A plea for symptom-based research in psychiatry

Area of Science:

• Psychiatry
• Neurobiology
• Clinical Psychology

Background:

• Subthreshold diagnoses, such as partial posttraumatic stress disorder (PTSD), highlight limitations in current psychiatric diagnostic systems.
• Traditional diagnostic categories hinder integrative research across behavioral and neurobiological levels, as noted by the Research Domain Criteria (RDoC) initiative.
• Existing core symptom-based research concepts have not been widely adopted to bridge the translational gap in psychiatry.

Purpose of the Study:

• To review literature on subthreshold PTSD as a representative example of subthreshold diagnoses.
• To advocate for and propose a revised symptom-based research framework in psychiatry.

Main Methods:

• Literature review on subthreshold PTSD.
• Proposal of a modified symptom-based research concept for psychiatric studies.

Main Results:

• Subthreshold PTSD and similar diagnoses lack clear definitions and are often empirically derived, indicating arbitrariness.
• There is a critical need for psychiatric diagnoses informed by neurobiology.
• The proposed concept suggests grouping research cohorts by chief complaints or predominant symptoms rather than traditional diagnoses.

Conclusions:

• Integrating the RDoC concept with symptom-based research may accelerate the development of biologically or symptom-based psychiatric diagnoses.
• These novel diagnoses could potentially replace current constructs like full and subthreshold PTSD.
• This approach may foster advancements in psychological and pharmacological treatments for mental disorders.