Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Robert F Krueger¹, Kelsey A Hobbs¹, Christopher C Conway², Danielle M Dick³, Michael N Dretsch⁴, Nicholas R Eaton⁵, Miriam K Forbes⁶, Kelsie T Forbush⁷, Katherine M Keyes⁸, Robert D Latzman⁹, Giorgia Michelini¹⁰, Christopher J Patrick¹¹, Martin Sellbom¹², Tim Slade¹³, Susan C South¹⁴, Matthew Sunderland¹³, Jennifer Tackett¹⁵, Irwin Waldman¹⁶, Monika A Waszczuk¹⁷, Aidan G C Wright¹⁸, David H Zald¹⁹, David Watson²⁰, Roman Kotov¹⁷; HiTOP Utility Workgroup

Affiliations

¹ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
² Department of Psychology, Fordham University, Bronx, NY, USA.
³ Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
⁴ US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA.
⁵ Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
⁶ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
⁷ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁸ Department of Epidemiology, Columbia University, New York, NY, USA.
⁹ Department of Psychology, Georgia State University, Atlanta, GA, USA.
¹⁰ Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Psychology, Florida State University, Tallahassee, FL, USA.
¹² Department of Psychology, University of Otago, Dunedin, New Zealand.
¹³ Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
¹⁴ Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
¹⁵ Department of Psychology, Northwestern University, Evanston, IL, USA.
¹⁶ Department of Psychology, Emory University, Atlanta, GA, USA.
¹⁷ Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
¹⁸ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
²⁰ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.

PMID: 34002506
PMCID: PMC8129870
DOI: 10.1002/wps.20844

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Robert F Krueger et al. World Psychiatry. 2021 Jun.

. 2021 Jun;20(2):171-193.

doi: 10.1002/wps.20844.

Authors

Affiliations

¹ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
² Department of Psychology, Fordham University, Bronx, NY, USA.
³ Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
⁴ US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA.
⁵ Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
⁶ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
⁷ Department of Psychology, University of Kansas, Lawrence, KS, USA.
⁸ Department of Epidemiology, Columbia University, New York, NY, USA.
⁹ Department of Psychology, Georgia State University, Atlanta, GA, USA.
¹⁰ Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
¹¹ Department of Psychology, Florida State University, Tallahassee, FL, USA.
¹² Department of Psychology, University of Otago, Dunedin, New Zealand.
¹³ Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
¹⁴ Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
¹⁵ Department of Psychology, Northwestern University, Evanston, IL, USA.
¹⁶ Department of Psychology, Emory University, Atlanta, GA, USA.
¹⁷ Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
¹⁸ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
¹⁹ Department of Psychology, Vanderbilt University, Nashville, TN, USA.
²⁰ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.

PMID: 34002506
PMCID: PMC8129870
DOI: 10.1002/wps.20844

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

Keywords: Cluster B personality disorders; HiTOP; antagonism; antisocial personality disorder; clinical utility; disinhibition; externalizing; substance use disorders.

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Figures

**Figure 1**
Conceptual model of the externalizing superspectrum. Dashed lines represent provisional inclusion. Specifically, the dashed line surrounding borderline personality disorder represents that this disorder falls under two superspectra (externalizing and internalizing). The dashed line surrounding the diagnoses section indicates that these categorical diagnoses do not belong to the model; they are meant to represent how a dimensional model encapsulates DSM diagnoses. HiTOP – Hierarchical Taxonomy Of Psychopathology, ADHD – attention‐deficit/hyperactivity disorder.

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References

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Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Affiliations

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): II. Externalizing superspectrum

Authors

Affiliations

Abstract

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources