Clinician Perception of the Utility of the Hierarchical Taxonomy of Psychopathology (HiTOP) System

Abstract

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been criticized through evidence suggesting it lacks appropriate validity, reliability, and clinical utility, and the Hierarchical Taxonomy of Psychopathology (HiTOP) has been offered as a solution to these criticisms. The goal of the present study was to compare clinician perceptions of these systems for the conceptualization of outpatient clinical cases. A sample of actively practicing clinicians (n = 143) rated one of three clinical vignettes using both diagnostic systems then rated the two approaches on seven indices of clinical utility. HiTOP was favored for overall clinical utility score as well as utility for formulating effective intervention, communicating clinical information to the client, comprehensively describing psychopathology, describing global functioning, and ease of application. There was no preference between HiTOP and the DSM for communicating with other mental health providers. The DSM was not favored for any clinical utility outcome. Statement of Relevance The standard of diagnosing and categorizing mental disorders in the USA has long been the DSM, but the manual has been criticized through evidence suggesting it is not clinically nor empirically useful. HiTOP was introduced in 2017 as an evidence-based reorganization of the signs, symptoms, and traits of mental illness and a potential solution to the limitations of the DSM. The recommendation to move away from the DSM and towards HiTOP has been met with criticism by others in the field, and a common concern is the lack of empirical evidence that the HiTOP approach is clinically useful or that clinicians would be open to applying it. However, in the present study, a sample of 143 actively practicing clinicians displayed preference for HiTOP over the DSM in measures of clinical utility. From this vantage point, it appears that when it comes to HiTOP, clinicians are capable and interested.