A network theory of mental disorders

Abstract

In recent years, the network approach to psychopathology has been advanced as an alternative way of conceptualizing mental disorders. In this approach, mental disorders arise from direct interactions between symptoms. Although the network approach has led to many novel methodologies and substantive applications, it has not yet been fully articulated as a scientific theory of mental disorders. The present paper aims to develop such a theory, by postulating a limited set of theoretical principles regarding the structure and dynamics of symptom networks. At the heart of the theory lies the notion that symptoms of psychopathology are causally connected through myriads of biological, psychological and societal mechanisms. If these causal relations are sufficiently strong, symptoms can generate a level of feedback that renders them self-sustaining. In this case, the network can get stuck in a disorder state. The network theory holds that this is a general feature of mental disorders, which can therefore be understood as alternative stable states of strongly connected symptom networks. This idea naturally leads to a comprehensive model of psychopathology, encompassing a common explanatory model for mental disorders, as well as novel definitions of associated concepts such as mental health, resilience, vulnerability and liability. In addition, the network theory has direct implications for how to understand diagnosis and treatment, and suggests a clear agenda for future research in psychiatry and associated disciplines.

PTSD symptomics: network analyses in the field of psychotraumatology

“…We hope that this special issue encourages researchers to conceptualize and model PTSD data from a network perspective, which arguably has the potential to inform and improve the efficacy of therapeutic interventions (Borsboom, 2017; Cramer et al, 2010; Hayes & Strauss, 1998; McNally, 2016). The methodological field of psychological network psychometrics has moved remarkably quickly from visualizing correlation matrices in 2010 (Cramer et al, 2010) to using sophisticated statistical models in 2014 (Van Borkulo et al, 2014).…”

“…A new research framework entitled ‘Symptomics’ was proposed recently that aims to describe such studies under one framework, and complement diagnosis-level research with more detailed research on symptoms (Fried, 2017). Symptomics has three cornerstones:The relationship of individual symptoms with important variables such as risk factors, biomarkers, impairment of functioning, and treatment response (Bentall et al, 2012; Costello, 1993; Fried & Nesse, 2015b; Hieronymus, Emilsson, Nilsson, & Eriksson, 2016; Persons, 1986);The analysis of the potentially causal relations among symptoms in symptom networks (Borsboom, 2017; Cramer, Waldorp, van der Maas, & Borsboom, 2010; Wichers, Wigman, & Myin-Germeys, 2015);Gaining better understanding of psychopathology by investigating personalized processes at the level of individuals instead of heterogeneous groups of patients (Fisher & Boswell, 2016; Molenaar, 2004). …”

“…The analysis of the potentially causal relations among symptoms in symptom networks (Borsboom, 2017; Cramer, Waldorp, van der Maas, & Borsboom, 2010; Wichers, Wigman, & Myin-Germeys, 2015);…”

A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse

“…The network perspective on psychopathology, pioneered by Borsboom and his associates (e.g. Borsboom, 2008, 2017; Borsboom & Cramer, 2013; Cramer, Borsboom, Aggen, & Kendler, 2012; Cramer, Waldorp, van der Maas, & Borsboom, 2010), offers a radically different way of understanding PTSD (McNally, 2012) and other mental disorders (for reviews, see Fried et al, 2017; McNally, 2016). According to this perspective, a mental disorder is not an underlying, latent (unobserved) disease entity, whether construed categorically or dimensionally.…”

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

“…This model assumes that psychological constructs, such as mental disorders, are reflective and not directly observable entities that can be measured only indirectly by the symptoms they cause (Borsboom & Cramer, 2013). Recent theoretical and empirical considerations have questioned this approach and have put forward another model, the network model, as an alternative basis for modeling psychological constructs and their interactions (Borsboom, 2017; Schmittmann et al, 2013), including PTSD (Armour, Fried, Deserno, Tsai, & Pietrzak, 2017; McNally et al, 2015). In the network model, the associations of variables can be visualized and investigated in an explorative manner on the item/symptom level (e.g.…”