Advancing Dimensional Models of Psychopathology in Cancer: Insights From Applying the Hierarchical Taxonomy of Psychopathology (HiTOP)

OBJECTIVE: Cancer survivors, defined as those living with or beyond a cancer diagnosis, experience more than double the prevalence of psychopathology when compared to the general population. Categorical diagnostic systems, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), remain dominant in psycho-oncology despite concerns about reliability, validity, and clinical utility for this population. Dimensional frameworks, such as the Hierarchical Taxonomy of Psychopathology (HiTOP), offer a more precise alternative; however, they have not yet been widely applied in cancer survivors. Accordingly, the objective of this research was to examine the applicability of HiTOP to cancer survivors. METHODS: Data from 1389 participants in 28 countries (n = 728 cancer survivors; n = 661 community/psychiatric) were collected using the 405-item HiTOP-SR, alongside demographic, clinical, and cancer-specific measures. The HiTOP-SR normative sample (n = 780) was also used. Analyses included parametric, non-parametric, and factor analytic approaches. RESULTS: All HiTOP-SR scales demonstrated strong homogeneity and reliability in cancer survivors. Cancer survivors showed significant elevations across Internalising and Somatoform spectra, with current cancer associated with additional elevations in domains of Thought Disorder and components of Disinhibited and Antagonistic psychopathology. An 11-factor model was developed and supported for both cancer and community/psychiatric samples, though the magnitudes of the factor loadings sometimes varied between samples. External validity was strong with theoretically aligned associations. CONCLUSION: The HiTOP-SR appears reliable within cancer survivors and provides utility in quantifying a broad array of psychopathology experienced. The results highlight the potential applicability and utility of HiTOP to improve cancer research and clinical practice in psycho-oncology.