Research Topic

New Approaches on Psychiatric Diagnosis – RDoC, HiTOP, DSM-5, ICD-11

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In the last years, Psychiatry has experienced changes in some crucial areas, such as conceptual models of mental disorders, classification and diagnosis. In part, this is a consequence of certain limitations of former nosological systems, as well as the constant need to refine the conceptualization of such a ...

In the last years, Psychiatry has experienced changes in some crucial areas, such as conceptual models of mental disorders, classification and diagnosis. In part, this is a consequence of certain limitations of former nosological systems, as well as the constant need to refine the conceptualization of such a complex phenomenon as psychopathology. In this sense, evolving research methods have allowed testing new models of mental disorders. To what extent have these models impacted psychiatric taxonomy? Moreover, beyond the influence of biological research and statistical methods, one cannot underestimate the influence of society’s values and public opinion on the updating of classification systems. An example of this being the removal of gender incongruence/transgender from the mental health chapter of ICD-11.

Traditionally, mental disorders have been conceptualized as psychopathological categories formulated by committees of experts. The presence or absence of a specific disorder is, then, determined by whether the subject reaches a clinical threshold from symptoms listed in diagnostic manuals. The adoption of operational diagnostic criteria in DSM-III represented a major advance in terms of diagnostic reliability. However, its limitations, such as the high prevalence of comorbidities, the heterogeneity within a same diagnostic category and the lack of validity of many of these diagnoses, soon started to be acknowledged. Instead of clear-cut categories, mental disorders may be better conceptualized as symptomatic dimensions considering the number and the intensity of symptoms, as well as the severity of the specific condition presented by the patient. Similarly, some scientists advocate mental disorder constructs would be better defined from bottom-up research, from the analysis of how symptoms naturally aggregate in patients, using methods such as factor, cluster, latent class and network analysis. And ideally, mental disorder concepts would incorporate etiological markers revealed by biological research.

Released by the American Psychiatric Association in 2013, DSM-5 initially intended to incorporate dimensions and biomarkers in psychiatric diagnoses, but the scientific evidence was not considered sufficient during its elaboration, and the task forces avoided adopting radical changes on the way clinicians understand and diagnose mental disorders. Its most remarkable innovation is the Alternative Model of Personality Disorders, a hybrid of the dimensional and categorical approaches. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a work in progress intended to overcome the aforementioned limitations of traditional taxonomies. The HiTOP adopts a dimensional approach to explore the structure of psychopathology with latent methods of data analysis. In this way, covarying symptoms are grouped together into syndromes and their subtypes; and co-occurring syndromes are grouped into spectra. Therefore, HiTOP expects to improve psychopathological research and have a positive impact on clinical taxonomy and the diagnostic process.

Another initiative is the Research Domain Criteria (RDoC), proposed by the National Institute of Mental Health. With no intention to serve as a diagnostic manual, it consists of a framework for investigating and understanding mental health-illness continuum as variations in major psychological and biological domains of human functioning. In this sense, it integrates different levels of information, from genomics and brain circuits to behavior and self-report. Finally, in June 2018, the World Health Organization launched the 11th Revision of the International Classification of Diseases (ICD-11). It is a comprehensive classification and diagnostic system that defines diseases, disorders, injuries, causes of death and other health-related conditions. On the mental health section, one of the major changes are the adoption of simpler diagnostic descriptions, facilitating the diagnosis of mental disorders. Moreover, ICD-11 introduces a new chapter on sexual health, which includes, for example, gender incongruence, emphasizing that this is not a mental health condition, which may contribute to reducing stigma.

The goal of this Research Topic is to invite authors interested in presenting the state-of-the-science in Psychiatric diagnosis, updating recent developments, promising initiatives and frontline research which help expand Psychiatry's borders.

Interested authors are welcome to submit review or original articles addressing the following questions:

1. Why do we need new diagnostic and classification system?
2. Social values, public opinion, cultural diversity and psychiatric diagnoses: what is “normal” in the globalized digital era?
3. How has DSM-5 influenced clinical practice and psychiatric research?
4. Which are the concepts of mind and of mental disorders underlying DSM-5 and ICD-11?
5. Which are the major changes introduced by ICD-11 and how they are expected to influence clinical practice and psychiatric research?
6. Going beyond reliability and clinical utility: how can we improve the validity of psychiatric diagnoses?
7. Future directions of in assessing and diagnosing personality disorders
8. Hierarchical models in the nosology: HiTOP and alternative taxonomies of mental disorders
9. State-of-art of the RDoC framework: promises and achievements
10. Advances in statistical methods
a. Using Big Data to forecast “human nature” and psychopathology
b. Contributions of machine and deep learning in psychiatric diagnoses

The Guest Topic Editors are indebted to the critical contribution made by Dr. Geilson Lima Santana in coordinating the launch of this Research Topic. They would also like to acknowledge the contribution of Dr. Bruno Mendonça Coêlho during the initial stages of creating this Research Topic.


Keywords: DSM-5, ICD 11, RDoC, HiTOP, Models of Mental Disorders, Research Methods, Diagnostic Assessment


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