HiTOP: a possible alternative to DSM

Currently, most professionals in clinical and health psychology and psychiatry use a number of clinical entities and criteria for diagnosis from one of the two main diagnostic manuals that bring them together. It is the Diagnostic and Statistical Manual of Mental Disorders or DSM of the American Psychological Association or the Chapter F of the International Classification of Diseases or ICD of the World Health Organization (which includes the set of of the classified diseases and disorders, with chapter F being the one focused on mental disorders), the most widely used being first.

However, many authors consider that the taxonomies offered by these manuals are excessively rigid and that in For the most part, it is difficult to find a case of a pure mental disorder and completely separated from other complications. In order to replace the DSM, different authors who are critical of the existing classifications up to now have generated different alternatives, one of the best known being the Hierarchical Taxonomy of Psychopathology or HiTOP.

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The HiTOP: what it is, and its main characteristics

The Hierarchical Taxonomy of Psychopathology or HiTOP is an alternative type of taxonomic classification to traditional classifications for psychopathologies proposed by a series of well-known authors (among them 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 together to reduce the heterogeneity.

HiTOP considers psychopathology not as an entity in itself but as a spectrum on which they can co-occurring syndromes in which the different psychological problems share characteristics Similar. The possible comorbidity between different alterations is taken into account, and in fact they can stop being considered separately, when observing the different problems 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 its components is more prevalent than others or it is linked more to a specific type of symptoms, having a hierarchical but broad structure and allowing flexible work for the staff who work with it. employ.

This model is considered promising and can provide a great level of information not only in regards to diagnosis, but also to risk factors, possible causes, courses and response to treatment, also covering most of the previously classified psychopathologies. In addition, it is a model that does not start or act through mere supposition, but rather acts from a rigorous analysis of the empirical evidence. However, it is still in the process of creation and refinement.

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Their spectra or dimensions

The HiTOP establishes a series of dimensions or spectrums to categorize the different symptoms and alterations typical of people suffering from psychopathology. Likewise, it must be taken into account that we are in a continuum in which not only are people with psychopathology but also include some elements that can also be found to some degree in the population not clinic.

Specifically, in this classification a total of six spectrums or dimensions are established. It is necessary to bear in mind that these dimensions are not diagnostic categories, but refer to continuums in which a person with psychopathology is situated, all of them being evaluable in all the situations. The examples that are given in each one are merely (that is, if in introspection depression is given as an example, it is not This implies that depression is a disorder of introspection, but rather that it is one of the cases in which it can occur at a higher level).

1. Introspection/ Internalization

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 to impulsiveness 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 can lead to aggression or self-harm. It is not necessary, however, that there is real violence, and it may be a mere opposition or displeasure.

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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 can be found in the autism.

6. Mental disorder or Psychoticism

This dimension refers to the level at which disturbances in perception or content of thought.

7. somatization

Dimension that is based on the existence of physiological symptoms not explained as a medical disorder or as a consequence of a physical illness. The need for constant medical attention is also incorporated, as occurs in the 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.

In the first place, one of the reasons is the aforementioned inflexibility of the diagnostic labels (although this tries to be replaced with the inclusion of specifiers), the existence of some degree of comorbidity between two or more disorders being frequent (for example, the joint existence of anxiety and depression is frequent) and it is more difficult to find cases of disorders pure. 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 criteria level: 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 those most identifying the disorder (for example, in depression there must be at least a depressed mood and/or anhedonia or in the schizophrenia the presence of hallucinations, delusions or disorganized speech), in the case of other symptoms of a more secondary, a certain amount is still required in the absence of which, technically, the amount could not be identified. disorder.

Another aspect to highlight is that its realization is carried out by a committee that decides which classifications incorporate and which ones to modify or eliminate, sometimes with questionable criteria for many professionals of the sector. Pathologies that many consider unhelpful and dubious are incorporated and tags that could have relevant differences are agglutinated or eliminated with each other (for example, the elimination of the subtypes of schizophrenia or the agglutination in a single category of spectrum disorders autistic). 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.

Bibliographic references

• Kotov, R.; Krueger, R.F.; Watson, D.; Achenbach, T.M.; Althoff, R.R.; Bagby, R.M.; Brown, T.A.; Carpenter, W.T.; Caspi, A.; Clark, L.A.; Eaton, N.R.; Forbes, M.K.; Forbush, K.T.; Goldberg, D.; Hasin, D.; Hyman, S.E.; Ivanova, M.Y.; Lynam, D.R.; Markon, K.; Miller, J.D.; Moffitt, T.E.; Morey, L.C.; Mullins-Sweatt, S.N.; Ormel, J.; Patrick, C.J.; Regier, D.A.; Rescorla, L.; Ruggero, C.J.; Samuel, D.B.; Sellbom, M.; Simms, L.J.; Skodol, A.E.; Slade, T.; South, S.C.; Tackett, J.L.; Waldman, I.D.; Waszczuk, M.A.; Wright, A.G.C. & Zimmerman, M. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126 (4): 454-477.