Currently, most clinical and health psychology and psychiatry professionals employ a series of clinical entities and criteria for diagnosis from one of the two main diagnostic manuals that bring them together. This is the Diagnostic and Statistical Manual of Mental Disorders, or DSM, of the American Psychological Association, or chapter F of the International Classification of Diseases, or ICD, of the World Health Organization (which includes all of the classified diseases and disorders, with chapter F focusing on mental disorders), the first being the most used.

However, many authors consider that the taxonomies offered by these manuals are excessively rigid and that it is mostly complicated to find a case of a pure mental disorder completely separate from other complications. With the aim of replacing the DSM, different authors critical of the classifications that have existed until now have generated different alternatives, one of the best known being the Hierarchical Taxonomy of Psychopathology or HiTOP .

The HiTOP: what it is, and its main characteristics

The Hierarchical Taxonomy of Psychopathology or HiTOP is a type of alternative taxonomic classification to the traditional classifications for psychopathologies proposed by a number of well-known authors (among them Kotov, Krueger, Watson, Achenbach, Clark, Caspi, Slade, Zimmerman, Rescorla or Goldberg). This taxonomic classification is based on the existence of difficulties in the current classifications to propose a different model, based on the covariation of symptoms and grouping similar symptoms to reduce heterogeneity.

The HiTOP considers psychopathology not as an entity in itself but as a spectrum in which concurrent syndromes can be observed in which different psychological problems share similar characteristics. The possible comorbidity between different alterations is taken into account , and in fact they can no longer be considered separately, as the different problems are observed in a series of dimensions in the form of a continuum.

These dimensions can be subdivided according to need in order to detect whether any of its components is more prevalent than others or more linked to a particular type of symptom, having a hierarchical but broad structure and allowing flexible work for the staff that employs it.

This model is considered promising and can provide a high level of information not only with regard to diagnosis, but also to risk factors, possible causes, courses and response to treatment , covering also most of the psychopathologies previously classified. Moreover, it is a model that does not start or act through mere assumption, but acts from a rigorous analysis of the empirical evidence. However, it is still in the process of creation and refinement.

Its spectra or dimensions

The HiTOP establishes a series of dimensions or spectra to categorize the different symptoms and alterations characteristic of people suffering from a psychopathology. Likewise, it must be taken into account that we are in a continuum in which not only are people with psychopathology situated but also some elements that can also be found to some degree in the non-clinical population.

Specifically, a total of six spectra or dimensions are established in this classification. It is necessary to take into account that these dimensions are not diagnostic categories, but refer to the continuum in which a person with psychopathology is situated, all of which can be evaluated in all situations. The examples given in each one are merely (that is, if introspection is used as an example, it does not imply that depression is an introspection disorder, but rather that it is one of the cases in which the highest level can be found).

1. Introspection/ Internalization

Introspection is understood as focusing on one’s own thoughts and qualities and valuing both the present and the future , generally experiencing negative emotions, in the case of mental disorders. This is typical of disorders such as depression and anxiety disorders.

3. Disinhibition/uninhibited outsourcing

This dimension refers to the propensity for impulsiveness or unreasonable action. Some of the older disorders that would score highest on this element would be those of substance abuse.

4. Antagonism/antagonistic externalization

This dimension refers to the presence of hostility and aggressiveness towards others, which may lead to aggression or self-harm . It is not necessary, however, that there is real violence, which may be mere opposition or displeasure.

5. Insulation

This concept refers to the absence or difficulty in establishing or maintaining social relations, as well as the interest in doing so. An example in which this dimension occurs to a high degree can be found in autism.

6. Mental Disorder or Psychoticism

This dimension refers to the level at which perceptual or content of thought alterations occur .

7. Somatization

Dimension based on the existence of physiological symptoms that cannot be explained as a medical disorder or as a consequence of a physical illness. It also incorporates the need for constant medical attention, as occurs in hypochondria.

An alternative to DSM

As we have said, the creation of the HiTOP arises as an alternative that seeks to replace the DSM and the current classifications of mental disorders , considering the existence of multiple deficiencies or problems at the time of generating the diagnostic entities or in their practical application.

Firstly, one of the reasons for this is the above-mentioned lack of flexibility in diagnostic labels (although this is attempted to be replaced by the inclusion of specifiers), with the existence of some degree of comorbidity between two or more disorders being frequent (for example, the joint existence of anxiety and depression is frequent) and it is more complicated to find cases of pure disorders. It is also frequent to find a high level of heterogeneity between the symptomatological manifestations of the same diagnostic entity , and atypical characteristics may be found.

Another criticism is at the level of criteria: the diagnosis of many of the majority of mental disorders requires the presence of a certain number of symptoms. While this could be understood in the case of those most identifying of the disorder (for example in depression there must be at least a depressed and/or anhedonic mood or in schizophrenia the presence of hallucinations, delusions or disorganized speech), in the case of other symptoms of a more secondary nature a certain amount is still required in the absence of which the disorder could not technically be identified.

Another aspect to highlight is that it is carried out by a committee that decides which classifications to incorporate and which to modify or eliminate, sometimes with questionable criteria for many professionals in the sector. Pathologies that many consider unhelpful and questionable are incorporated and labels that could have relevant differences between them are agglutinated or eliminated (for example, the elimination of subtypes of schizophrenia or the agglutination in a single category of autism spectrum disorders). Sometimes different authors have also speculated that such committees may have political and economic interests behind them that would alter the creation of such diagnostic labels.

Bibliographic references

  • Kotov, R.; Krueger, R.F.; Watson, D.; Achenbach, T.M.; Althoff, R.R.; Bagby, R.M.; Brown, T.A.; Carpenter, W.T.; Caspi, A.; Clark, L.A.; Eaton, N.R.; Forbes, M.K.; Forbush, K.T.; Goldberg, D.; Hasin, D.; Hyman, S.E.; Ivanova, M.Y.; Lynam, D.R.; Markon, K.; Miller, J.D.; Moffitt, T.E.; Morey, L.C.; Mullins-Sweatt, S.N.; Ormel, J.; Patrick, C.J.; Regier, D.A.; Rescorla, L.; Ruggero, C.J.; Samuel, D.B.; Sellbom, M.Simms, L.J.; Skodol, A.E.; Slade, T.; South, S.C.; Tackett, J.L.; Waldman, I.D.; Waszczuk, M.A.; Wright, A.G.C. & Zimmerman, M. (2017) The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126 (4): 454-477.