Cited by 596Mental Health Research TopicsPersonality Disorders and PsychopathologyMental Health and Psychiatry

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The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

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Kotov, Roman, Krueger, Robert F., Watson, David, Cicero, David C., Conway, Christopher C., DeYoung, Colin G., Eaton, Nicholas R., Forbes, Miriam K., Hallquist, Michael N., Latzman, Robert D., Mullins-Sweatt, Stephanie N., Ruggero, Camilo J., Simms, Leonard J., Waldman, Irwin D., Waszczuk, Monika A., Wright, Aidan G.C.·2021·Annual Review of Clinical Psychology

DOI 10.1146/annurev-clinpsy-081219-093304

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Abstract

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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Effects of acute stress on executive functions in depression, generalised anxiety and borderline personality disorder
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“While the DSM framework remains the prevailing system for clinical diagnosis and research (e.g., Haeffel et al., 2022), alternative conceptual approaches have emerged that challenge its underlying assumptions (e.g., DeYoung et al., 2022; Kotov et al., 2021; Smederevac et al., 2025).”
The etiological relationship between the general factors of psychopathology and personality; a longitudinal twin study from adolescence into young adulthood
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Neurofunctional representations of instrumental learning in psychosis: a meta-analysis of neuroimaging studies
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“…thus, identifying the aberrant brain mechanisms of instrumental learning is also highly important for further understanding potential biobehavioral systems underlying psychopathology and ultimately informing future classifications (Kotov et al., 2021; Michelini et al., 2021; Ruggero et al., 2019).”
The Emerging Role of the DDAH Proteins in Psychiatric Disorders
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“Such pleiot-ropy underscores the need for a multimodal approach that incorporates genetics, neuroimaging, cognition, circadian rhythms, comorbidities, and physical health, supported by frameworks such as the Hierarchical Taxonomy of Psycho-pathology and Research Domain Criteria (19,20).”
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“…the methodological foundation on which the clinical protocol for parent training in autism is built: a defined theoretical framework that finds its operational translation in a phased protocol, capable of guiding clinical work and systematizing the application of the identified principles [13].”
Depression, anxiety, and internalizing symptoms in Spanish children and adolescents: estimated rates and comorbidity patterns
Orgilés, M., Amorós-Reche, V., Morales, A., Marzo, J. C., Piqueras, J. A., & Espada, J. P. (2025) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-025-02916-1 · Cited by 2
“Although GAD and social anxiety involve distinct processes related to distress and fear [4 ], they share mechanisms such as worry, intolerance of uncertainty and problem orientation [61 ].”
Exploring the Dodo-Bird Effect in Psychotherapy: A Transmodal, Transdiagnostic, and Factor-Analytic Meta-Analysis of Effects and Rates-of-Change
Boxell, O., Esperance, T., Sullivan, A., Kannan, R., Realbuto, E., de la Fuente, E. R. M., Bohman, R., Wang, A., Huang, Y., & Weiss, A. (2025) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-025-09712-7 · Cited by 2
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“Modern research is moving toward a data-driven understanding of psychopathology (Kotov et al. 2021; Cuthbert 2022; Conway et al. 2023).”
Heightened Affective Reactivity Is Associated With More-Severe Symptoms of Emotional Disorders
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“…(Rosen & Lilienfeld, 2008), echoing prior critiques of categorical nosology (Lilienfeld, 2014) and the growing support for dimensional models of psychopathology such as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2021) and Research Domain Criteria (RDoC; Insel et al., 2010).”
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“These overlaps align with the notion of a general factor of psychopathology ( p -factor), which reflects shared variance across mental disorders and has been proposed as a transdiagnostic dimension of psychopathology severity [23,24].”
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“…signifcantly higher levels of NA, which may represent a dimension involved in the high co-occurrence rates revealed between these syndromes and internalizing psychopathological disorders (e.g., depression, anxiety, and PTSD), which are characterized by core emotional dysfunctions [21, 22].”
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“In addition, the Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically based dimensional and hierarchical framework of psycho-pathology (Kotov et al., 2021) that organizes lower-order symptom components and maladaptive traits into higher-order subfactors, spectra, and superspectra.”
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Self-citation
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Self-citation
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“In response, dimensional and trans-diagnostic models such as the Research Domain Criteria (RDoC; (7)) and the Hierarchical Taxonomy of Psychopa-thology (HiTOP [8, 9]) have been proposed.”
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“Regarding HiTOP, it still needs to extend its classification system to include Major ND [12].”
Obsessive-compulsive tendencies shift the balance between competitive neurocognitive functions
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Robust single‐trial event‐related potentials differentiate between distress and fear disorders
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“…perspectives are compatible with the clinical science approach including categorical diagnostic (e.g., American Psychiatric Association, 2013; Haeffel et al., 2022), dimensional (e.g., Kotov et al., 2017; Kotov et al., 2021), and network analytic (e.g., Borsboom, 2017; McNally, 2021) ones.”
Method
Fundamentals of the septo-hippocampal system
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0009 · Cited by 1
Memory and the septo-hippocampal system
McNaughton, N., & Gray, J. A. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780198843313.003.0008 · Cited by 1
The association between posttraumatic stress disorder symptom severity and distress tolerance in traumatic stress treatment
Byllesby, B. M., & Palmieri, P. A. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23092 · Cited by 1
Forensic Assessment of Psychological Injury Claims
Rosenberg, S. E., Pignolo, C., Viglione, D. J., Giromini, L., Arbisi, P. A., & Wright, A. J. (2025) · Springer eBooks · doi:10.1007/978-3-031-69734-0_17 · Cited by 1
Self-citation
Validation of a transdiagnostic measure of fears of recurrence and progression about mental health conditions
Coutts‐Bain, D., Sharpe, L., & Hunt, C. J. (2025) · British Journal of Clinical Psychology · doi:10.1111/bjc.12536
“The second comparison was selected given the existing literature has largely focused on FORP in the context of psychosis, in contrast to the relative lack of research on FORP in non-psychotic conditions, and in light of the overlapping nature of psychosis and mania (Kotov et al., 2021).”
A Contemporary Integrative Interpersonal Theory Formulation of Self and Social Pathology
Wright, A. G. C., & Nielsen, S. R. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009445955.007 · Cited by 1
Self-citation
Dispositional threat sensitivity as a liability for fear-related pathologies: Evidence from a child-aged twin sample
Sawyers, C. K., Moore, A. A., Patrick, C. J., Yancey, J. R., Brotman, M. A., Leibenluft, E., Pine, D. S., Roberson‐Nay, R., Kramer, M. D., & Hettema, J. M. (2025) · Development and Psychopathology · doi:10.1017/s0954579425000380 · Cited by 1
“…distress ” dimension reflecting symptoms oflow mood and pervasivenegativeaffectandcognitions, associated with disorders including major depression, persistent depressive (dysthymic) disorder, generalized anxiety disorder (GAD), and post-traumatic stress disorder (Kotov et al., 2017, 2021).”

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: Kotov, Roman
Krueger, Robert F.
Watson, David
Cicero, David C.
Conway, Christopher C.
DeYoung, Colin G.
Eaton, Nicholas R.
Forbes, Miriam K.
Hallquist, Michael N.
Latzman, Robert D.
Ruggero, Camilo J.
Simms, Leonard J.
Waldman, Irwin D.
Waszczuk, Monika A.
Wright, Aidan G.C.
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
DOI: 10.1146/annurev-clinpsy-081219-093304
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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The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence

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