The Brief Hierarchical Taxonomy of Psychopathology (B-HiTOP), developed by the HiTOP Consortium, is a 45-item self-report measure designed to provide broad screening assessment of dimensions that span the hierarchical structure of psychopathology in adults (HiTOP Consortium, 2025).
Developed within the empirical framework of the Hierarchical Taxonomy of Psychopathology, the B-HiTOP evaluates six primary spectra and two secondary scales:
Example B-HiTOP Item
The B-HiTOP offers clinicians a practical, evidence-based alternative to traditional diagnostic checklists like the DSM-5. As an alternative to discrete categories, this innovative screening tool uses a dimensional approach which views symptoms as part of a spectrum rather than an all-or-nothing diagnosis. The B-HiTOP is grounded in the Hierarchical Taxonomy of Psychopathology (HiTOP) model.
The Hierarchical Taxonomy of Psychopathology (HiTOP) framework (see picture above) is a hierarchy of dimensional constructs derived from decades of research on the patterns of covariation among symptoms, traits, and traditional mental disorders (Kotov et al., 2017). Dimensional approaches to quantifying mental illness operate outside the confines of traditional categorical diagnoses and are gaining traction as a way to advance research on the causes and consequences of mental illness (Conway et al., 2022). Unlike traditional categorical diagnostic systems such as the DSM-5-TR, which impose arbitrary diagnostic thresholds and exclude subclinical symptomatology, HiTOP provides continuous dimensional scores that capture the full range of psychopathological variation observed in both clinical and community populations (Kotov et al., 2017). The framework addresses fundamental limitations of categorical systems, as generations of psychologists have been taught that mental disorder can be carved into discrete categories, each qualitatively different from the others and from normality, but this model is now outdated (Conway et al., 2021). Research demonstrates that a hierarchical taxonomy of psychopathology can transform mental health research by providing phenotypes that cut across traditional diagnostic boundaries (Conway et al., 2019). Additionally, empirical reorganisation of DSM-5 symptoms into data-driven hierarchical frameworks demonstrates that symptom overlap between diagnoses and heterogeneity within diagnoses can be addressed through empirically derived homogeneous constructs (Forbes et al., 2024). Research demonstrates that HiTOP offers superior clinical utility compared to traditional diagnostic systems, with clinicians rating it as significantly more useful for describing psychopathology and assessing global functioning (Hetfeld et al., 2025). Consequently, the B-HiTOP serves as an efficient screening tool that enables clinicians to identify areas of clinical concern in the HiTOP dimensions that span traditional diagnostic boundaries and use the results to target more in-depth assessments relevant to the specific needs of the client.
The B-HiTOP employs dimensional scoring approaches where higher scores indicate greater symptom severity within each spectrum. This dimensional framework enables clinicians to capture a broad range of psychological difficulties rather than relying on arbitrary diagnostic cut-offs that may miss subclinical but clinically relevant symptoms. The measure’s transdiagnostic approach allows clinicians to identify symptom patterns that span traditional diagnostic boundaries, providing a more comprehensive understanding of patient presentations and comorbidity patterns. Unlike categorical systems that force clinicians into either-or diagnostic decisions, the B-HiTOP’s continuous scoring enables more nuanced clinical judgement and targeted intervention planning. For busy clinical settings, the B-HiTOP serves as an efficient broad screening tool that can quickly identify areas of concern across the full spectrum of psychopathology, allowing clinicians to direct their limited assessment time towards more detailed evaluation of the specific domains where clients show elevated symptoms.
The Brief Hierarchical Taxonomy of Psychopathology (B-HiTOP) scores consist of dimensional scores across six primary spectra and two secondary scales. Higher average scores represent higher levels of symptoms within each spectrum measured.
Scores are provided for the following spectra and scales of the B-HiTOP:
The B-HiTOP employs dimensional scoring approaches where average scores for each spectrum provide continuous measures of symptom severity. Average scores are calculated by dividing the total raw score by the number of items in each spectrum. The percentiles are based upon these dimensional average scores and are derived from community normative samples. Scores are presented as percentile ranks indicating the individual’s position relative to peers in the normative sample. A percentile of 50 indicates that the symptom level is at average and expected levels, whilst a percentile of 85 indicates relatively high symptom levels compared to peers (i.e., higher than 85 percent of peers).
The B-HiTOP uses percentile-based interpretation ranges. Dimensional scores are categorised into three interpretive ranges based on normative percentiles:
These percentile-based ranges enable clinicians to interpret B-HiTOP scores within a dimensional framework that recognises the continuous nature of psychopathological experiences. Unlike traditional categorical diagnostic cutoffs, these ranges provide graduated levels of clinical concern that can guide assessment and intervention decisions.
On the first administration of the B-HiTOP, two types of plots are typically shown. The first is a stacked bar chart displaying percentile scores for all spectra and secondary scales with background shading indicating elevated and clinically significant ranges. The second is a series of horizontal bar charts showing average scores for each spectrum compared to community percentile distributions, with guidelines marking the 25th, 50th, and 75th percentiles and coloured regions indicating normal range, elevated, and clinically significant ranges.
When B-HiTOP scores are available from multiple timepoints, changes in scores can provide valuable information about the effectiveness of interventions or changes in symptoms. Although B-HiTOP does not have an established framework for interpreting change over time, we can use the established recommendation of changes of at least 0.5 standard deviations in average scores being considered clinically meaningful (the minimally important difference) (Norman et al., 2003; Turner et al., 2010). These changes are categorised as ‘significant improvement’ (≥0.5 SD reduction in average score), ‘significant deterioration’ (≥0.5 SD increase in average score), ‘slight improvement or deterioration’ (<0.5 SD change in average score), or ‘none’ (no change in average score). If applicable, this interpretive text outlining change in scores is displayed first within the interpretive text section.
Normative data for the B-HiTOP has been established through a demographically-representative cross-validation study conducted via the Prolific research platform (HiTOP Consortium, 2025). The normative sample comprised 780 adults in the USA ranging in age from 18 to 80 years (M = 44.42, SD = 14.90), with a balanced gender distribution of 48.6% male and 50.5% female participants. The sample demonstrated good demographic diversity, with 70.5% identifying as White, 10.7% as Black, 5.8% as Asian, 4.4% as Hispanic, and 7.7% as multiple races. Educational attainment varied considerably, with 33.3% holding bachelor’s degrees, 13.7% having completed graduate degrees, and 22.4% reporting some college or university education.
Mental health service utilisation was substantial within the sample, with 20.3% currently receiving services, 15.9% having received services within the past two years, 26.9% having received services more than two years previously, and 36.5% reporting no history of mental health service use.
The following means and standard deviations provide reference points for clinical interpretation across the B-HiTOP spectra and secondary scales:
All scales demonstrated appropriate distributional properties for clinical use, with skewness values ranging from 0.55 to 2.51 and kurtosis values from -0.72 to 7.24. The Thought Disorder spectrum showed the greatest positive skew (2.51) and kurtosis (7.24), reflecting the expected low base rate of psychotic-spectrum symptoms in the general population. Conversely, the Detachment spectrum exhibited the most normal distribution characteristics (skew = 0.55, kurtosis = -0.72), consistent with its conceptualisation as a fundamental personality dimension.
The B-HiTOP demonstrated good internal consistency across both derivation and cross-validation samples (HiTOP Consortium, 2025). Cronbach’s alpha coefficients for the six primary spectra ranged from .82 to .90 in the cross-validation sample. Specifically, alpha values were: Internalising (.90), Somatoform (.88), Detachment (.86), Thought Disorder (.85), Disinhibition (.86), and Antagonism (.82). The secondary scales also demonstrated good reliability, with the Externalising scale achieving alphas of .83 and the p-Factor scale achieving .86.
Discriminant validity was supported by appropriate intercorrelations between spectra. In the cross-validation sample, correlations ranged from .13 (Detachment-Antagonism) to .73 (Internalising-Somatoform), with most correlations falling in the moderate range (.30-.60). The strongest association was observed between Internalising and Somatoform spectra (.73), consistent with theoretical expectations regarding shared distress components. The weakest correlation was between Detachment and Antagonism (.13), supporting their distinctiveness as separate spectra. These correlation patterns replicated well across samples, providing evidence for stable factor structure and discriminant validity.
Due to the over-representation of individuals with current mental health difficulties within the normative sample (20.3% currently accessing mental health services), traditional statistical cutoffs based on 1 standard deviation (approximately 85th percentile) and 1.5 standard deviations (approximately 93rd percentile) above the mean were adjusted downwards to provide more clinically meaningful interpretive thresholds. The adjusted percentile cutoffs were:
– Normal Range: Less than 75th percentile – Symptom levels within expected limits for the general population
– Elevated: ≥75th percentile but <85th percentile – Symptom levels somewhat above average but not yet in the clinically significant range
– Clinically Significant: ≥85th percentile – Symptom levels substantially above average, suggesting potential clinical concern
HiTOP refers to the Hierarchical Taxonomy of Psychopathology, a data-driven, dimensional framework for understanding mental illness that organises symptoms and traits into a hierarchical structure rather than discrete diagnostic categories like the DSM or ICD. By conceptualising psychopathology on a continuum and grouping symptoms into dimensions, HiTOP offers a potential way to improve the reliability, reduce co-occurrence issues, and enhance the clinical utility of traditional diagnostic systems for mental health care.
The Brief Hierarchical Taxonomy of Psychopathology (B-HiTOP) is a 45-item self-report measure that represents a fundamental shift from traditional categorical diagnostic approaches to dimensional assessment. Rather than determining whether someone “has” or “doesn’t have” a specific disorder, the B-HiTOP measures six primary spectra of psychopathology (Internalising, Somatoform, Detachment, Thought Disorder, Disinhibition, and Antagonism) as continuous dimensions. This approach recognises that psychological symptoms exist on a spectrum rather than as discrete categories, capturing the full range of psychopathological variation observed in quantitative research.
The B-HiTOP addresses several limitations of traditional diagnostic systems like the DSM-5. It eliminates the problem of arbitrary diagnostic thresholds that may miss subclinical but clinically relevant symptoms, captures the high comorbidity patterns seen in clinical practice, and provides a more nuanced understanding of symptom severity. For busy clinical settings, it serves as an efficient broad screening tool that can quickly identify areas of concern across the full spectrum of psychopathology, allowing clinicians to direct their limited assessment time towards more detailed evaluation of specific domains where clients show elevated symptoms. The dimensional scores enable more precise treatment planning and progress monitoring than simple present/absent diagnostic categories.
The p-Factor, or general psychopathology factor, is one of the B-HiTOP’s secondary scales that measures psychological difficulties spanning multiple domains of mental health. Think of it as analogous to the ‘g’ factor in intelligence testing – just as ‘g’ represents general cognitive ability underlying specific cognitive skills, the p-Factor represents a general vulnerability to psychopathology that cuts across traditional diagnostic boundaries. When elevated, it indicates that rather than having difficulties in one specific area, the client is experiencing widespread challenges affecting emotional, cognitive, behavioural, and interpersonal functioning.
One of the B-HiTOP’s key strengths is its ability to capture the complex comorbidity patterns commonly seen in clinical practice without the conceptual confusion created by multiple overlapping diagnoses. The six primary spectra naturally accommodate symptom patterns that span traditional diagnostic boundaries – for instance, a client presenting with both anxiety and depression would show elevations on the Internalising spectrum rather than requiring separate diagnostic labels. The measure’s structure reflects decades of research showing that mental health symptoms tend to cluster into these broader dimensions rather than discrete categories.
The B-HiTOP’s approach is particularly valuable for understanding clients whose presentations don’t fit neatly into existing diagnostic categories. For example, someone with chronic interpersonal difficulties might show elevations across Detachment (social withdrawal), Antagonism (interpersonal hostility), and Internalising (emotional distress) spectra, providing a more complete picture than trying to determine whether they meet criteria for a personality disorder. The secondary Externalising scale captures the common co-occurrence of disinhibited and antagonistic behaviours, while spectrum scores help identify which transdiagnostic processes might be maintaining symptoms. This comprehensive assessment enables clinicians to select interventions targeting underlying dimensional vulnerabilities rather than treating multiple “comorbid” conditions as separate entities.
The B-HiTOP serves as an ideal initial screening tool when clinicians need a broad overview of a client’s psychological functioning across multiple domains. It’s particularly valuable during intake assessments, when diagnostic clarity is lacking, or when clients present with complex, multifaceted symptoms that don’t fit traditional diagnostic categories. The measure’s efficiency – capturing six major dimensions of psychopathology in just 45 items – makes it practical for routine clinical use and repeated administration to monitor treatment progress. Its dimensional approach is especially useful for identifying subthreshold symptoms that may be clinically relevant but wouldn’t meet categorical diagnostic criteria.
However, the B-HiTOP is designed as a broad screening instrument rather than a comprehensive diagnostic tool. When elevated scores are identified in specific spectra, clinicians should follow up with more detailed, disorder-specific measures. The technical documentation provides recommended assessments for each spectrum – for instance, elevated Internalising scores might prompt administration of measures like the DASS-21 or GAD-7, while elevated Thought Disorder scores could indicate the need for assessments like the MID-60 or MDQ. Think of the B-HiTOP as a psychological “vital signs” measure that efficiently identifies areas needing closer examination, allowing clinicians to strategically deploy their assessment resources where they’re most needed rather than administering extensive batteries to every client.
HiTOP Consortium. (2025). Hierarchical Taxonomy of Psychopathology (HiTOP) B-HiTOP Overview. https://www.hitop-system.org/hitop-self-report-measures
Conway, C. C., Forbes, M. K., South, S. C., & HiTOP Consortium. (2022). A Hierarchical Taxonomy of Psychopathology (HiTOP) primer for mental health researchers. Clinical Psychological Science, 10(2), 236–258. https://doi.org/10.1177/21677026211017834
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