Transdiagnostic models for the diagnosis of psychopathological disorders

P. van der Heijden, M. Hendriks. C. Witteman, J. Egger

The last decades, empirical, dimensional models have gained influence over categorical models in classifying, defining and understanding mental disorders. In the current article we first evaluate the advantages and disadvantages of a categorical approach to mental disorders. Secondly, we describe two dimensional alternatives for the categorical approach: the Hierarchical Taxonomy of Psychopathology (HiTOP), which is based on empirically observed patterns of co-occurrence among psychological symptoms and the NIMH’s Research Domain Criteria (RDoC) that provides a framework that integrates behavioural and neuroscience perspectives to understand the etiology of mental disorders. HiTOP and RDoC have overlapping and distinguishing features that complement each other to improve assessment of mental disorders and insight in possible explanations and course. In the current article, we address the implications of this paradigm shift into transdiagnostic dimensional models for the education of academic psychologists.


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In theorievorming over de diagnostiek van psychische stoornissen is de laatste jaren een verschuiving waarneembaar in het belang dat wordt gehecht aan een classificatie van psychische stoornissen volgens de DSM. Met de Hierarchical Taxonomy of Psychopathology (HiTOP) en de Research Domain Criteria (RDoC) wordt in wetenschappelijke kringen afstand genomen van een visie op psychische stoornissen als te onderscheiden categorieën. Deze verschuiving kan belangrijke gevolgen hebben voor de dagelijkse klinische praktijk en daarmee ook voor het (post)academisch diagnostiekonderwijs, betogen Paul van der Heijden en collega’s.

In de geestelijke gezondheidszorg worden voortdurend diagnostische beslissingen genomen. Dat is niet altijd makkelijk, om diverse redenen. Allereerst is de informatie die clinici hebben vaak onvolledig en is er meestal geen sprake van feiten, maar van te interpreteren gegevens. Cliënten hebben soms weinig zelfinzicht, kunnen of willen niet alles laten zien of vertellen, of hebben bewust of onbewust belang bij het overdrijven of ontkennen van klachten (Dandachi & Ponds, 2013). Ten tweede krijgen clinici doorgaans weinig systematische, bruikbare feedback op hun diagnostische beslissingen (Furnham & Schofield, 1987). Ten derde ontbreekt het in de klinische praktijk nogal eens aan systematische oordeelsvorming en maken clinici in hun oordeelsvorming te weinig gebruik van statistische kennis (Merkelbach & Dandachi, 2020; Tiemens, Wagenvoorde & Witteman, 2018; Witteman, Van der Heijden & Claes, 2018). En, ten slotte en meer fundamenteel, ontbreekt het aan een gouden standaard: er is binnen het psychologische en psychiatrische wetenschapsgebied en de geestelijke gezondheidszorg geen overeenstemming over wat wel of geen stoornis is (Frances, 2013).

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