Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice

Camilo J. Ruggero, Roman Kotov, Christopher J. Hopwood, Michael First, Lee Anna Clark, Andrew E. Skodol, Stephanie N. Mullins-Sweatt, Christopher J. Patrick, Bo Bach, David C. Cicero, Anna Docherty, Leonard J. Simms, R. Michael Bagby, Robert F. Krueger, Jennifer L. Callahan, Michael Chmielewski, Christopher C. Conway, Barbara De Clercq, Allison Dornbach-Bender, Nicholas R. EatonMiriam K. Forbes, Kelsie T. Forbush, John D. Haltigan, Joshua D. Miller, Leslie C. Morey, Praveetha Patalay, Darrel A. Regier, Ulrich Reininghaus, Alexander J. Shackman, Monika A. Waszczuk, David Watson, Aidan G.C. Wright, Johannes Zimmermann

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1069-1084
Number of pages16
JournalJournal of consulting and clinical psychology
Volume87
Issue number12
DOIs
StatePublished - Dec 2019

Bibliographical note

Funding Information:
This article was organized by members of the HiTOP Consortium, a grassroots organization open to all qualified investigators (https://medicine .stonybrookmedicine.edu/HITOP). Alexander J. Shackman was supported by the National Institutes of Health (DA040717 and MH107444) and the University of Maryland. Authors 15 through 33 are listed alphabetically by last name.

Keywords

  • Classification
  • Diagnosis
  • Nosology
  • Psychopathology
  • Treatment

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