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

Roman Kotov, Katherine G. Jonas, William T. Carpenter, Michael N. Dretsch, Nicholas R. Eaton, Miriam K. Forbes, Kelsie T. Forbush, Kelsey Hobbs, Ulrich Reininghaus, Tim Slade, Susan C. South, Matthew Sunderland, Monika A. Waszczuk, Thomas A. Widiger, Aidan G. C. Wright, David H. Zald, Robert F. Krueger, David Watson, HiTOP Utility Workgroup

    Research output: Contribution to journalArticlepeer-review

    37 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)151-172
    Number of pages22
    JournalWorld Psychiatry
    Volume19
    Issue number2
    DOIs
    Publication statusPublished - Jun 2020

    Keywords

    • HiTOP
    • psychosis
    • thought disorder
    • detachment
    • schizophrenia
    • psychotic disorders
    • personality disorders
    • psychoticism
    • introversion
    • clinical utility

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