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The Hierarchical Taxonomy of Psychopathology (HiTOP): A Quantitative Nosology Based on Consensus of Evidence
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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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Díaz-Moreno, E., & Heredia‐Jimenez, J. (2025) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acaf105
Seo, G. E., & Choi, H. (2025) · International Journal of Cognitive Behavioral Therapy · doi:10.1007/s41811-025-00274-z
“BPD shows a broad spectrum of symptoms that can be understood through both internalizing and externalizing symptom dimensions (Bohus et al., 2021; Kotov et al., 2017, 2021 ) and effective therapeutic interventions are needed to alleviate its symptoms.”
Sühlmann-Faul, F. (2025) · Zeitschrift für Psychodrama und Soziometrie · doi:10.1007/s11620-025-00890-z · Cited by 1
Mandić, D. (2025) · Psiholoska istrazivanja · doi:10.5937/psistra0-59009
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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