The Overhaul continues: DSM5 vs. RDoC and the coming storm

Introduction

I can’t help but write about what I am reading right now.  The Research Domain Criteria (RDoC) lead by Bruce Cuthbert and supported by NIMH (national institute of mental health/USA) and director Thomas Insell, M.D., have led workshops with experts in the field between 2010 and 2012.  Their purpose:  restructure and rewrite the diagnoses of mental health.  There is much to be said about their new approach, and momentum and steam are gathering behind their proposed constructs and their overarching model.

I read an article (referenced below and linked here which talks about the history and lead up to Dr. Cuthbert’s work and the genesis of the RDoC.  It’s a nice easy fun read that could get you into the spirit of the overhaul.  I am.

Or course, the real meat and potatoes (for those interested) can be find here;  please read about the RDoC matrix, since that is the consummation of their efforts so far, in readable form; read the workshop proceedings to get more details about each construct.

Drilling down a  bit:  can you explain?

Well, there appear to be five (5) domains of psychophysiological functioning, thus far, that are most important–five key modes of brain function that mediate (control)  behavior.

1. Negative Valence System

2. Positive Valence System

3. Systems for Social Processes

4. Cognitive Systems

5. Arousal and Regulatory Systems

Description

Roughly:  There is valence and arousal:  1) processing valence and approach good things and retreat from bad things; processing arousal by increasing all systems or shutting down all systems.  That is the core of behavior, and the original thinking behind the RDoc.  Its the work of Peter Lang and Bruce Cuthbert.  The article tells the history.   It totally makes sense to me!  And, I take comfort in knowing it’s not just a made up model, it’s been scientifically explored, researched, and shown in humans and animals.  In fact, its fundamental to mammalian behaviour (or even lower animals).   It make sense as a way of organizing our thinking about ourselves, too.

Specifically: Positive Valence includes seeking out rewards and involve the reward centre of the brain and dopamine.  Negative Valence would include fight or flight, stress response, and hypervigilance (being on alert), and involve cortisol, adrenaline, and serotonin and the amydala.  Cognitive systems use all sorts of neurotransmitters and growth factors and neural networks, and as a a group defines, first, functions of control and effort:  how we/the brain sorts through information; determines what to pay attention to, what is important or not;  how to store memories and retrieve memories; how to organize, plan, and execute.  It also handles perception:  mediating the senses; language behaviour, memory storage of perceptions.  Social systems would include systems that mediate behaviors such as attachment, love, connection, and involve oxytocin and vasopression.  Finally, Arousal and Regulatory Systems control wakefulness, circadian rhythms, and sleep/wake cycles.

Translation (just a few examples):

1. Positive valence–addiction, compulsion, impulsivity

2. Negative Valence- anxiety, depression, PTSD, aggression, neuroticism

3. Arousal and Regulatory- insomnia, eating disorders

4. Social systems- attachment problems, relationship problems, autistic behaviors, detachment

5. Cognitive- ADHD, psychosis, delusion, hallucination, dementia, obsessiveness, eccentricity

Conclusions

Note:  This is my rough estimate and report on what I just read.  Everyone knows this is preliminary and subject to correction.  The RDoC won’t be definitive for years, it’s just exciting to be there at the beginning years.

Special Note:  All these systems are generally normal!  Disorders and mental conditions emerge when the normal systems are not running correctly.  I hate to make it a car metaphor, but it’s kind of like something under the hood needs to be examined when behaviors change.  RDoc is clear: all mental illness is on a spectrum with normal within each domain.

So, we are on our way:  THe DSM5’s complex diagnostic catergories can be roughly translated into these scientific models of behaviour quite quickly.  Personally, I thought that was what the DSM5 was promising before it came out.  I guess they didn’t go far enough–probably tradition and caution got in the way.

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