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 Diagnostic and Statistical Manual of Mental Disorders 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 holdout (n = 3,000) samples to identify a robust hierarchy of empirically derived constructs, 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 reorganization in the structure. The inclusion of broad disinhibition/hypomania and pathological introversion dimensions represented the most prominent differences compared with 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 remapped the disorders included in the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-5th Edition onto the new framework model. Overall, the results suggest that the structural foundations of the HiTOP model are largely sound. (PsycInfo Database Record (c) 2026 APA, all rights reserved).