Clinical Utility and Applicability of the Hierarchical Taxonomy of Psychopathology (HiTOP) vs. ICD-11: A Comparative Analysis

Categorical classification systems (DSM, ICD) are criticized for arbitrary diagnostic criteria and thresholds, leading to artificially dichotomous disorder categories and low interrater reliability. The Hierarchical Taxonomy of Psychopathology (HiTOP) offers an empirical, dimensional, and hierarchical alternative. Expanding on Balling et al., 2023, this study compares ICD-11 and HiTOP through clinicians’ (N = 212) evaluations of case vignettes, examining clinical utility, diagnostic procedures, and case assessment. No clear preference emerged for overall clinical utility (p = .203) or the majority of indicators (ps = .348 - .705). HiTOP was rated significantly more useful for describing psychopathology (d = 0.33; p = .02) and global functioning (d = 0.63; p <.001), ICD-11 for professional communication (d = 0.51; p <.001). Interrater reliability was fair/moderate for ICD-11 (κ=.34, .49; p <.001) and moderate for HiTOP (ICC=.516, .55; p <.001). Clinical assessments showed no differences. Despite ICD-11’s familiarity, results support HiTOP’s clinical potential.