Rebuilding HiTOP from the ground up: Symptom-level analyses and a revised mapping to the DSM

The evidence for the structure of the Hierarchical Taxonomy of Psychopathology (HiTOP) model relies heavily on analyses of correlations among DSM diagnoses, which entrenches some of their limitations. In this study, we deconstructed the mental disorders covered in HiTOP into individual symptoms—with personality disorders represented via item-level assessment of the Alternative Model for Personality Disorders facets—and rebuilt the HiTOP model from the ground up. Participants self-selected into an online mental health study and were randomly split into primary (n = 11,762) and hold-out (n = 3,000) samples to identify a robust hierarchy of empirically derived constructs in the results, ranging from symptoms and syndromes to very broad ‘superspectra’ of psychopathology. In each sample, both hierarchical clustering and hierarchical principal components analyses were used; the final hierarchical structure was derived based on points of cross-sample and cross-method agreement. The resulting model was remarkably similar to the HiTOP model, including nearly all of the same subfactors, spectra, and superspectra—albeit with some reorganisation in the structure. The inclusion of broad hypomania/disinhibition and pathological introversion dimensions represented the most prominent differences compared to the current higher-order structure of HiTOP. The detailed lower-order constructs found here also mirrored many of the existing components and traits in HiTOP, as well as indicating some potential areas for revision. Finally, we re-mapped the disorders included in the Structured Clinical Interview for the DSM-5 onto the new model. Overall, the results suggest that the structural foundations of the HiTOP model are largely sound.