkers, and treatment response shared by cooccurring forms of psychopathology (Kotov et al, 2020;Krueger et al, 2021;Watson et al, 2022). The DSM attempts to achieve something similar, but it often groups symptoms and disorders in ways that do not reflect empirical reality.…”

“…Both structural and validity evidence are considered when evaluating constructs for inclusion in HiTOP (Kotov et al, 2017(Kotov et al, , 2021. Validation of HiTOP is an ongoing process, but it has already produced a substantial body of evidence reviewed in consortium publications (see especially Kotov et al, 2020;Krueger et al, 2021;Watson et al, 2022). We highlight two specific examples of HiTOP's validity and utility for research.…”

“…consortium (e.g., Kotov et al, 2017Kotov et al, , 2020Kotov et al, , 2021Krueger et al, 2021;Watson et al, 2022).…”

Perceptions of childhood unpredictability, delay discounting, risk-taking, and adult externalizing behaviors: A life-history approach

“…The Externalizing Spectrum Inventory (ESI-BF) (Patrick et al, 2013) assesses a range of traits and behaviors in the domain of deficient impulse control. Consistent with current clinical models, items cluster along three higher order dimensions reflecting general disinhibition, callous aggression, and substance use (Patrick et al, 2013; see also Kotov et al, 2017;Krueger et al, 2021). We used the 160-item brief form version of the ESI.…”

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

“…To put the tutorials in context, we begin with a brief review of the motivation behind and makeup of the HiTOP model of psychopathology. We refer readers to prior consortium publications for the full account of HiTOP’s dimensional structure (Kotov et al, 2017, 2020; Krueger et al, 2018, 2021; Watson et al, 2022) and its implications for substantive research on the origins, development, consequences, and treatment of psychopathology (Conway et al, 2019; Latzman et al, 2020; Ruggero et al, 2019; Waszczuk et al, 2020).…”