Describing disorder: The importance and advancement of compositional explanations in psychopathology

Classification Schemes ◽

Research And Practice ◽

Assessment And Treatment ◽

Historical Accounts ◽

Understanding the makeup of mental disorders has great value for both research and practice in psychopathology. The richer and more detailed our compositional explanations of mental disorder—that is, comprehensive accounts of client signs and symptoms—the more information we have to inform etiological explanations, classification schemes, clinical assessment, and treatment. However, at present, no explicit compositional explanations of psychopathology have been developed and the existing descriptive accounts that could conceivably fill this role—DSM/ICD syndromes, transdiagnostic and dimensional approaches, symptom network models, historical accounts, case narratives, and the Research Domain Criteria (RDoC)—fall short in critical ways. In this article, we discuss what compositional explanations are, their role in scientific inquiry, and their importance for psychopathology research and practice. We then explain why current descriptive accounts of mental disorder fall short of providing such an explanation and demonstrate how effective compositional explanations could be constructed.

Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC)

Psychological Science in the Public Interest ◽

10.1177/1529100617727266 ◽

2017 ◽

Vol 18 (2) ◽

pp. 72-145 ◽

Cited By ~ 157

Author(s):

Lee Anna Clark ◽

Bruce Cuthbert ◽

Roberto Lewis-Fernández ◽

William E. Narrow ◽

Geoffrey M. Reed

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

International Classification Of Diseases ◽

The United States ◽

Classification Systems ◽

Prescribe Medication ◽

Classification Of Diseases ◽

Key Issues ◽

The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manuals—the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders—provide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health’s Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems’ approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.

Research domain criteria and the study of trauma in children: Implications for assessment and treatment research

Clinical Psychology Review ◽

10.1016/j.cpr.2016.11.002 ◽

2018 ◽

Vol 64 ◽

pp. 77-86 ◽

Cited By ~ 5

Author(s):

Carla Smith Stover ◽

Brooks Keeshin

Keyword(s):

Assessment And Treatment ◽

Treatment Research ◽

The Nimh Research Domain Criteria Project

10.1093/med/9780190681425.003.0071 ◽

2017 ◽

Author(s):

Bruce N. Cuthbert

Keyword(s):

Mental Illness ◽

Signs And Symptoms ◽

Disease Classification ◽

Abnormal Behavior ◽

Negative Valence ◽

Regulatory Systems ◽

Positive Valence ◽

Fear And Anxiety ◽

The Research Domain Criteria (RDoC) project grew from recognized deficiencies in currently used diagnostic schemes for mental illness, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the latter is based on a series of signs and symptoms of illnesses that can co-occur in groups of individuals, without consideration of underlying biological factors, RDoC is based on the increasing ability to relate normal as well as abnormal behavior to particular molecules and circuits in the brain across animal species and humans. Behavioral domains include negative valence systems (e.g., fear and anxiety), positive valence systems (e.g., reward and motivation), cognitive systems, social processes, and arousal and regulatory systems, several of which might be affected in a given DSM disease classification. RDoC is seen as a step toward a “precision psychiatry,” where increasing knowledge of the genetic, molecular, cellular, and circuit basis of mental illness will yield biologically based diagnoses that offer important pathophysiological, treatment, and prognostic implications.

The Present and Future of Psychiatric Diagnosis

10.1093/med/9780190681425.003.0070 ◽

2017 ◽

Author(s):

Steven E. Hyman

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

Signs And Symptoms ◽

International Classification Of Diseases ◽

Diagnostic Classification ◽

Statistical Manual ◽

Classification Schemes ◽

Diagnostic And Statistical Manual ◽

Classification Of Diseases

Psychiatric disorders are currently diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders and the closely related International Classification of Diseases. Both diagnostic classification schemes are descriptive and based on a collection of signs and symptoms associated with a given disorder. The fundamental weakness of the schemes is that they are not based on the underlying genetic or neurobiological etiology or pathophysiology of a disorder which of course remain unknown for all common psychiatric syndromes. As more is learned about the biological basis of a mental disorder it will be possibly increasingly to build more accurate diagnostic schemes with greater prognostic and treatment validity.

Phenomena complexes as targets of explanation in psychopathology: The relational analysis of phenomena approach

Theory & Psychology ◽

10.1177/0959354320906462 ◽

2020 ◽

Vol 30 (2) ◽

pp. 164-185 ◽

Cited By ~ 3

Author(s):

Kristopher Nielsen ◽

Tony Ward

Keyword(s):

Mental Disorders ◽

Network Models ◽

The Self ◽

Small Systems ◽

Research Teams ◽

Explanatory Framework ◽

Complementary Method ◽

Relational Analysis ◽

In this article, we briefly overview some current approaches to identifying targets of explanation in psychopathology. We suggest that DSM syndromes and symptom network models are too large to facilitate explanatory progress, while approaches couched in the Research Domain Criteria (RDoC) are too tightly focused, thereby overlooking the self-maintaining structures and processes that constitute mental disorders. We then present the Relational Analysis of Phenomena (RAP) as a complementary method. The RAP is a metamethodological explanatory framework that prescribes the repeated targeting of “phenomena complexes” (PCs). PCs are small systems of clinical phenomena and their relations. We describe a process by which PCs are targeted, richly described, and then explained. The RAP’s explanatory focus is on the relationships between clinical phenomena, which should help to reveal the constitutional structure of mental disorders. This framework is designed to be useful for theoreticians, research teams planning multidisciplinary investigatory projects, and clinicians reflecting on their explanatory methods.

Evolution and Mental Disorders

Evolutionary Psychopathology ◽

10.1093/med-psych/9780190246846.003.0005 ◽

2018 ◽

pp. 129-152

Author(s):

Marco Del Giudice

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

Psychiatric Comorbidity ◽

Broad Sense ◽

Network Approach ◽

Developmental Processes ◽

Definition Of ◽

The chapter discusses the definition of mental disorder, reviews the biological explanations for vulnerability to disease, and presents a detailed taxonomy of undesirable conditions that may be regarded as disorders in a broad sense (whether or not they involve genuine dysfunctions). After detailing the main evolutionary and developmental processes that can lead to psychopathology, the chapter addresses some important questions about the structure and classification of disorders and the nature of psychiatric comorbidity. The chapter also considers the strengths and weaknesses of other emerging approaches: computational psychiatry, the network approach to psychopathology, the Research Domain Criteria (RDoC), and transdiagnostic models such as the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Distinction between Psychological Kinds and Natural Kinds Revisited: Can Updated Natural-Kind Theory Help Clinical Psychological Science and beyond Meet Psychology's Philosophical Challenges?

Review of General Psychology ◽

10.1037/gpr0000100 ◽

2017 ◽

Vol 21 (1) ◽

pp. 82-94 ◽

Cited By ~ 7

Author(s):

Barbara S. Held

Keyword(s):

Mental Disorder ◽

Natural Kind ◽

Natural Kinds ◽

Inductive Generalization ◽

Psychological Science ◽

Essential Properties ◽

Alternative Approaches ◽

Homeostatic Property Cluster ◽

Philosophers and psychologists have long held that mind-dependent/human (or social) kinds are not natural kinds. Yet in the last three decades philosopher of science Richard Boyd has challenged this belief to widespread acclaim in the philosophy of biology, where the natural-kind status of species taxa has been debated. Boyd proposed that natural-kind status hinges not on a kind's mind independence or on demonstration of its essential properties but rather on whether it supports inductive generalization, in which case it is a “homeostatic property cluster” (HPC) kind. Boyd indicates that any human/mental kind can in principle be a natural kind, without physical reduction of its properties, as long as it constitutes an HPC kind and so can be studied by way of the causal mechanisms that, he theorizes, underlie all natural kinds. In the last decade Boyd's HPC theory of natural kinds has influenced theory of mental disorder kinds and shares commonality with Denny Borsboom's burgeoning “symptom network” approach to psychiatric diagnosis. It therefore warrants more thoroughgoing theoretical and empirical analysis. This article revisits the heterogeneity that inheres in DSM categories and motivated alternative approaches, such as the Research Domain Criteria (RDoC) of the NIMH. Also assessed are two worries about the future of “HPC kinds” of mental disorder kinds: (a) ontological relativism and reification, and (b) epistemic perspectivalism and relativistic knowledge. Though focused on clinical kinds, this analysis has implications for psychological science beyond its clinical subdiscipline.

Diagnosis as dialogue: historical and current perspectives

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2020.22.1/phoff ◽

2020 ◽

Vol 22 (1) ◽

pp. 27-35 ◽

Cited By ~ 1

Keyword(s):

Scientific Inquiry ◽

18Th Century ◽

Clinical Encounter ◽

Diagnostic Systems ◽

Specific Nature ◽

Clinical Communication ◽

Late 18Th Century ◽

History Of ◽

Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed in light of these considerations.

Towards a new conceptual framework for psychopathology: Embodiment, enactivism, and embedment

Theory & Psychology ◽

10.1177/0959354318808394 ◽

2018 ◽

Vol 28 (6) ◽

pp. 800-822 ◽

Cited By ~ 3

Author(s):

Kristopher Nielsen ◽

Tony Ward

Keyword(s):

Mental Disorders ◽

Mental Disorder ◽

Conceptual Framework ◽

Continuous Model ◽

Eliminative Materialism ◽

The Mind ◽

Metaphysical Position ◽

Psychopathology classification is at a conceptual crossroads. It is becoming increasingly accepted that the flaws of the DSM relate to its struggles to pick out “real” entities as opposed to clusters of symptoms. The Research Domain Criteria (RDoC) was formulated in response to this failure, and attempts to address the concerns confronting the DSM by shifting to a causal and continuous model of psychopathology. Noting key criticisms of neurocentricism and problems with conceptual validity leveled at the RDoC, we argue that they stem from its grounding in the metaphysical position of eliminative materialism, or at least material-reductionism. We propose that 3e cognition (viewing the mind as embodied, embedded, and enactive) offers a superior alternative to eliminative materialism. A 3e-informed framework of mental disorder is sketched out and its advantages as a basis for classifying and conceptualizing mental disorders are considered.

Special, radical, failure of reduction in psychiatry

Behavioral and Brain Sciences ◽

10.1017/s0140525x18001164 ◽

2019 ◽

Vol 42 ◽

Author(s):

Don Ross

Keyword(s):

Mental Disorder ◽

Brain Structure ◽

Causal Structure ◽

Network Models ◽

Gambling Addiction ◽

Brain Disorder ◽

Mental Processes ◽

Special Radical ◽

Intentional Relationships

AbstractUse of network models to identify causal structure typically blocks reduction across the sciences. Entanglement of mental processes with environmental and intentional relationships, as Borsboom et al. argue, makes reduction of psychology to neuroscience particularly implausible. However, in psychiatry, a mental disorder can involve no brain disorder at all, even when the former crucially depends on aspects of brain structure. Gambling addiction constitutes an example.