HiTOP (Hierarchical Taxonomy Of Psychopathology): A Possible Alternative To The DSM
Currently, most professionals in clinical and health psychology and psychiatry use a series of clinical entities and criteria for diagnosis coming from one of the two main diagnostic manuals that bring them together. This is the Diagnostic and Statistical Manual of Mental Disorders or DSM of the American Psychological Association or chapter F of the International Classification of Diseases or ICD of the World Health Organization (which includes all the diseases and disorders classified , chapter F being the one focused on mental disorders), the first being the most used.
However, many authors consider that the taxonomies offered by these manuals are excessively rigid and that for the most part it is difficult to find a case of a pure mental disorder completely separated from other complications. With the aim of replacing the DSM, different authors critical of the hitherto existing classifications have generated different alternatives, one of the best known being the Hierarchical Taxonomy of Psychopathology (Hierarchical Taxonomy of Psychopathology) or HiTOP
The HiTOP: what it is, and its main characteristics
The Hierarchical Taxonomy of Psychopathology or HiTOP is a type of taxonomic classification alternative to traditional classifications for psychopathologies proposed by a series of well-known authors (including Kotov, Krueger, Watson, Achenbach, Clark, Caspi, Slade, Zimmerman, Rescorla or Goldberg). This taxonomic classification is based on the existence of difficulties in current classifications to propose a different model, based on the covariation of symptoms and grouping similar symptoms to reduce heterogeneity.
The HiTOP considers psychopathology not as an entity in itself but as a spectrum in which concurrent syndromes can be observed in which different psychological problems share similar characteristics. Possible comorbidity between different disorders is taken into account and in fact they can no longer be considered separately, when the different problems are observed in a series of dimensions in the form of a continuum.
These dimensions can be subdivided depending on the need in order to detect if any of their components is more prevalent than others or is more linked to a specific type of symptoms, having a hierarchical but broad structure and allowing flexible work for the patient. personnel who employ it.
This model is considered promising and can provide a great level of information not only with regard to diagnosis, but also risk factors, possible causes, courses and response to treatment , also covering most of the previously classified psychopathologies. Furthermore, it is a model that does not start or act through mere supposition, but acts from a rigorous analysis of empirical evidence. However, it is still in the process of creation and refinement.
Its spectrums or dimensions
The HiTOP establishes a series of dimensions or spectrums to categorize the different symptoms and alterations typical of people who suffer from psychopathology. Likewise, it must be taken into account that we are in a continuum in which not only people with psychopathology are located but also include some elements that can also be found to some degree in the non-clinical population.
Specifically, in this classification a total of six spectrums or dimensions are established. It is necessary to keep in mind that these dimensions are not diagnostic categories, but rather refer to continuums in which a person with psychopathology is placed, all of which can be assessed in all situations. The examples given in each one are merely (that is, if depression is given as an example in introspection, it does not imply that depression is a disorder of introspection but rather that it is one of the cases in which the highest level can occur).
Introspection is understood as focusing on one’s own thoughts and qualities and valuing both the present and the future , generally experiencing negative emotions, in the case of mental disorders. It is typical of disorders such as depression and anxiety disorders.
3. Disinhibition/disinhibited externalization
This dimension refers to the propensity for impulsivity or unreasoned action. Some of the old disorders that would score the most in this element would be those of substance abuse.
4. Antagonism/antagonistic externalization
This dimension refers to the presence of hostility and aggressiveness towards others, which may lead to aggression or self-harm It is not necessary, however, that there is real violence, and it may be mere opposition or displeasure.
5. Isolation
This concept refers to the absence or difficulty in establishing or maintaining social relationships, as well as the interest in doing so. An example in which this dimension occurs to a high degree could be found in autism.
6. Mental disorder or Psychoticism
This dimension refers to the level at which perceptual alterations or thought content
7. Somatization
Dimension that is based on the existence of physiological symptoms not explainable as a medical disorder or as a consequence of a physical illness. The need for constant medical attention is also incorporated, as occurs in hypochondria.
An alternative to the DSM
As we have said, the creation of the HiTOP emerges as an alternative that seeks to replace the DSM and the current classifications of mental disorders considering the existence of multiple deficiencies or problems when generating diagnostic entities or in their practical application.
Firstly, one of the reasons is the aforementioned lack of flexibility in diagnostic labels (although this attempts to be replaced with the inclusion of specifiers), with the existence of some degree of comorbidity between two or more disorders being common (for example , the joint existence of anxiety and depression is common) and it is more difficult to find cases of pure disorders. It is also common to find a high level of heterogeneity between the symptomatological manifestations of the same diagnostic entity being able to find atypical characteristics.
Another criticism occurs at the level of criteria: for the diagnosis of many of the majority of mental disorders, the presence of a certain number of symptoms is required. Although this could be understood in the case of the most identifiable of the disorder (for example in depression there must be at least a depressed mood and/or anhedonia or in schizophrenia the presence of hallucinations, delusions or disorganized speech), in the case For other symptoms of a more secondary nature, a certain amount is still required, in the absence of which the disorder could not technically be identified.
Another aspect to highlight is that its implementation is carried out by a committee that decides which classifications to incorporate and which to modify or eliminate, sometimes with questionable criteria for many professionals in the sector. Pathologies that many consider unhelpful and dubious are incorporated and labels that could have relevant differences between them are grouped or eliminated (for example, the elimination of the subtypes of schizophrenia or the grouping of autism spectrum disorders into a single category). On occasions different authors have also speculated that These committees may have political and economic interests behind them that would alter the creation of said diagnostic labels.
