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The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence
Open accessAbstract
Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.
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“Interestingly, this is in line with the proposed Hierarchical Taxonomy of Psychopathology (HiTOP) system, where symptoms of mania are thought to associate with obsessive-compulsive symptoms like checking, ordering, and cleaning (Kotov et al., 2017, 2021).”
From Using network analysis to examine connections between Acceptance and Commitment Therapy (ACT) processes, internalizing symptoms, and well-being in a sample of undergraduates (2023) · cites this paper as Kotov et al., 2021
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“In the HiTOP model, functioning is assessed as a separate domain [71], and hence is included here as an auxiliary spectrum.”
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“Exclusively taxonomic approaches, referring for example to “ RDoc ” or “ HiTOP ” (Clark et al., 2017; Kotov et al., 2021) were also excluded.”
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InfluentialSelf-citationDiversity and the Hierarchical Taxonomy of Psychopathology (HiTOP)
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“Clinical presentation was coded at four levels of specificity based on the HiTOP model (Kotov et al., 2017, 2021; Ringwald et al., 2021).”
The Normative Modeling Framework for Computational PsychiatryPreprint
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“[64,65]) of RDoC and HiTOP with addition of a tentative comparison of HiTOP with the Big 5.”
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The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM
Haeffel, G. J., Jeronimus, B. F., Fisher, A. J., Kaiser, B. N., Weaver, L. J., Vargas, I., Goodson, J. T., Soyster, P. D., & Lu, W. (2022) · Clinical Psychological Science · doi:10.1177/21677026211068873 · Cited by 32
“Empirical evidence must supersede popularity, endorsements, membership numbers, academic prowess, publication rates, and citation counts (cf. Kotov et al., 2021).”
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“Therefore, contemporary models of psychopathology postulate dimensional spectra (eg, internalizing, thought disorder, and externalizing) comprising multiple mental health syndromes with co-occurring genetic, neurobiological, environmental, and behavioral indicators [20].”
BackgroundMethodInfluentialBauer, B. W., Norel, R., Leow, A., Rached, Z. A., Wen, B., & Cecchi, G. (2024) · JMIR Mental Health · doi:10.2196/57234 · Cited by 42
“…support the superspectra put forth by the Hierarchical Taxonomy of Psychopathology (HiTOP)—a recent statistically driven diagnostic classification system for mental disorders [26]—compared to traditional clusters found in the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition [23].”
MethodCraske, M. G., Herzallah, M. M., Nusslock, R., & Patel, V. (2023) · Nature Mental Health · doi:10.1038/s44220-022-00012-w · Cited by 31
“Dimensional hierarchical models, such as the HiTop model 4,5 or the depression and anxiety Tri-level model 65,66 , have been gaining support as alternatives to categorical diagnoses.”
Sperry, S. H., Sharpe, B. M., & Wright, A. G. C. (2021) · Journal of Abnormal Psychology · doi:10.1037/abn0000720 · Cited by 28
Self-citationWendt, L. P., Jankowsky, K., Schroeders, U., Nolte, T., Fonagy, P., Montague, P. R., Zimmermann, J., & Olaru, G. (2022) · Personality and Mental Health · doi:10.1002/pmh.1566 · Cited by 37
“…that many risk (e.g., adverse childhood experiences and low cognitive functioning) and outcome variables (e.g., self-harm and incarceration) are similarly related to psycho-pathology (e.g., Kotov et al., 2020; Krueger et al., 2021; Smith et al., 2020; Watson, Levin-Aspenson, et al., 2022).”
BackgroundMethodInfluentialConway, C., Kotov, R., Krueger, R. F., & Caspi, A. (2022) · American Psychologist · doi:10.1037/amp0001046 · Cited by 36
“Previous research found consistent psychopathology structures across age, gender, race/ethnicity, and sexual orientation (Eaton, 2014; Eaton et al., 2012; He & Li, 2021; McElroy et al., 2018) as well as 24 Western and 25 non-Western societies (Ivanova et al., 2007, 2015, 2019; Krueger et al., 2003).”
BackgroundSelf-citationA Network Control Theory of Dynamic Systems Approach to Personalize Therapy
Hofmann, S. G. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.10.006 · Cited by 28
Lages, Y., & McNaughton, N. (2022) · Personality Neuroscience · doi:10.1017/pen.2022.4 · Cited by 28
“HiTOP/The Hierarchical Taxonomy of Psychopathology initiative “constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, [and] combines cooccurring syndromes into spectra, therebymapping out comorbidity” (Kotov et al., 2017, 2021).”
BackgroundUnifying Principles of Generalization: Past, Present, and Future
Wu, C. M., Meder, B., & Schulz, E. (2024) · Annual Review of Psychology · doi:10.1146/annurev-psych-021524-110810 · Cited by 37
“…rooted in targeted observations about features that were shared or differed between species (Doolittle & Bapteste 2007), and dimensional accounts of psychopathology similarly aim to capture shared symptom patterns across mental illnesses based on a targeted subset of features (Kotov et al. 2021).”
Passive Smartphone Sensors for Detecting Psychopathology
Ringwald, W. R., King, G. A., Vize, C. E., & Wright, A. G. C. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.19047 · Cited by 30
Self-citationStrategies and foundations for scientific discovery in longitudinal studies of bipolar disorder
McInnis, M. G., Andreassen, O. A., Andreazza, A. C., Alon, U., Berk, M., Brister, T. S., Burdick, K. E., Cui, D., Frye, M. A., Leboyer, M., et al. (2022) · Bipolar Disorders · doi:10.1111/bdi.13198 · Cited by 27
Sharp, C. (2022) · New England Journal of Medicine · doi:10.1056/nejmra2120164 · Cited by 33
Nature and Assessment of Personality Pathology and Diagnosis
Sharp, C., & Oldham, J. M. (2022) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20220016 · Cited by 34
Balling, C. E., South, S. C., Lynam, D. R., & Samuel, D. B. (2023) · Clinical Psychological Science · doi:10.1177/21677026221138818 · Cited by 32
Hankin, B. L., & Griffith, J. M. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00437-4 · Cited by 38
“The Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium (e.g., Kotov et al., 2021), for example, provides a promising framework that illustrates how the field can employ stages 1 and 2 of the construct validation process to better understand and organize sur-face-level signs and symptoms of…”
DeYoung, C. G., Kotov, R., Krueger, R. F., Cicero, D. C., Conway, C., Eaton, N. R., Forbes, M. K., Hallquist, M. N., Jonas, K. G., Latzman, R. D., et al. (2021) · Clinical Psychological Science · doi:10.1177/21677026211049390 · Cited by 30
“Moreover, extensive evidence indicates that such constructs capture information about common genetics, risk factors, biomarkers, and treatment response shared by co-occurring forms of psychopathology (Kotov et al., 2020; Krueger et al., 2021; Watson et al., in press).”
BackgroundMethodInfluentialSelf-citationKnott, R., Johnson, B. P., Tiego, J., Mellahn, O. J., Finlay, A., Kallady, K., Kouspos, M., Sindhu, V. P. M., Hawi, Z., Arnatkevičiūtė, A., et al. (2021) · Molecular Autism · doi:10.1186/s13229-021-00457-3 · Cited by 28
Integrating and distinguishing personality and psychopathology
Wright, A. G. C., & Hopwood, C. J. (2021) · Journal of Personality · doi:10.1111/jopy.12671 · Cited by 33
Self-citationTransdiagnostic Approaches to Sexual- and Gender-Minority Mental Health
Eaton, N. R., Rodriguez-Seijas, C. A., & Pachankis, J. E. (2021) · Current Directions in Psychological Science · doi:10.1177/09637214211043918 · Cited by 27
“Transdiagnostic factor models—such as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2021)—represent underlying core dimensions of psychopathology that permeate traditional categorical diagnostic constructs.”
BackgroundSelf-citationHaywood, D., Baughman, F. D., Mullan, B. A., & Heslop, K. (2022) · Brain Sciences · doi:10.3390/brainsci12040421 · Cited by 29
“Rather than classifying collections of symptoms into categories known as diagnoses, dimensional approaches typically assess symptoms and organise them into dimensional structures of psychopathology using factor analytic approaches [19,20].”
BackgroundTanaka, M. (2024) · Advances in Clinical and Experimental Medicine · doi:10.17219/acem/197425 · Cited by 27
The Use of Ontologies to Accelerate the Behavioral Sciences: Promises and Challenges
Sharp, C., Kaplan, R. M., & Strauman, T. J. (2023) · Current Directions in Psychological Science · doi:10.1177/09637214231183917 · Cited by 27
“…as the National Institute of Mental Health Research Domain Criteria (Insel et al., 2010) and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2021), address some problems of the DSM system (e.g., common co-occurrence of psychiatric disorders and heterogeneity within disorders)…”
BackgroundHoy, N., Lynch, S. J., Waszczuk, M. A., Reppermund, S., & Mewton, L. R. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105431 · Cited by 31
“Importantly, a superordinate general dimension of psycho-pathology (often referred to as the p-factor) is positioned at the top of this hierarchical structure (Kotov et al., 2021).”
BackgroundMethodSelf-citationNew approaches to deep phenotyping in addictions.
Watts, A. L., Latzman, R. D., Boness, C. L., Kotov, R., Keyser‐Marcus, L., DeYoung, C. G., Krueger, R. F., Zald, D. H., Moeller, F. G., & Ramey, T. (2022) · Psychology of Addictive Behaviors · doi:10.1037/adb0000878 · Cited by 31
Self-citationLavigne, K. M., Deng, J., Raucher‐Chéné, D., Hotte‐Meunier, A., Voyer, C., Sarraf, L., Lepage, M., & Sauvé, G. (2023) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2023.110894 · Cited by 32
McNaughton, N. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.877633 · Cited by 24
“But the categories are based on symptoms (and often a required duration), not neurobiological causes, which are likely dimensional and reflected in traits (Kotov et al., 2021; Michelini et al., 2021; DeYoung et al., 2022).”
BackgroundHaywood, D., Henry, M., Dauer, E., Lederman, O., Farley, M. J., Henneghan, A. M., O’Connor, M., Jefford, M., Rossell, S. L., & Hart, N. H. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08696-9 · Cited by 24
“Decades of data-driven research support the more accurate viewpoint of understanding mental health as existing dimensionally along spectrums rather than as distinct categories [11, 12].”
BackgroundMethodHaywood, D., Baughman, F. D., Mullan, B. A., & Heslop, K. (2021) · Psychiatry International · doi:10.3390/psychiatryint2030018 · Cited by 23
“Furthermore, it has been suggested that these dimensional models may be used to inform treatment by basing and prioritising treatment decisions on the symptom dimensions at the various levels of the models’ hierarchy (see [27]).”
BackgroundPsychosocial work factors affecting mental health of young workers: a systematic review
van Veen, M., Hengel, K. M. O., Schelvis, R. M. C., Bongers, P. M., Ket, J. C. F., van der Beek, A. J., & Boot, C. R. L. (2022) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-022-01907-y · Cited by 24
Alcohol use disorder criteria exhibit different comorbidity patterns
Watts, A. L., Watson, D., Heath, A. C., & Sher, K. J. (2023) · Addiction · doi:10.1111/add.16121 · Cited by 26
Self-citationYan, R., Ringwald, W. R., Vega, J., Kehl, M., Bae, S. W., Dey, A. K., Low, C. A., Wright, A. G. C., & Doryab, A. (2021) · PsyArXiv (OSF Preprints) · doi:10.1016/j.future.2022.02.010 · Cited by 23
Self-citationEditorial: an emerging field with bright prospects
Corr, P. J., & Mobbs, D. (2023) · Personality Neuroscience · doi:10.1017/pen.2022.6 · Cited by 23
“This is facilitated by the integration of the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2021) system, which is an attempt from various mental health disciplines to improve the organisation, description, and measurement of psychopathology.”
MethodPickersgill, M. D. (2023) · Sociology of Health & Illness · doi:10.1111/1467-9566.13682 · Cited by 27
Zhong, Q., Niu, L., Chen, K., Lee, T. M. C., & Zhang, R. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.031 · Cited by 33
Personality traits associate with behavioral problems in pet dogs
Salonen, M. K., Mikkola, S., Hakanen, E., Sulkama, S., Puurunen, J., & Lohi, H. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-01841-0 · Cited by 28
“S1a–f) [21, 25], but we also defined a structure based on previous canine behavior studies (Supplementary Fig.”
BackgroundBi, X.-A., Li, L., Wang, Z., Wang, Y., Luo, X., & Xu, L. (2022) · Briefings in Bioinformatics · doi:10.1093/bib/bbac093 · Cited by 22
Recommendations for Adjudicating Among Alternative Structural Models of Psychopathology
Waldman, I. D., King, C. D., Poore, H. E., Luningham, J. M., Zinbarg, R. E., Krueger, R. F., Markon, K. E., Bornovalova, M. A., Chmielewski, M. S., Conway, C., et al. (2023) · Clinical Psychological Science · doi:10.1177/21677026221144256 · Cited by 27
“…HiTOP model is intended to reduce the heterogeneity within and comorbidity among diagnostic categories, and its components are intended to be construed as testable hypotheses that are subject to falsification and revision (DeYoung et al., 2022; Kotov et al., 2021; Krueger et al., 2018).”
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Metadata
- Authors
- Kotov, R., Krueger, R. F., Watson, D., Cicero, D. C., Conway, C. C., DeYoung, C. G., Eaton, N. R., Forbes, M. K., Hallquist, M. N., Latzman, R. D., Mullins-Sweatt, S. N., Ruggero, C. J., Simms, L. J., Waldman, I. D., Waszczuk, M. A., & Wright, A. G. C.
- Affiliations
- Stony Brook University (US)
- University of Minnesota (US)
- University of Notre Dame (US)
- University of North Texas (US)
- Fordham University (US)
- Macquarie University (AU)
- University of North Carolina at Chapel Hill (US)
- Georgia State University (US)
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma 74078, USA
- University at Buffalo, State University of New York (US)
- Emory University (US)
- Rosalind Franklin University of Medicine and Science (US)
- University of Pittsburgh (US)
- Corresponding author
- Kotov, Roman
- ORCID
- Venue
- Annual Review of Clinical Psychology
- Publisher
- Annual Reviews
- Published
- 2021-05-07
- Volume
- 17
- Issue
- 1
- Pages
- 83-108
- ISSN
- 1548-5943 (ISSN-L)
- 1548-5951
- OpenAlex
- W3127024923
- Cited by
- 596
- References
- 138
- Citations by year
- 2026: 101 · 2025: 108 · 2024: 146 · 2023: 110 · 2022: 87 · 2021: 42
- FWCI
- 15.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Annual Review of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R56MH122537)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- Hierarchical Taxonomy of Psychopathology, disease classification, dimensional models of psychopathology, diagnostic heterogeneity, comorbidities, diagnostic reliability, etiology of mental disorders, risk factors, treatment response, clinical implementation
- MeSH terms
- Mental Disorders, Humans, Mental Health, Psychopathology, Comorbidity, Practice Guidelines as Topic, Consensus
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