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From Symptoms to Biology: Why is RDoC considered a revolution in psychological medicine?
With the evolution of psychological medicine, traditional diagnostic systems such as the Diagnostic and Statistical Manual (DSM) are gradually considered unable to effectively explain the complexity of mental illness. In order to find a more scientific and unified classification method, the National Institute of Mental Health (NIMH) launched the "Research Domain Criteria" (RDoC) project, aiming to build a more comprehensive framework for understanding mental illness based on biology. .
"RDoC is an effort to create a new taxonomy of mental illness that incorporates modern research methods from genetics, neuroscience, and behavioral science into the problem of mental illness."
The origins of RDoC can be traced to the 2008 NIMH strategic plan, which called for “new ways to classify mental illness based on observable behaviors and neurobiological measurements” (NIMH, 2008). This vision reflects concerns that current symptom-based diagnostic systems cannot effectively integrate the latest neuroscience research findings. As scientific research progresses, it is understood that the manifestations of mental illness should be viewed as a continuation of a range of behaviors and biological markers rather than fixed categories.
"Current diagnoses of psychiatric disorders are based on clinical observations and patient phenomenological symptom reports. However, this diagnostic system does not reflect the latest breakthroughs in genetics and neuroscience."
The core goal of RDoC is to explore and define the connections between the two fields of biology and behavior to gain a deeper understanding of the causes and mechanisms of mental illness. This is not a simple list of symptoms, but a multidimensional system that emphasizes the biological basis of behavior. Researchers hope to observe from multiple dimensions, identify basic behavioral components related to this, such as governance functions, emotion regulation, and interpersonal perception, and combine them with the latest findings in neuroscience.
Comparison between RDoC and DSM
The emergence of RDoC complements the criticism of DSM. In 2013, NIMH Director Thomas Insel's evaluation of the DSM sparked widespread discussion. He said that the diagnostic method of the DSM was more like a dictionary than a Bible and lacked validity. He noted that traditional definitions of mental illness are often based on consensus on clinical symptoms and lack objective laboratory measurements.
"Patients deserve better diagnostic criteria."
As the biological understanding of mental illness deepens, the four assumptions followed by RDoC point out that diagnostic methods must go beyond existing DSM categories because a mental disorder is a biological disorder involving specific cognitions, emotions, or behaviors. This means that future research will no longer rely solely on traditional clinical diagnostic criteria, but will consider a more macroscopic neurobiological level.
RDoC matrix and its methodology
The design framework of RDoC includes multiple "domains", each of which is subdivided into "structures" and "sub-structures". These constructs are not just conceptual divisions, but also emphasize their connection with behavior. The difference between RDoC and traditional diagnostic systems is that it uses a "dimensional system" rather than simple category classification. This design enables RDoC to involve a wider range of data sources, including genes, molecules, cells, and their interactions in the larger environment.
"The official document from RDoC states that we should start research through the relationship between behavior and the brain, rather than starting from the definition of disease."
Following early data-driven research, the RDoC continuum across diagnostic psychiatric symptoms predicts clinical outcomes and can reflect correlations at the genetic level. The advancement of this new approach will open new perspectives on the future of psychological medicine.
Therefore, the revolution of RDoC is not only to solve the current diagnostic dilemma, but also to provide a clear way out for future research and treatment. So, how can we further understand and apply this emerging research framework to improve the diagnosis and treatment of mental illness?
