Transdiagnostic process

A transdiagnostic process is a proposed psychological mechanism underlying and connecting a group of mental disorders.

History

Over the last two centuries, western mental health science has focused on nosology whereby panels of experts identify hypothetical sets of signs and symptoms, label, and compile them into taxonomies such as the Diagnostic and Statistical Manual of Mental Disorders. While this is one of the approaches that has historically driven progress in medicine, such taxonomies have long been controversial on grounds including bias, diagnostic reliability and potential conflicts of interest amongst their promoters. Over-reliance on taxonomy may have created a situation where its benefits are now outweighed by the fragmentation and constraints it has caused in the training of mental health practitioners, the range of treatments they can provide under insurance cover, and the scope of new research.

To date, no biological marker or individual cognitive process has been associated with a unique mental diagnosis but rather such markers and processes seem implicated across many diagnostic categories. For these reasons, researchers have recently begun to investigate mechanisms through which environmental factors such as poverty, discrimination, loneliness, aversive parenting, and childhood trauma or maltreatment might act as causes of many disorders and which therefore might point towards interventions that could help many people affected by them. Research suggests that transdiagnostic processes may underlie multiple aspects of cognition including attention, memory/imagery, thinking, reasoning, and behavior.

Examples

Transdiagnostic processes well-supported by evidence

While an exhaustive, confirmed list of transdiagnostic processes does not yet exist, relatively strong evidence exists for processes including:

Selective attention to external stimuli

Selective attention to internal stimuli [1]

Avoidance behavior: distracting ourselves or deliberately not entering feared situations, thereby blocking the opportunity to disconfirm negative beliefs.

Safety behavior: habitual behaviors we execute because we believe they will help us to avoid something we fear (for example, vomiting, dieting or excessive exercise to avoid weight gain)

Experiential avoidance

Explicit selective memory

Recurrent memory

Interpretation reasoning: how we reach conclusions regarding the meaning of ambiguous or open-ended situations.

Expectancy reasoning: predicting likely future events and outcomes that may follow specific actions or situations.