From symptoms to spectra: testing the hierarchical taxonomy of psychopathology structure and its relation to functional outcomes

Background Mental disorders are highly prevalent and frequently comorbid, contributing to substantial functional impairment and reduced quality of life. The Hierarchical Taxonomy of Psychopathology provides a dimensional, empirically derived framework that organizes psychopathology hierarchically, addressing limitations of traditional categorical nosologies.Aims Examine (1) the latent structure of HiTOP using dimensional measures aligned with the model, and (2) associations between hierarchical dimensions and functional outcomes, including global functioning and personality functioning.Methods 1085 participants from community (n = 742) and clinical (n = 343) samples completed measures assessing internalizing, externalizing, detachment, and thought disorder domains, as well as functional impairment (WHODAS 2.0) and personality functioning (LPFS-BF 2.0).Results Confirmatory factor analyses supported unidimensionality of individual HiTOP factors, and a hierarchical model indicated robust higher-order spectra and a general p-factor. Associations with external outcomes increased across hierarchical levels, with internalizing spectra and the p-factor showing the strongest correlations with functional and personality impairment. Self-functioning was more closely linked to internalizing and detachment dimensions, whereas interpersonal functioning related primarily to externalizing processes.Conclusions These findings provide empirical support for HiTOP’s hierarchical structure and highlight its clinical utility for predicting real-world functional outcomes, underscoring the importance of transdiagnostic, dimensional approaches in assessment and intervention.