L5: Dimensional Taxonomy (HiTOP) Flashcards
What is essentialism?
the fact that psychiatry is rooted within the medical discipiline, and accordingly understands psychopathology as a structural, (epi)genetic, cellular, molecular, or other underyling disturbance that is located inside the body/brain
theres implicit essentialism in the DSM
How does essentialism relate to DSM?
its implicit
“mental disorder is syndrome characterized by clinically significant disturbance in an individual’s cognitive, emotion regulation, or behaviour that reflects a dysfunction in the psych, bio, or dev process underlying mental functioning
What are the core ideas of essentialism?
- theres an underlying cause that explains the occurence of all symptoms of a cluster of symptoms
- mental disorders are defined by these clusteres of symptoms
- clusters of symptoms are independent from each other because they have a different cause (categorical taxonomy)
What are the blinding effects of essentialism?
this view negates the possibility that mental disorders may be unique in presentation & etiology per person:
- alternative perspectives: blinds us to alternerative explanations of mental disorders
- context: may be blind to the context surrounding symptoms
- meaning
- social construction
- individual variation: may blind us to the fact that ppl just vary on certain traits, doesnt mean they have an undelrying mental disorder
- personal understanding
What are the issues with essentialism? 4
- aribitrary cut-offs instead of empirical basis: a )within syndromes, ex: meet 5 out of 9 symptoms b) between syndromes (lots of overlap between some)
- Heterogeneity within syndromes: a) of symptoms: many different profiles (ppl) meet the same syndrome but very different symptoms b) of causes (ex: BPD could be from trauma, substance abuse, difficult current context etc)
- Co-occurence (“comorbidity”): a) of syndromes (many BPD patients also meet depression, PTSD etc) b) of causes (one cause can lead to many different syndromes so many syndromes have common causes like trauma)
- Continuity of personality & psychopathology (spectrum from momentary/episode/changeable/what you have <-> pervasive/persistent/unchangeable/who you are is less and less big (less distinct between what is a permanent syndrome like BPD and what is a temporary one like MDD)
Why is having one model problematic?
categorical model is serving many parties & goals simultaneously (administartion, policy making, treatment, research etc)
while every level requires a different level of simplification vs precise representation, description at pop. level vs description at individual level
psychiatry needs more than one model so that it can be served both
- as a science
- as a practical, clinical discipline
What were proposed solutions for the problems of essentialism (and thus of having only one model)? 4
- Dimensional trait model (starting in the 90s) like HiTOP
- the Network approach
- the Transdiagnostic approach
- the Personalized approach
How did we get to HiTOP? 4
- psychiatric epidemiology: research into prevalence showed that comorbidity was super common
- questionnaire research in clinical & dev psych: bottom up disocveries of patterns & syndromes
- personality trait research: showed continuity between traits and psych problems
- psychometrics
What is the dimensional trait model?
- models grounded in empirical data & do not meet most of the essentialism critiques
- idea: need to think in continua about psychopathology
- spectrum of personality traits (as variants of normal personality) and its pathlogy (varying in severity) with an assumed underlying factor
- so symptoms and/or syndromes that occur at the same time are understood to co-occur because of this underlying facotr
What are some dimensional trait models?
- 5 Factor Model: of normal personality functioning (Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism)
- Personality psychopathology five: positive emotionality, aggressiveness, constraint, negative emotionality, psychoticism)
- Dimensional trait model proposed for DSM: negative affectivity, detachment, psychoticism, antagonism, disinhibition
- HiTOP: Hierarchical Taxonomy of Psychopathology
How does a dimensional trait approach work in steps?
- dimensionalize syndromes (instead of no depression to major depression with a cutoff of symptoms in the middle, we make a spectrum from low to high depressivity based on amount of symptoms)
- Factor analyze multiple syndromes: like social anxiety, MDD, PTSD overlap a lot so then we get the “internalizing spectrum”
- Factor analyze large sets of symptoms: put all DSM symptoms into one group and do hierarchical factor analysis on it all -> you get HiTOP
- Joint factor analysis of Five Factor Model (peronality) and Alternative Model of Personality Syndromes and see how both relate to each other and to HiTOP
What is HiTOP?
Hierarchical Taxonomy of Psychopathology
- aims to produce a tonomy that integrates & reflects quantitative outcomes in the area of mental health
- want to hypothesize and build an empirical classification system for psychopathology
- consists of hierarchically organised dimensions which start at the narrowest level of “symptoms” (particular signs) and moves up to the broadest level of “super spectra” (very broad dimesnions of multiple spectra)
- 6 spectra: internalizing, disinhibition, antagonism, thought disorder, detachment, and somatoform
What are shortcomings of the dimensional approach in general? Is it really “beyond” essentialism?
- questionable whether it can really serve psychiatry as a practical, clinical discpiline: can we really make clinical decisions without categories & cut-offs? doesnt really solve the arbitrary cutoff critique
- still problematic assumption of inferring a latent marker or substrate (aka underlying function/structure) from similarities/differences in appearances (morphology) (like the term internalizing pathology)
For what goals should we use dimensional taxonomy (HiTOP)? what are the pros basically
- empirically grounded taxonomy
- more adequate representation of dimensionality & heterogeneity
- continuity w epiodemiological reseach
What is the network approach?
Goal, Underlying Idea, Central Principles
Goal: better understand the processes behind mental disorderes and to optimally organise existing treatment interventions and develop new ones
Underlying idea: believes that there is no underlying central disease mechanism, rather they see mental disorders as “problems of living”
Central principles
- mental disorders are complex systems. symptoms are the results of connections petween symptoms (second principle) rather than as the result of a common cause (latent disease entity). mental disorder are made up of symptoms, not the cause of them.
- neurbio factors can still influence some symptoms but dont explain it all
- the covariance of mental symptoms follows a network structure: syndromes (clusters of symptoms) do esist & can be explained by strong causal relationships between the symptoms (so many feedback loops can be active)
- Hysteresis principle
- Symptom component correspondence principle
What is the idea of hysteresis?
the idea that in the network approach even when the trigger for activation of the network has subsided, the network becomes self-sustaining, and gets stuck in its active state
What is the “symptom-component correspondence’ principle?
the idea in network theory, that symptoms are actually just components of one big network, but they have found common network structures of symptoms that roughly align with some diagnoses
What are the shortcomings of the network approach?
reductionism still there!
- still implicity assumes that mental disorders can be described in terms of DSM symptoms (so they are using reductionism, essentialism, and a disease concept)
- network approach says that mental disorders are “problems of living” so many things could be included, so what determines what to include in the network as symptoms?
- but in reality the network approach uses mainly DSM symptoms as network components, instead of using an “open methodology”
What is reductionism vs essentialism vs disease concept
reductionism: tries to simplify complex problems by breaking them down into smaller parts
essentialism: looks for the essential, underlying quality that defines a mental disorder
disease concept: sees mental disorders as similar to physical diseases w clear causes & treatments
How did the transdiagnostic approach come about?
originated from contact w patients
clinicans observed that disorder specific CBT based on the DSM categories, missed some essential maintaining mechanisms of all EDs. this lack may explain the high comorbidity amongst the EDs as well
What is the transdiagnostic approach?
an approach that focuses on broad factors and mechanisms that are seen in multiple DSM diagnoses, and constructs treatments around this, rather than around specific disorders
(ex: treatment around emotional regulation, self esteem, etc)
- has many different models and approaches within itself
What are the pros of the transdiagnostic approach?
- it transcends taxonomical problem: addresses common factors across diagnoses, offering a more comprehensive treatment approach
- its bottom-up: it orginitated from clinical patient observation, allowing for factors to be introduced that transcend the DSM restrictions: it broadens our symptom conceptualization of mental disorders
What are the shortcomings of the transdiagnostic appraoch?
may just be a “lumping approach”, its not really diagnostic since its just combining multiple DSM diagnoses and giving treatment to it all together
for what goals should we use categorical taxonomy (DSM)?
- continuity with research tradition in psych
- communication w society
- status as a medical professional
- reimbursement by health insurance
