Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) Into Clinical Practice

Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. / Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. / Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility

Re-evaluation of the latent structure of common childhood disorders: is there a general psychopathology factor (P-factor)?

In the field of psychopathology, there is high comorbidity between different disorders. Traditionally, support for two broad correlated dimensions of internalizing and externalizing symptoms has consistently emerged for children and adolescents. To date, oblique 2 and 3 first-order factor models (factors for externalizing and internalizing, and fear, distress, and externalizing) and bi-factor models with the corresponding two and three group factors have been suggested for common internalizing and eternalizing child and adolescent disorders. The present study used confirmatory factor analyses to examine the relative support for these models in adolescents (≥ 12 to 18 years; N = 866) and children (6 to < 12 years; N = 1233) and the reliability and convergent and divergent validities of the psychopathology factor (P-factor) and group factors in the optimum bi-factor model. All participants were from a clinic and underwent Diagnostic and Statistical Manual of Mental Disorders, 4th Edition clinical diagnosis. The findings showed that the bi-factor model with two group factors (internalizing and externalizing) was the optimum model for both children and adolescents. For both groups, findings showed relatively higher reliability for the P-factor than the group factors, although the externalizing group factor showed substantial reliability in adolescents, and both the externalizing and internalizing group factors also showed substantial reliability in children. The factors of the optimum bi-factor model also showed good convergent and discriminant validities. The implications for theory and clinical and research practice related to psychopathology are discussed

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system—the Hierarchical Taxonomy of Psychopathology (HiTOP)—that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.FSW – Publicaties zonder aanstelling Universiteit Leide

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a dimensional approach to the science of mental illness. Here we outline one such dimensional system-the Hierarchical Taxonomy of Psychopathology (HiTOP)-that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness

Progress in achieving quantitative classification of psychopathology

Résumé: Les lacunes des classifications de la psychopathologie fondées sur des consensus d’experts ont conduit à de nombreuses tentatives actuelles pour classer la psychopathologie de manière quantitative. Dans cet article, nous passons en revue les progrès accomplis dans la réalisation d’une classification quantitative et empirique de la psychopathologie. Une littérature empirique substantielle montre que la psychopathologie est généralement plus dimensionnelle que catégorielle. Et lorsque la distinction entre une psychopathologie discrète et une psychopathologie continue est traitée comme une question de recherche, par opposition à une distinction basée sur un argument d’autorité, alors les preuves scientifiques soutiennent clairement l’hypothèse d’une psychopathologie continue. En outre, un corpus de littérature connexe montre comment les dimensions de la psychopathologie peuvent être organisées selon une hiérarchie qui va de dimensions très larges d’un niveau de type « spectre » à des groupes spécifiques et étroits de symptômes. De cette manière, une approche quantitative résout le « problème de la comorbidité » en modélisant explicitement la cooccurrence entre les signes et les symptômes au sein d’une hiérarchie détaillée et variée, maniant des concepts dimensionnels qui ont une utilité clinique directe. De nombreuses preuves concernant la structure dimensionnelle et hiérarchique de la psychopathologie ont conduit à la formation du consortium Hierarchical Taxonomy of Psychopathology (HiTOP, taxonomie hiérarchique de la psychopathologie). Il s’agit d’un groupe de 70 chercheurs travaillant ensemble pour étudier la classification empirique de la psychopathologie. Dans cet article, nous décrivons les objectifs et les axes de recherches actuels du consortium HiTOP. Ces objectifs concernent la poursuite des recherches sur l’organisation empirique de la psychopathologie ; le lien entre la personnalité et la psychopathologie ; l’utilité des construits empiriques de la psychopathologie, à la fois pour la recherche et pour la clinique ; et enfin, le développement de nouveaux modèles exhaustifs et d’instruments d’évaluation correspondant aux construits psychopathologiques dérivés d’une approche empirique. / Abstract: Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach

Progress in achieving quantitative classification of psychopathology

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS

Progress in Achieving Quantitative Classification of Psychopathology

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co‐occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach