ReviewLinking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience
Introduction
Accurately classifying mental disorders and elucidating their etiologies remain among the greatest challenges of modern clinical psychology and psychiatry. Ongoing efforts seek to refine psychiatric nosology, but rates of misdiagnosis remain high (Regier et al., 2013) and available categorical classification systems, including the Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 2013) and the International Classification of Diseases (ICD; WHO, 1992), carry limited clinical utility for prognosis and treatment (Conway et al., 2019). With regard to etiology, we lack a complete understanding of the causes of any mental disorder, despite considerable efforts in elucidating their genetic (Waszczuk et al., 2020) and neural (Thompson et al., 2020) bases.
These two issues (i.e., diagnostic classification and etiology) are strongly interdependent. On the one hand, developing a refined taxonomy of clinical problems requires a better understanding of the antecedents and processes that lead to different forms psychopathology in order to develop better treatments. On the other hand, progress in understanding the etiology of mental illnesses is hindered by common misdiagnosis and limited validity of diagnoses based on traditional nosologies. Integrating advances in empirical research on diagnostic classification and etiology has the potential to accelerate progress in these fields (Latzman et al., 2020; Waszczuk et al., 2020).
This article proposes an interface to advance these two fronts by leveraging two major initiatives that are using dimensional approaches to promote a radical change in the way mental illness is studied and classified: the Research Domain Criteria (RDoC) framework by the National Institute of Mental Health (NIMH; Cuthbert and Insel, 2013; Kozak and Cuthbert, 2016) and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017; Kotov et al., 2021; Krueger et al., 2018). We start with an overview of the challenges of psychiatric nosologies and the solutions offered by RDoC and HiTOP, highlighting the complementary nature of these frameworks and providing rationale for an interface that bridges between them. We then present a comprehensive map of the interface linking between RDoC constructs and HiTOP spectra based on narrative review of the empirical literature. We conclude with examples of integrative research linking biobehavioral systems with dimensions of psychopathology, and with recommendations for implementing this approach in future studies with the goal to promote progress in elucidating the causes of psychopathology and improving future classifications.
Section snippets
Dimensional classifications of psychopathology
Extensive evidence points to major limitation of categorical classifications that make them a poor guide for research and clinical practice, as explained in detail elsewhere (Cuthbert and Insel, 2013; Kotov et al., 2017). First, categorical diagnoses do not adequately reflect the extensive evidence that forms of psychopathology and their underlying processes are continuous in nature (Cuthbert and Insel, 2013; Markon and Krueger, 2005). The imposition of artificial categories can lead to low
A new interface linking RDoC and HiTOP
The complementary nature and strengths of RDoC and HiTOP can be leveraged to advance understanding of psychopathology and inform clinical practice (Latzman et al., 2020). Since RDoC currently lacks direct clinical applicability, HiTOP may aid RDoC-informed research by providing psychometrically robust clinical targets. Additionally, since HiTOP does not consider the etiology of psychopathology, RDoC provides a solid transdiagnostic framework for elucidating the underpinnings of the clinical
Literature review
Our review identified numerous HiTOP correlates of each RDoC construct/subconstruct.
RDoC-HiTOP interface summary and general discussion
In the previous section, we have delineated an interface between RDoC and HiTOP frameworks by identifying connections between their dimensions based on available literature. Our review indicates a large number of associations of between RDoC constructs/subconstructs and HiTOP spectra/subfactors, which are of varying strength and documented by a varying number of studies. More associations are expected to emerge in future research informed by this interface. Fig. 2 illustrates the most robust
Practical recommendations and future directions
In this article we have provided a detailed map (section 4, Supplementary Figs. 1–5) as well as an overarching summary (section 5, Fig. 2) of an interface between RDoC and HiTOP. We have delineated associations between transdiagnostic biobehavioral systems included in RDoC and various clinical phenomena organized in the HiTOP model, but also highlighted more tentative associations where additional research is needed. The identified connections between RDoC and HiTOP dimensions can guide design
Conclusions
The dimensional approach to clinical research endorsed by both RDoC and HiTOP is the most promising way forward. It requires larger samples and different sampling designs than those with which many clinical researchers are familiar, but the payoff will be more effective scientific research, illuminating the etiology and clinical manifestations of psychopathology. The RDoC-HiTOP interface delineated in this article provides a synergistic approach that brings these dimensional frameworks
Role of funding sources
Dr. Michelini was funded by a NARSAD Young Investigator Award from the Brain & Behavior Research Foundation (grant number 28566). Dr. Kotov was funded by the National Institute of Mental Health (grant number R01MH122537).
Contributors
Michelini, Kotov, Latzman and DeYoung conceived this work. Michelini, Palumbo, Latzman and Kotov reviewed the literature. Michelini wrote a first draft of most sections and prepared the figures. All authors contributed to the manuscript and approved the final version.
Declaration of Competing Interest
All authors report no conflict of interest.
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These two authors contributed equally.