Bottom-Up and Top-Down Paradigms for Psychopathology: A Half-Century Odyssey

Annu Rev Clin Psychol. 2020 May 7:16:1-24. doi: 10.1146/annurev-clinpsy-071119-115831.

Abstract

Bottom-up paradigms prioritize empirical data from which to derive conceptualizations of psychopathology. These paradigms use multivariate statistics to identify syndromes of problems that tend to co-occur plus higher-order groupings such as those designated as internalizing and externalizing. Bottom-up assessment instruments obtain self-ratings and collateral ratings of behavioral, emotional, social, and thought problems and strengths for ages 1½-90+. Ratings of population samples provide norms for syndrome and higher-order scales for each gender, at different ages, rated by different informants, in relation to multicultural norms. The normed assessment instruments operationalize the empirically derived syndromes and higher-order groupings for applications to clinical services, research, and training. Because cross-informant agreement is modest and no single informant provides comprehensive assessment data, software compares ratings by different informants. Top-down paradigms prioritize conceptual representations of the nature and structure of psychopathology, as exemplified by psychodynamic, DSM/ICD, and HiTOP paradigms. Although these paradigms originated with observations, they tend to prioritize conceptual representations over empirical data.

Keywords: autobiography; dimensional hierarchies; externalizing; internalizing; multicultural; psychopathology; syndromes.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Adult
  • Behavioral Symptoms* / classification
  • Behavioral Symptoms* / diagnosis
  • Behavioral Symptoms* / ethnology
  • Child
  • Cross-Cultural Comparison
  • History, 19th Century
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Mental Disorders* / classification
  • Mental Disorders* / diagnosis
  • Mental Disorders* / ethnology
  • Models, Psychological*
  • Neuropsychological Tests* / statistics & numerical data
  • Psychometrics* / statistics & numerical data
  • Psychopathology* / history
  • Psychopathology* / methods