Transdiagnostic approaches to mental health problems: Current status and future directions.

Abstract

Despite a longstanding and widespread influence of the diagnostic approach to mental ill health, there is an emerging and growing consensus that such psychiatric nosologies may no longer be fit for purpose in research and clinical practice. In their place, there is gathering support for a "transdiagnostic" approach that cuts across traditional diagnostic boundaries or, more radically, sets them aside altogether, to provide novel insights into how we might understand mental health difficulties. Removing the distinctions between proposed psychiatric taxa at the level of classification opens up new ways of classifying mental health problems, suggests alternative conceptualizations of the processes implicated in mental health, and provides a platform for novel ways of thinking about onset, maintenance, and clinical treatment and recovery from experiences of disabling mental distress. In this Introduction to a Special Section on Transdiagnostic Approaches to Psychopathology, we provide a narrative review of the transdiagnostic literature in order to situate the Special Section articles in context. We begin with a brief history of the diagnostic approach and outline several challenges it currently faces that arguably limit its applicability in current mental health science and practice. We then review several recent transdiagnostic approaches to classification, biopsychosocial processes, and clinical interventions, highlighting promising novel developments. Finally, we present some key challenges facing transdiagnostic science and make suggestions for a way forward. What is the public health significance of this article?Traditional diagnostic systems may no longer be fit for purpose for classifying mental ill health, facilitating understanding of its core underlying biopsychosocial processes, nor driving clinical developments. Here we propose that 'transdiagnostic' approaches have the potential to better represent the clinical and scientific reality of mental health problems, reflecting the complexity, dimensionality and comorbidity that is the norm in clinical practice.

Retiring Categorical Systems and the Biomedical Model of Mental Illness: The Why and the How—A Clinician’s Perspective

“…Second, it offers an organizing system that guides the training of mental health professionals around the world for the assessment, diagnosis, management and treatment of psychopathology. Third, like other biomedical models, the DSM system can be seen as reducing the stigma and personal weaknesses attributed to those individuals being diagnosed by bringing validation and legitimacy to their distress (Dalgleish et al, 2020). This issue related to stigma, however, constitutes a double-edged sword, as explained below.…”

“…The call made by psychologists and scholars to abandon the "Disease Model" of Mental Health and move to a "Psychosocial Model" abundant in the extant literature (Allsopp et al, 2019;Awenat et al, 2013;Bakker, 2019;Bentall, 2014;Deacon, 2013;Goldacre, 2014;Guerin, 2017;Hengartner & Lehmann, 2017;Kinderman, 2017;Middleton, 2015;Pemberton & Wainwright, 2014;Timimi, 2014) can no longer be ignored. Current traditional biomedical models that use categorical diagnostic approaches to mental health, such as those codified in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-created by the American Psychiatric Association (APA), and the International Classification of Diseases (ICD)-developed by the World Health Organization (WHO), have wielded a strong legacy in academic research, the mental health industry, and society at large (Dalgleish et al, 2020). The developments of their respective latest editions, the DSM-5 and ICD-11, revived contentions related to the nosology of psychiatry (Stein et al, 2013).…”

Concluding commentary: Treating perfectionism transdiagnostically with an eye on the future

“…The research directions were grouped into three main ideas, enlisted below, and they are by no means a comprehensive list of all the issues in the field. In this respect, the reader is recommended to read the work of Dalgleish et al (2020), which discusses also transdiagnostic assessment and diagnosis.…”

“…Therefore, the strong argument to using a transdiagnostic treatment is its expected cost-effectiveness in tackling more disorders at once which needs to be showcased in trials that are focused on other outcomes than diagnosis-specific symptomatology. Dalgleish et al (2020) mention in their review the need for a fit-for-purpose methodology in the case of transdiagnostic trials. The current prototypical superiority trial design against a diagnosis-specific treatment is arguably unsuitable for the proper evaluation of transdiagnostic interventions.…”

Transdiagnostic Risk and Protective Factors for Psychopathology in Young People: Systematic Review Protocol

“…Comorbidity among mental disorders is common, with estimates that up to two-thirds of adolescents with a mental disorder will also have at least one other mental disorder [ 3 , 5 ]. The prevalence of comorbidity makes diagnostic and treatment decision making complicated, as additional disorders can affect treatment outcome [ 6 , 7 ]. Furthermore, failing to account for comorbid mental disorders when investigating risk and protective factors could mean that relationships with mental disorders might be due to the compounding nature of overall psychopathology rather than any specific associations, hampering research, prevention, and treatment efforts.…”