HiTOP (Hierarchical Taxonomy of Psychopathology): a possible alternative to DSM

This initiative views disorders not as closed categories, but as a continuum of symptoms.

At present, most professionals in clinical and health psychology and psychiatry use a series of clinical entities and criteria for diagnosis from one of the two major from one of the two main diagnostic manuals that bring them together. These are 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 gathers all the classified diseases and disorders, being Chapter F the one focused on mental disorders), being the most used the first one.

However, many authors consider that the taxonomies offered by these manuals are excessively rigid and that in most cases it is difficult to find a case of a pure mental disorder completely separated from other complications. With the aim of replacing the DSM, different authors critical of the existing classifications have generated different alternatives, one of the most well known being the Hierarchical Taxonomy of Psychopathology (HiTOP)..

The HiTOP: what it is, and its main features

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

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 disorders is taken into account.In fact, they can cease to be considered separately, as the different problems are observed in a series of dimensions in the form of a continuum.

These dimensions can be further subdivided according to need in order to detect whether any of their components are more prevalent than others or are linked more to a particular type of symptoms, having a hierarchical but broad structure and allowing flexible work for the staff using it.

This model is considered promising and can provide a great level of information not only with regard to diagnosis, but also to risk factors, possible causes, courses, and response to treatmentIt also covers most of the previously classified psychopathologies. Moreover, it is a model that does not start or act on the basis of mere assumptions, but rather on the basis of a rigorous analysis of empirical evidence. However, it is still in the process of creation and refinement.

Its spectra or dimensions

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

Specifically, this classification establishes a total of six spectra or dimensions. It should be borne in mind that these dimensions are not diagnostic categories, but refer to continuums in which a person with psychopathology is situated, all of them being assessable in all situations. The examples given in each are merely examples (i.e., if depression is given as an example in introspection, it does not imply that depression is a disorder of introspection, but that it is one of the cases in which it can occur at a higher level).

1. Introspection / Internalization

Introspection is understood as focusing on one's own thoughts and qualities and assessing both the present and the future.In the case of mental disorders, generally experiencing negative emotions. It is typical of disorders such as depression and anxiety disorders.

3. Disinhibition/ disinhibited externalization

This dimension refers to the propensity for impulsivity or unreasoned action. Some of the older disorders that would score higher on this item would be those of substance abuse.

4. Antagonism/antagonistic externalizing

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

5. Isolation

This concept refers to the absence or difficulty in establishing or maintaining social relationships, as well as the lack of 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 alterations or alterations of the perceptual alterations or alterations in the content of thought..

7. Somatization

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

An alternative to the DSM

As we have said, the creation of the HiTOP emerges as an alternative that seeks to replace the DSM and the current classifications of mental disordersThe HiTOP is based on the existence of multiple deficiencies or problems in the generation of diagnostic entities or in their practical application.

First of all, one of the reasons is the aforementioned lack of flexibility of the diagnostic labels (although this tries to be compensated with the inclusion of specifiers), being frequent the existence of some degree of comorbidity between two or more disorders (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 common to find a high level of heterogeneity among the symptomatological manifestations of the same diagnostic entity.and atypical features may be found.

Another criticism is at the level of criteria: for the diagnosis of many of the majority of mental disorders, the presence of a certain number of symptoms is required. While this could be understood in the case of the most identifying symptoms of the disorder (for example, in depression there must be at least depressed mood and/or anhedonia or in schizophrenia the presence of hallucinations, delusions or disorganized speech), in the case of other more secondary symptoms a certain number 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 criteria that are questionable for many professionals in the sector. Pathologies that many consider not very useful and dubious are incorporated and labels that could have relevant differences between them are agglutinated or eliminated (for example, the elimination of schizophrenia subtypes or the agglutination of autism spectrum disorders into a single category). Sometimes different authors have also speculated that that these committees may have political and economic interests behind them that would alter the creation of such diagnostic labels.

Bibliographical 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.