In the contemporary environment, new ways are emerging to scrutinize mental disorders’ diagnosis and treatment. Transdiagnostic (TraD) concept is among one of such concepts. TraD is an evidence-driven application to demonstrate the set of factors, which can help in gaining complete learning of the cause and maintenance of disorders with detailed multifinality and divergent trajectories (Krueger & Eaton, 2015; Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015). However, such TraD approach differs significantly from the DSM thinking models, which are mainly based on the medicalised method of thinking about the psychological complications. Therefore, this essay tends to discuss the transdiagnostic concept to mental in detail while comparing it with the DSM 5.
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The global practitioners used earlier DSM-5 diagnostic model for fostering communication about the clinical descriptions and diagnostic assessments of the different mental disorders across the range of professional users such as clinicians, researchers, judicial systems and insurance companies. DSM taxonomy was based on notion rather than psychopathology. However, despite the range of advantages of this approach, the two key problems associated with DSM ultimately give rise to the Transdiagnostic approach to mental health (Krueger & Eaton, 2015). The first problem leading to the paradigm shift is related to the dichotomous classification of the diagnostic criteria as the two individuals facing a similar personality disorder may satisfy different numbers of criteria. Person A may satisfy no criterion and person B satisfy only three criteria out of the total nine criteria of borderline personality disorderunder the DSM V, but both are classified as “no BPD diagnosed”. The presence of three criteria in person B is overlooked under DSM V because at least five out of eight criteria are required to be satisfied to classify a person with the “BPD diagnosis”. Hence, significant differences among the individuals with respect to symptom frequency and severity are not regarded under DSM V. Secondly, another problem related with the classification is its focus on the mental disorder diagnosis as independent entities or absence of comorbidity. On the contrary, TraD approach has emerged out as a new solution to the DSM V problems (Krueger & Eaton, 2015).
Transdiagnostic approach to the mental health offers a unique concept to mental health addressing that shared symptoms can help the practitioners in understanding the development and progress of disorders (Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015). According to the TraD approach to mental health, some common features or factors are shared by different psychological and mental disorders, which can further be reduced to the two significant groups such as internalizing and externalizing. Internalizing refers to the propensity to encounter distress inwards while externalizing refers to experience outward distress (Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015). These factors taken into account the TraD approach include genetic, biological and psychological factors. However, TraD differs significantly from the DSM diagnostic model, which is mainly connected with the biological taxonomy. DSM, therefore heavily rely on the biological treatments compared to multidimensional treatment approach in the TraD (Krueger & Eaton, 2015).
Both internalising and externalising factors are connected with the personality traits within the TraD theory as the theory suggests that abnormal and normal personalities of the individuals have a significant impact on the disorder’s development and causes for a specific person.
Likewise, another fundamental aspect of the TraD approach is related to the comorbidity, which is regarded as a replication of several disorders, which are exhibitions of fewer core ones. Hence, by considering comorbidity as a fundamental aspect, diagnostics of mental disorders has turned out easier for the research community under this approach compared to the DSM 5. It can be depicted that the DSM perspective, therefore believed that either a person meet the diagnostic threshold of a disorder or does not meet it or there is no overlapping of disorders or comorbidity issues (Krueger & Eaton, 2015; Carragher, Krueger, Eaton, & Slade, 2015). In simple words, DSM indicates that there is no likelihood that one disorder is associated with another disorder. It means that comorbidity is recognised as an anomaly for DSM and therefore DSM focuses on the independence of disorders. On the contrary, the novelty of TraD approach can be examined from the multifinality, which explains that certain risk factors can assist in examining how multiple disorders occur. Likewise, a feature of divergent trajectories of the TraD allows the researchers to understand how the individual with a specific transdiagnostic risk factor results in the one set of symptoms while another person with the same set of factors develops another mental disorder (Krueger & Eaton, 2015). Examples from eating disorders and substance disorders identify the same set of factors. In a similar context, the range of global authorities like National Eating Disorder Association, NICE and NHS have reported the eating disorders and substance abuse share common risk factors such as brain chemistry, family history, low self-esteem, depression, anxiety and social pressure. Likewise, the other factors considered in the comorbidity of the substance abuse and eating disorder include compulsive behaviours, social isolation and suicide risk (NEDA, 2019; NICE, 2017).
Additionally, the analysis of the Research Domain Criteria project has also substantiated the use of TraD approach as effective for the diagnosis, causes and treatment of mental disorders. The project has also identified the primary issues associated with the DSM framework i.e. comorbidity and DSM classification categories not focused on scientific evidence. Hence, lack of validity about the research evidence DSM V due to its focus on customers of clinical symptoms has been increased by the new TraD approach. The RDoC project has further highlighted the need to identify noble ways to classify mental disorders ahead of the biological dimensions and including neurobiology and behaviour measures simultaneously. Instead, application of TraD-based diagnostic can be applied to the RDoC project by directing its significance to the investigation of genetic variance among the different mental disorders and neurobiological systems shared by the emotional disorders (Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015).
It can be depicted that transdiagnostic process is based on the heuristic method, which is focused around the intermediate phenotypes or within-person variables to examine and diagnose the mental disorders. For example, notional regulation, perfectionism, personality analysis can assist the practitioners in understanding variability inability of mental disorders. In bridging the loophole and deficiencies of DSM V, TraD allows the ways to diagnose an approved mental disorder problem through discovery and learning in a practical manner to reach towards an immediate goal. For example, by focusing on the fearful disposition of the phobia can be better understood while the same is translated into phobia exposed to the acute and stress persuading inducement. The theory, therefore, informs about the key role of the development or different behaviours in analysing how mental disorders occur within the individuals (Nolen-Hoeksem & Watkins, 2011).
Hence, the new process can allow the practitioners to identify distal and proximal factors, which are intervening the conditions. Distal refers to the factors which are further away in time such experiences and characteristics, independent of the actions of an individual person. On the other side, proximal factors refer to the factors, which are close in time such as biological factors, cognitive deficits, or biases, stable psychological different factors. It can be depicted that under TraD approach, all these three proximal factors are interrelated (Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015).
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It can be further depicted from the comparison of the DSM V and TraD approach that the former was dependent on the categorical diagnosis of the mental disorders while the later has assisted in the evidence-based diagnosis of the mental disorders by focusing on variability in comorbidity between the different mental disorders. TraD, unlike DSM V, did not rely only on the patients’ interview-based diagnosis rather require a much broader investigation of the disorder around different proximal and distal factors (Krueger & Eaton, 2015).
It can, therefore, be analysed that under TraD approach, comorbidity is examined as a rule rather than the exception. Understanding of the coexistence of different comorbidities is necessary for the evidence-based practices as no mental disorder occurs in isolation and therefore categorical distinction cannot be regarded as a key element in nature. For example, in analysing the depressive disorders and generalised anxiety disorder, concurrence patterns can be predicted as these disorders by chance have the propensity to occur in 4 per 1000 individuals. Thus, DSM V showed significant loopholes in the context of the categorisations, which do not facilitate interventions as it lacks the theory necessary to direct causes behind the mental disorders and necessary interventions. On the other side, latent factors in the TraD approach can help the individuals in understanding the psychopathology or the mental disorders in a more effective manner and ultimately eliminates the problems of DSM V (Eaton, Rodriguez-Seijas, Carragher, & Krueger, 2015).
Hence, from the analysis of the transdiagnostic approach, it can be concluded that TraD has offered a unique solution to the understanding of the mental disorders, their causes, diagnostic and treatment. It has helped in bridging the deficiencies of DSM V by focusing around all the related factors without overemphasising on the biological factors. TraD has also helped the researchers in the medical field to understand the mechanisms of mental disorders through comorbidity. Hence, by focusing on specific factors and mechanisms shaping two different mental disorders, it is easier for medical practitioners to identify the solutions and interventions to treat specific disorders.
- Carragher, N., Krueger, R. F., Eaton, N. R., & Slade, T. (2015). Disorders without borders: current and future directions in the meta-structure of mental disorders. Social Psychiatry and Psychiatric Epidemiology, 50(3), 339-350.
- Eaton, N. R., Rodriguez-Seijas, C., Carragher, N., & Krueger, R. F. (2015). Transdiagnostic factors of psychopathology and substance use disorders: a review. Social Psychiatry and Psychiatric Epidemiology, 50(2), 171-178.
- Krueger, R. F., & Eaton, N. R. (2015). Transdiagnostic factors of mental disorders. World Psychiatry, 14(1), 27-29.
- NEDA. (2019). SUBSTANCE ABUSE AND EATING DISORDERS. Retrieved February 22, 2019, from https://www.nationaleatingdisorders.org/substance-abuse-and-eating-disorders
- NICE. (2017). NICE eating disorders guideline. Retrieved February 22, 2019, from https://www.guidelines.co.uk/eating-disorders/nice-eating-disorders-guideline-/453334.article
- Nolen-Hoeksem, S., & Watkins, E. R. (2011). A Heuristic for Developing Transdiagnostic Models of Psychopathology: Explaining Multifinality and Divergent Trajectories. Perspectives on Psychological Science, 6(6).
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