How the HiTOP model, proposed by Miri Forbes, changed the way I understand psychopathology

By Roxana Nicolau / 21/10/2025 / Uncategorized /

Why the HiTOP model deserves every clinician’s attention

I admit: although in Romania we officially work with the ICD , I was, for the most part, raised professionally with the DSM on my desk . Ever since college, I felt that the information I was receiving about mental disorders was somehow outdated – static, fragmented, too far from the human reality in the office. My affinity for professionals from the American and Australian space, whom I followed for their theoretical benchmarks, naturally brought me closer to their way of thinking about psychopathology: more conceptual, more integrative and more courageous in questioning old models. However, over time, I began to feel that the DSM, while useful, also limited our understanding of the human experience. Many clients did not fit neatly into a diagnosis, and comorbidities had become the rule rather than the exception. When I discovered the work of Miri Forbes and the HiTOP (Hierarchical Taxonomy of Psychopathology) model , I felt that the pieces were falling into place.

What made me look differently?

HiTOP sees disorders not as separate entities, but as dimensions that coexist and influence each other . It is not about “having” or “not having” a disorder, but about where you are on a spectrum of emotions, cognitions, and behaviors.

Source wikipedia

In the office, I began to notice how anxiety, avoidance, perfectionism, or poor emotional regulation are interconnected, forming a common structure – and HiTOP explains exactly this interconnection.

What’s new with the HiTOP model?

Dimensional approach: assesses intensities, not just the presence or absence of symptoms.
Hierarchical structure: links specific symptoms to broader domains such as internalizing or externalizing .
Focus on comorbidity: explains why multiple disorders coexist – through common mechanisms, not by “coincidence”.
Empirical foundation: it is based on massive statistical analyses, not theoretical consensus.

About Miri Forbes and why it mattered to me

Miri Forbes , a senior lecturer at Macquarie University (Australia) , is one of the researchers who transformed HiTOP from a theoretical idea into a solid scientific tool. Her research, based on tens of thousands of clinical cases, has shown that real symptoms do not respect the boundaries of the DSM, but rather cluster into hierarchical, interrelated dimensions .

I was impressed by the balance between rigor and clarity in her work—a science that never breaks away from people. Today, Forbes is a member of the international HiTOP team and an associate editor of the Journal of Psychopathology and Clinical Science . Beyond the headlines, she brings something clinicians are always looking for: meaning and coherence to the complexity of mental suffering .

What I gained as a psychologist

Since I look at cases through the HiTOP lens:

case formulations are clearer and more integrative ;
assessments are finer – they see nuances, not labels;
interventions are more personalized .

I often tell clients, “it’s not a disease that defines you, but a tendency that we can understand and adjust together.”
This perspective changes not only the language, but also the therapeutic relationship.

Conclusion

When I discovered the HiTOP model through the work of Miri Forbes, I felt I had found a more accurate map of psychopathology. HiTOP does not simplify, but adds depth—providing an empirical, human, and dynamic perspective on suffering.
For me, as a clinical psychologist, it was a reorientation from “disorders” to a continuum of understanding of the human .

Recommended bibliography

Forbes, M. K., Wright, A. G. C., Markon, K. E., & Krueger, R. F. (2017). Evidence that psychopathology symptom networks have limited replicability. Journal of Abnormal Psychology, 126(7), 969–988.
Forbes, M. K., et al. (2025). A Hierarchical Model of the Symptom-Level Structure of Psychopathology. Clinical Psychological Science.
Kotov, R., Krueger, R. F., Watson, D., et al. (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477.