Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Roman Kotov¹, Katherine G Jonas¹, William T Carpenter², Michael N Dretsch³, Nicholas R Eaton⁴, Miriam K Forbes⁵, Kelsie T Forbush⁶, Kelsey Hobbs⁷, Ulrich Reininghaus^{8

9

10}, Tim Slade¹¹, Susan C South¹², Matthew Sunderland¹¹, Monika A Waszczuk¹, Thomas A Widiger¹³, Aidan G C Wright¹⁴, David H Zald¹⁵, Robert F Krueger⁷, David Watson¹⁶; HiTOP Utility Workgroup

Affiliations

¹ Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
² Department of Psychiatry, University of Maryland, Baltimore, MD, USA.
³ Walter Reed Army Institute of Research, US Army Medical Research Directorate - West, Silver Spring, MD, USA.
⁴ Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
⁵ Department of Psychology, Macquarie University, Sydney, Australia.
⁶ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁷ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
⁹ ESRC Centre for Society and Mental Health, King's College London, London, UK.
¹⁰ Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹¹ Matilda Centre for Research in Mental Health and Substance Abuse, University of Sydney, Sydney, NSW, Australia.
¹² Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
¹³ Department of Psychology, University of Kentucky, Lexington, KY, USA.
¹⁴ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁵ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
¹⁶ Department of Psychology, University of Notre Dame, South Bend, IN, USA.

PMID: 32394571
PMCID: PMC7214958
DOI: 10.1002/wps.20730

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Roman Kotov et al. World Psychiatry. 2020 Jun.

. 2020 Jun;19(2):151-172.

doi: 10.1002/wps.20730.

Authors

Affiliations

¹ Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
² Department of Psychiatry, University of Maryland, Baltimore, MD, USA.
³ Walter Reed Army Institute of Research, US Army Medical Research Directorate - West, Silver Spring, MD, USA.
⁴ Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
⁵ Department of Psychology, Macquarie University, Sydney, Australia.
⁶ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁷ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany.
⁹ ESRC Centre for Society and Mental Health, King's College London, London, UK.
¹⁰ Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹¹ Matilda Centre for Research in Mental Health and Substance Abuse, University of Sydney, Sydney, NSW, Australia.
¹² Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
¹³ Department of Psychology, University of Kentucky, Lexington, KY, USA.
¹⁴ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁵ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
¹⁶ Department of Psychology, University of Notre Dame, South Bend, IN, USA.

PMID: 32394571
PMCID: PMC7214958
DOI: 10.1002/wps.20730

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis-related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

Keywords: HiTOP; clinical utility; detachment; introversion; personality disorders; psychosis; psychotic disorders; psychoticism; schizophrenia; thought disorder.

PubMed Disclaimer

Figures

**Figure 1**
Dimensions within the Hierarchical Taxonomy of Psychopathology (HiTOP) psychosis superspectrum. PD – personality disorder

See this image and copyright information in PMC

References

1. Kotov R, Krueger RF, Watson D et al. The Hierarchical Taxonomy of Psychopathology (HiTOP): a dimensional alternative to traditional nosologies. J Abnorm Psychol 2017;126:454‐77. - PubMed
1. Markon KE, Chmielewski M, Miller CJ. The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychol Bull 2011;137:856‐79. - PubMed
1. Shankman SA, Funkhouser CJ, Klein DN et al. Reliability and validity of severity dimensions of psychopathology assessed using the Structured Clinical Interview for DSM‐5 (SCID). Int J Methods Psychiatr Res 2018;27(1). - PMC - PubMed
1. Chmielewski M, Clark LA, Bagby RM et al. Method matters: understanding diagnostic reliability in DSM‐IV and DSM‐5. J Abnorm Psychol 2015;124:764‐9. - PMC - PubMed
1. Watson D. Subtypes, specifiers, epicycles, and eccentrics: toward a more parsimonious taxonomy of psychopathology. Clin Psychol Sci Pract 2003;10:233‐8.

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Affiliations

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): I. Psychosis superspectrum

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

Full Text Sources

Medical