Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice.

Abstract

Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability in daily practice, high co-morbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimension-based approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. To this end, the present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. We review potential advantages and limitations for clinical utility, including case conceptualization and treatment planning. We illustrate what a HiTOP approach might look like in practice relative to traditional nosology. Finally, we discuss common barriers to using HiTOP in real-world healthcare settings and how they can be addressed.

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

“…Application of dimensional measures in clinical practice faces practical challenges, including limited reimbursement for assessment, patient burden, and need for categorical decisions (e.g., to treat or wait) 20 . In other fields of medicine, these challenges have not precluded a widespread use of dimensional markers, such as testing levels of metabolites in blood or pathogens in cerebrospinal fluid.…”

“…The HiTOP system was derived from a large body of structural research 1,17,18 , but its external validity and utility are less established, as previous reviews of these topics had limited scope 19‐21 . To address this shortcoming, the Utility Workgroup of HiTOP consortium assembled teams of experts to systematically review evidence on validity and utility of the system.…”

Treatment of personality pathology through the lens of the hierarchical taxonomy of psychopathology: Developing a research agenda

“…There are a few recent notable HiTOP papers beyond the current issue of Personality and Mental Health that are particularly relevant to the current manuscript. Widiger et al 40 describe the potential role, importance and implications of personality within the HiTOP dimensional model of psychopathology, Hopwood et al 27 focus on specific potential advantages of HiTOP for psychotherapy research and practice, and Ruggero et al 41 outline general issues involved in translating HiTOP to clinical practice. The goal of the current paper is to integrate these three areas to highlight potential psychotherapeutic and pharmacological treatment technique recommendations for personality pathology specifically defined within the HiTOP model.…”

“…High internalizing High internalizing Cognitive processing 33,34 Analysing transference 38,41 Cognitive restructuring 5 Clarification 41 Mentalizing 35,36 Emotional expression 42 Mindfulness 37 Mirroring 38 SSRI 39 TCA 39 Unified protocol 40 Low internalizing Facial emotion recognition 43 Family psychoeducation on emotion reactivity 44…”

“…increased negative affect, cognitive processing biases and behavioural avoidance) that are thought to underpin many symptoms within the internalizing spectrum. 41,92 This approach has shown efficacy for anxiety and depressive disorders, post-traumatic stress disorder, BPD and non-suicidal self-injury. 92 Recent research has also examined the effect of mindfulness-based cognitive therapy 96 to target internalizing traits.…”