Introduction to the hierarchical taxonomy of psychopathology
L'Encéphale. 2022-02-01; 48(1): 92-101
DOI: 10.1016/J.ENCEP.2021.05.008
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1. Encephale. 2022 Feb;48(1):92-101. doi: 10.1016/j.encep.2021.05.008. Epub 2021
Sep 17.
[Introduction to the hierarchical taxonomy of psychopathology].
[Article in French]
Gauld C(1), Giroux É(2), Micoulaud-Franchi JA(3).
Author information:
(1)Service de Psychiatrie, Université Grenoble-Alpes, avenue du Maquis du
Grésivaudan, 38000 Grenoble, France; UMR CNRS 8590 IHPST, Sorbonne University,
Paris 1, 75231 Paris, France. Electronic address: .
(2)Institut de Recherches philosophiques de Lyon (EA 4187), Université Jean
Moulin Lyon 3, 69008 Lyon, France.
(3)Service universitaire de médecine du sommeil, CHU de Bordeaux, place
Amélie-Raba-Léon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, université de
Bordeaux, CHU Pellegrin, 33076 Bordeaux cédex, France.
INTRODUCTION: In clinical practice, the usefulness of diagnosis based on the
Diagnostic or Statistical Manual of Mental Disorders (DSM) or the International
Classification of Diseases, 11th edition, appears essential from a clinical,
research, epidemiological, administrative, economic and political level.
However, such diagnostic systems have shortcomings in terms of validity, little
consideration of comorbidities and strong intra-class heterogeneity. On a
structural level, the operationalization of its criteria is based on a
reliability which has been defined a posteriori and which does not lead to
improving the validity of the diagnosis but rather to the reification of the
diagnostic categories.
METHODS: First published in its current form in 2017, the Hierarchical Taxonomy
of Psychopathology (HiTOP) constitutes a nosological alternative based on
statistics. It conceptualizes psychopathology as a set of hierarchical
dimensions, i.e. in “transdiagnostic” continua. The HiTOP is structured
according to super-spectra, spectra, sub-factors, syndromes, components and
symptoms. This comes from the current dimensional psychology and quantitative
nosology. This article describes the basic principles of the HiTOP project and
its potential to integrate into clinical and psychiatric research based on its
advantages and limitations.
RESULTS: Unlike the DSM, which is descriptive and categorical, the HiTOP is
first a dimensional classification. This dimensionality describes psychiatric
phenomena on continua, each dimension providing a diagnostic continuum to
situate a clinical patient. This dimensionality avoids the reification of
categories and it limits the dichotomy between normal and pathological. In
addition, HiTOP shows a hierarchical structure: vertical refinement of
dimensions allows to circumvent the problem of comorbidities, proposes a new
conception of etiopathogenic mechanisms, and improves management of care.
DISCUSSION: Thus, we provide an illustration of the applications of a
dimensional and hierarchical classification in current clinical practice and
scientific research, compared to traditional nosology. The challenges of the
HiTOP arise in terms of validity, i.e. in the relation of dimensions with
physiopathological mechanisms, in clinical terms, i.e. in the potential
contribution of dimensions in relation to categories. Moreover, methodological
challenges will be important given the inherent limitations of the HiTOP.
CONCLUSION: The HiTOP allows to examine the conceptualization of psychiatric
disorders, the search for explanatory mechanisms, and treatment from another
perspective for psychiatry.
Copyright © 2021 L’Encéphale, Paris. Published by Elsevier Masson SAS. All
rights reserved.
DOI: 10.1016/j.encep.2021.05.008
PMID: 34544589 [Indexed for MEDLINE]