A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

Christopher C Conway¹, Miriam K Forbes², Kelsie T Forbush³, Eiko I Fried⁴, Michael N Hallquist⁵, Roman Kotov⁶, Stephanie N Mullins-Sweatt⁷, Alexander J Shackman⁸, Andrew E Skodol⁹, Susan C South¹⁰, Matthew Sunderland¹¹, Monika A Waszczuk⁶, David H Zald¹², Mohammad H Afzali¹³, Marina A Bornovalova¹⁴, Natacha Carragher¹⁵, Anna R Docherty¹⁶, Katherine G Jonas⁶, Robert F Krueger¹⁷, Praveetha Patalay¹⁸, Aaron L Pincus⁵, Jennifer L Tackett¹⁹, Ulrich Reininghaus^{20

21}, Irwin D Waldman²², Aidan G C Wright²³, Johannes Zimmermann²⁴, Bo Bach²⁵, R Michael Bagby²⁶, Michael Chmielewski²⁷, David C Cicero²⁸, Lee Anna Clark²⁹, Tim Dalgleish³⁰, Colin G DeYoung¹⁷, Christopher J Hopwood³¹, Masha Y Ivanova³², Robert D Latzman³³, Christopher J Patrick³⁴, Camilo J Ruggero³⁵, Douglas B Samuel¹⁰, David Watson²⁹, Nicholas R Eaton³⁶

Affiliations

¹ 1 Department of Psychological Sciences, College of William & Mary.
² 2 Centre for Emotional Health, Department of Psychology, Macquarie University.
³ 3 Department of Psychology, University of Kansas.
⁴ 4 Department of Psychology, University of Amsterdam.
⁵ 5 Department of Psychology, Pennsylvania State University.
⁶ 6 Department of Psychiatry, State University of New York.
⁷ 7 Department of Psychology, Oklahoma State University.
⁸ 8 Department of Psychology and Neuroscience and Cognitive Science Program, University of Maryland.
⁹ 9 Department of Psychiatry, University of Arizona.
¹⁰ 10 Department of Psychological Sciences, Purdue University.
¹¹ 11 National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales.
¹² 12 Department of Psychology, Vanderbilt University.
¹³ 13 Department of Psychiatry, University of Montreal.
¹⁴ 14 Department of Psychology, University of South Florida.
¹⁵ 15 Medical Education and Student Office, Faculty of Medicine, University of New South Wales.
¹⁶ 16 Department of Psychiatry, University of Utah.
¹⁷ 17 Department of Psychology, University of Minnesota.
¹⁸ 18 Institute of Psychology, Health and Society, University of Liverpool.
¹⁹ 19 Department of Psychology, Northwestern University.
²⁰ 20 Department of Psychiatry and Psychology, Maastricht University.
²¹ 21 Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London.
²² 22 Department of Psychology, Emory University.
²³ 23 Department of Psychology, University of Pittsburgh.
²⁴ 24 Department of Psychology, University of Kassel.
²⁵ 25 Psychiatric Research Unit, Slagelse Psychiatric Hospital.
²⁶ 26 Departments of Psychology and Psychiatry, University of Toronto.
²⁷ 27 Department of Psychology, Southern Methodist University.
²⁸ 28 Department of Psychology, University of Hawaii at Manoa.
²⁹ 29 Department of Psychology, University of Notre Dame.
³⁰ 30 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom.
³¹ 31 Department of Psychology, University of California, Davis.
³² 32 Department of Psychiatry, University of Vermont.
³³ 33 Department of Psychology, Georgia State University.
³⁴ 34 Department of Psychology, Florida State University.
³⁵ 35 Department of Psychology, University of North Texas.
³⁶ 36 Department of Psychology, Stony Brook University.

PMID: 30844330
PMCID: PMC6497550
DOI: 10.1177/1745691618810696

Review

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

Christopher C Conway et al. Perspect Psychol Sci. 2019 May.

. 2019 May;14(3):419-436.

doi: 10.1177/1745691618810696. Epub 2019 Mar 7.

Authors

Affiliations

¹ 1 Department of Psychological Sciences, College of William & Mary.
² 2 Centre for Emotional Health, Department of Psychology, Macquarie University.
³ 3 Department of Psychology, University of Kansas.
⁴ 4 Department of Psychology, University of Amsterdam.
⁵ 5 Department of Psychology, Pennsylvania State University.
⁶ 6 Department of Psychiatry, State University of New York.
⁷ 7 Department of Psychology, Oklahoma State University.
⁸ 8 Department of Psychology and Neuroscience and Cognitive Science Program, University of Maryland.
⁹ 9 Department of Psychiatry, University of Arizona.
¹⁰ 10 Department of Psychological Sciences, Purdue University.
¹¹ 11 National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales.
¹² 12 Department of Psychology, Vanderbilt University.
¹³ 13 Department of Psychiatry, University of Montreal.
¹⁴ 14 Department of Psychology, University of South Florida.
¹⁵ 15 Medical Education and Student Office, Faculty of Medicine, University of New South Wales.
¹⁶ 16 Department of Psychiatry, University of Utah.
¹⁷ 17 Department of Psychology, University of Minnesota.
¹⁸ 18 Institute of Psychology, Health and Society, University of Liverpool.
¹⁹ 19 Department of Psychology, Northwestern University.
²⁰ 20 Department of Psychiatry and Psychology, Maastricht University.
²¹ 21 Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London.
²² 22 Department of Psychology, Emory University.
²³ 23 Department of Psychology, University of Pittsburgh.
²⁴ 24 Department of Psychology, University of Kassel.
²⁵ 25 Psychiatric Research Unit, Slagelse Psychiatric Hospital.
²⁶ 26 Departments of Psychology and Psychiatry, University of Toronto.
²⁷ 27 Department of Psychology, Southern Methodist University.
²⁸ 28 Department of Psychology, University of Hawaii at Manoa.
²⁹ 29 Department of Psychology, University of Notre Dame.
³⁰ 30 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, United Kingdom.
³¹ 31 Department of Psychology, University of California, Davis.
³² 32 Department of Psychiatry, University of Vermont.
³³ 33 Department of Psychology, Georgia State University.
³⁴ 34 Department of Psychology, Florida State University.
³⁵ 35 Department of Psychology, University of North Texas.
³⁶ 36 Department of Psychology, Stony Brook University.

PMID: 30844330
PMCID: PMC6497550
DOI: 10.1177/1745691618810696

Abstract

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.

Keywords: DSM; HiTOP; Hierarchical Taxonomy of Psychopathology; ICD; RDoC; individual differences; mental illness; nosology; transdiagnostic.

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Figures

**Figure 1.**
Hierarchical Taxonomy of Psychopathology (HiTOP) consortium working model. Constructs higher in the figure are broader and more general, whereas constructs lower in the figure are narrower and more specific. Dashed lines denote provisional elements requiring further study. At the lowest level of the hierarchy (i.e., traits and symptom components), for heuristic purposes, conceptually related signs and symptoms (e.g., Phobia) are indicated in bold, with specific manifestations indicated in parentheses. **Abbreviations**—ADHD: attention-deficit/hyperactivity disorder; GAD: generalized anxiety disorder; IED: intermittent explosive disorder; MDD: major depressive disorder; OCD: obsessive-compulsive disorder; ODD: oppositional defiant disorder; SAD: separation anxiety disorder; PD: personality disorder; PTSD: post-traumatic stress disorder.

**Figure 2.**
Conceptual diagrams of three possible HiTOP research designs. (A) Comparing the predictive validity across HiTOP levels. (B) Comparing predictive validity within a HiTOP level. (C) Comparing the predictive validity of categorical diagnoses to HiTOP dimensions. **Abbreviations**—BPD I: bipolar I disorder; BPD II: bipolar II disorder; MDD: major depressive disorder; OSDD: other specified depressive disorder; PDD: persistent depressive disorder.

**Figure 3.**
Heuristic model of the internalizing domain in relation to autonomic reactivity to a laboratory challenge. Paths a, b, and c represent regressions of the outcome on dimensions at different levels of the hierarchical model. See the main text for details.

See this image and copyright information in PMC

References

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A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

Affiliations

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical