HiTOP (hierarchical taxonomy of psychopathology): a possible alternative to DSM

Today, most professionals in clinical and health psychology and psychiatry use a number of clinical entities and diagnostic criteria 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 diseases and disorders classified, chapter F focusing on mental disorders), the former being the most widely used.

However, many authors consider that the taxonomies proposed by these textbooks are too rigid and that it is especially difficult to find a case of pure mental disorder and completely separated from the other complications. With the aim of replacing the DSM, different reviewers with the existing classifications so far have generated different alternatives, being one of the best known. the 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 of psychopathologies proposed by a number of well-known authors (including Kotov, Krueger, Watson, Achenbach, Clark, Caspian, Slade, Zimmerman, Rescorla or Goldberg). This taxonomic classification starts from the existence of difficulties in the current classifications to propose a different model, based on the covariation of symptoms and grouping together similar symptoms to reduce heterogeneity.

    Hitop does not view psychopathology as an entity in itself but as a spectrum in which simultaneous syndromes can be observed in which different psychological problems share similar characteristics. The possible comorbidity between different alterations is taken into account, And in fact they can cease to be considered separately, observing the different issues in a series of dimensions in the form of a continuum.

    These dimensions can be subdivided according to need in order to detect whether one of its components is more prevalent than others or is more closely related to a specific type of symptoms, having a hierarchical but broad structure and allowing flexible working at the staff using the.

    This model is considered promising and can provide a great level of information not only in terms of diagnosis, but also in terms of risk factors, possible causes, course and response to treatment, Also covering most of the psychopathologies previously classified. It is also a model that does not start or act with a simple hypothesis, but acts from a rigorous analysis of empirical evidence. However, it is still being created and refined.

      Its spectra or dimensions

      The Hitop establishes a series of dimensions or spectra to categorize the different symptoms and alterations specific to people with psychopathology. It should also be borne in mind that we are on a continuum in which not only people with psychopathology are placed, but also collect certain elements that can also be found to some extent in the non-clinical population.

      More specifically, a total of six spectra or dimensions are established in this classification. It should be remembered that these dimensions are not diagnostic categories, but refer to continuums in which a psychopathological person finds himself, all of which are useful in all situations. The examples given in each are simply (i.e., if introspection is given as an example, depression does not imply that depression is an introspection disorder but is one of the cases where a higher level may occur).

      1. Introspection / internalization

      Introspection is understood as focusing on one’s own thoughts and qualities and appreciating the present and the futureUsually experiencing negative emotions, in the case of mental disorders. This is something typical of disorders such as depression and anxiety disorders.

      3. Uninhibition / unrestricted subcontracting

      This dimension refers to the propensity for impulsivity or unreasoning action. Some of the old disorders that would get the most results in this element would be drug addiction.

      4. Antagonism / antagonistic externalization

      This dimension refers to the presence of hostility and aggression towards others, and may lead to aggression or self-harm. It is not necessary, however, that there be actual violence, which may be mere opposition or discontent.

        5. Isolation

        This concept refers to the absence or difficulty of establishing or maintaining social relationships, as well as the interest in doing so. An example in which this dimension is given to a high degree could be found in autism.

        6. Mental disorder or psychoticism

        This dimension refers to the level at which they are presented perceptual alterations or content of thought.

        7. Somatization

        Dimension based on the existence of unexplained physiological symptoms as a medical condition or as a result of physical illness. It also incorporates the need for constant medical attention, as in hypochondria.

        An alternative to DSM

        As we said, the creation of the Hitop appears as an alternative that seeks to replace the DSM and current classifications of mental disorders, Considering the existence of multiple deficiencies or problems in the generation of diagnostic entities or in their practical application

        First, one of the reasons is the aforementioned lack of flexibility of diagnostic labels (although this attempts to be supplemented by the inclusion of specifiers), and the existence of some degree of comorbidity between two or more disorders. is common (eg, joint the existence of anxiety and depression is common) and results in more complicated cases of discovery of pure disorders. It is also common to find a strong heterogeneity between the symptomatic manifestations of the same diagnostic entity, Be able to find atypical characteristics.

        Another criticism is made at the level of the criteria: for the diagnosis of most mental disorders, the presence of a certain number of symptoms is required. Although this can be understood in the case of the most identifying disorder (e.g. in depression there must be at least depressed mood and / or anhedonia or in schizophrenia the presence of hallucinations, delusions or disorganized speech ), in the case of other more secondary symptoms a certain amount is still necessary in the absence technically, the disorder could not be identified.

        Another aspect to underline is that its implementation is carried out by a committee which decides which classifications to integrate and which to modify or eliminate, sometimes with criteria questionable by many professionals of the industry. Pathologies are incorporated that many consider unnecessary and questionable and clump or eliminate labels that might have significant differences with each other (for example, removing schizophrenia subtypes or clumping into a single category of disorder. of the autism spectrum). Sometimes different authors have also hypothesized that these committees may have political and economic interests behind them which would modify the creation of these diagnostic labels.

        bibliographical references

        • Kotov, R .; Krueger, RF; Watson, D .; Achenbach, TM; Althoff, RR; Bagby, RM; Brown, TA; Fuster, WT; Caspi, A .; Clark, LA; Eaton, NR; Forbes, MK; Forbush, KT; Goldberg, D .; Hasin, D .; Hyman, SE; Ivanova, MY; Lynam, DR; Markon, K .; Miller, JD; Moffitt, TE; Morey, LC; Mullins-Sweatt, SN; Ormel, J .; Patrick, CJ; Regier, DA; Rescorla, L .; Ruggero, CJ; Samuel, DB; Sellbom, M .; Simms, LJ; Skodol, AE; Slade, T .; South, SC; Tackett, JL; Waldman, ID; Waszczuk, MA; Wright, AGC and Zimmerman, M. (2017). The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126 (4): 454-477.

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