Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

David Watson; Holly F Levin-Aspenson; Monika A Waszczuk; Christopher C Conway; Tim Dalgleish; Michael N Dretsch; Nicholas R Eaton; Miriam K Forbes; Kelsie T Forbush; Kelsey A Hobbs; Giorgia Michelini; Brady D Nelson; Martin Sellbom; Tim Slade; Susan C South; Matthew Sunderland; Irwin Waldman; Michael Witthöft; Aidan G C Wright; Roman Kotov; Robert F Krueger; HiTOP Utility Workgroup

doi:10.1002/wps.20943

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

World Psychiatry. 2022 Feb;21(1):26-54. doi: 10.1002/wps.20943.

Authors

David Watson¹, Holly F Levin-Aspenson², Monika A Waszczuk³, Christopher C Conway⁴, Tim Dalgleish^{5

6}, Michael N Dretsch⁷, Nicholas R Eaton⁸, Miriam K Forbes⁹, Kelsie T Forbush¹⁰, Kelsey A Hobbs¹¹, Giorgia Michelini¹², Brady D Nelson⁸, Martin Sellbom¹³, Tim Slade¹⁴, Susan C South¹⁵, Matthew Sunderland¹⁴, Irwin Waldman¹⁶, Michael Witthöft¹⁷, Aidan G C Wright¹⁸, Roman Kotov³, Robert F Krueger¹¹; HiTOP Utility Workgroup

Collaborators

HiTOP Utility Workgroup:
Kamran Afzali, Marina A Bornovalova, William T Carpenter, Natacha Carragher, David C Cicero, Danielle M Dick, Anna R Docherty, Michael B First, Eiko I Fried, Michael N Hallquist, Katherine Jonas, Katherine M Keyes, Robert D Latzman, Kristian E Markon, Les C Morey, Stephanie N Mullins-Sweatt, Kristin Naragon-Gainey, Thomas M Olino, Praveetha Patalay, Christopher J Patrick, Aaron L Pincus, Ulrich Reininghaus, Craig Rodriguez-Seijas, Lauren A Rutter, Giovanni A Salum, Alexander J Shackman, Andrew E Skodol, Tim Slade, Kathryn Tabb, Jennifer L Tackett, Ashley L Watts, Amanda A Uliaszek, Thomas A Widiger, David H Zald, Johannes Zimmermann, Richard E Zinbarg

Affiliations

¹ Department of Psychology, University of Notre Dame, South Bend, IN, USA.
² Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
³ Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
⁴ Department of Psychology, Fordham University, Bronx, NY, USA.
⁵ Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.
⁶ Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
⁷ US Army Medical Research Directorate - West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA.
⁸ Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
⁹ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia.
¹⁰ Department of Psychology, University of Kansas, Lawrence, KS, USA.
¹¹ Department of Psychology, University of Minnesota, Minneapolis, MN, USA.
¹² Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
¹³ Department of Psychology, University of Otago, Dunedin, New Zealand.
¹⁴ Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, NSW, Australia.
¹⁵ Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA.
¹⁶ Department of Psychology, Emory University, Atlanta, GA, USA.
¹⁷ Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany.
¹⁸ Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.

Abstract

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

Keywords: HiTOP; anxiety disorders; clinical utility; depression; eating disorders; emotional dysfunction; internalizing; negative affect; neuroticism; sexual dysfunction; somatoform.

Grants and funding

R01 MH107444/MH/NIMH NIH HHS/United States