The State of the Art of The HiTOP Model


The State of the Art of The HiTOP Model is the title of a new review on the Hiearchical Taxonomy of Psychopathology (HiTOP). The paper is part of a special issue published by Behavior Therapy on new trends and approaches in psychotherapy. I am happy to have been part of the team led by David Cicero.

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a dimensional framework for psychopathology advanced by a consortium of nosologists. In the HiTOP system, psychopathology is grouped hierarchically from super-spectra, spectra, and subfactors at the upper levels to homogeneous symptom components and maladaptive traits and their constituent symptoms, and maladaptive behaviors at the lower levels.

HiTOP has the potential to improve clinical outcomes by planning treatment based on symptom severity rather than heterogeneous diagnoses, targeting treatment across different levels of the hierarchy, and assessing distress and impairment separately from the observed symptom profile.

Assessments can be performed according to this framework with the recently developed HiTOP-Self-Report (HiTOP-SR). Examples of how to use HiTOP in clinical practice are provided for the internalizing spectrum, including the use of the Unified Protocol and other modularized treatments, measurement-based care, psychopharmacology, and in traditionally underserved populations.

Future directions are discussed in this State of the Science review including HiTOP’s use in further developing transdiagnostic treatments, extending the model to include other information such as environmental factors, establishing the treatment utility of clinical assessment for the HiTOP-SR, developing new treatments, and disseminating the model.

The State of the Art of The HiTOP Model presents the potential of this new approach in promoting a dimensionally oriented conceptualization. At the same time, it highlights the need for further research about how to apply it in clinical practice. In previous works both David Cicero and I discussed the HiTOP potential in the field – for example – in the conceptualization and treatment of schizotypy.

Cicero, D. C., Ruggero, C., Balling, C., Bottera, A. R., Cheli, S., Elkrief, L., … Thomeczek, M. L. (2024, February 1). State of the Science: The Hierarchical Taxonomy of Psychopathology (HiTOP). Behavior Therapy, Online publication.

Preprint on OSF: