Hierarchical structuring of psychopathological dimensions in youth: current progress and future steps with the Hierarchical Taxonomy of Psychopathology (HiTOP)

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Over the past two decades, it has become clear that psychopathology exists on continuous spectra organized hierarchically from broad, general symptom dimensions to more specific ones. This structure is best represented by the Hierarchical Taxonomy of Psychopathology (HiTOP) framework that incorporates individual signs, symptoms, and behaviors at its most specific level while encompassing higher-order dimensions at its broadest level. This commentary gives an overview of studies that evaluated higher-order dimensions of psychopathology and their alignment with the HiTOP framework. Studies consistently support the alignment of youth psychopathology with the HiTOP framework, particularly its general dimension of psychopathology and the broad internalizing and externalizing spectrum. The model also identifies distinct, lower-level dimensions such as fear, affectivity, antagonism, and attention problems. This hierarchical structure is evident across the entire age span but with specific makeup of dimensions appearing to differ between children and adolescents. Rapidly gaining momentum, current evidence indicates HiTOP’s effectiveness in conceptualizing youth mental health. Future studies should focus on exploring the HiTOP structure across different ages and populations, testing its real-world generalizability, selecting the most appropriate assessment tools, and understanding how the framework applies to youth from diverse societies and cultures.