Classifying Psychopathology in Clinical Practice: Do Diagnosis and Taxonomy Matter to Clients?

Among mental health providers, there is growing dissatisfaction with the DSM, and preliminary research suggests clinicians prefer the dimensional HiTOP model over the DSM’s categorical approach. Whether this preference generalizes to clients, however, remains unknown. In the present study, 457 age-stratified adults with a history of psychiatric treatment completed both survey and experimental arms. The survey arm explored the prevalence and perceived value of psychodiagnostic assessment and diagnostic feedback in clinical care. In an experimental arm, participants were randomly assigned to receive DSM, HiTOP, or no diagnostic feedback after reading a vignette depicting either internalizing or psychotic symptoms. Survey data revealed high diagnostic comorbidity and considerable heterogeneity in diagnostic histories. Participants reported strong attachment to prior diagnoses and identified explicit diagnostic feedback as the most helpful among commonly used assessment strategies including self-report and semi-structured or structured interviewing. Diagnostic feedback—regardless of classification system—was consistently rated as more useful than receiving no feedback across most outcome measures. Although HiTOP did not significantly outperform the DSM, it was received comparably. Clients may be less concerned with specific diagnostic language and more focused on whether the feedback feels validating and informative. These findings suggest HiTOP was not perceived as confusing or alienating, indicating that the model can be integrated into clinical care without diminishing perceived utility. These findings support the viability of HiTOP as a clinically acceptable alternative to the DSM and provide evidence for its broader implementation in practice.