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Free keywords:
Posttraumatic stress disorder, subtreshold PTSD, subsyndromal PTSD, symptom-based research, RDoC, PTSD subtypes, PTSD subtyping
Abstract:
Background: The significant proportion of patients suffering from
subthreshold diagnoses such as partial posttraumatic stress disorder
(PTSD) shows that today's diagnostic entities do not fully meet the
reality and needs of clinical practice. Moreover, as stated also in the
recently announced concept of research domain criteria (RDoC), the use
of today's traditional diagnostic systems in psychiatric research does
not sufficiently promote an integrative understanding of mental
disorders across multiple units of analysis from behavior to
neurobiology. Besides RDoC, core symptom-based research concepts have
been proposed to bridge the translational gap in psychiatry, but,
unfortunately, have not yet become the rule.
Objective/method: First, this article briefly reviews literature on
subthreshold PTSD (as an example for subthreshold diagnoses) and,
second, pleas for and proposes a modified symptom-based research concept
in psychiatry.
Results: Subthreshold PTSD has, like other subthreshold psychiatric
diagnoses, not yet been clearly defined. Diagnostic entities such as
subthreshold PTSD are subject to a certain arbitrariness as they are
mainly the result of empiricism. This fact stresses the urgent need for
neurobiologically-informed psychiatric diagnoses and motivated the
here-presented proposal of a symptom-based research concept. As proposed
here, and before by other researchers, symptom-based research in
psychiatry should refrain from studying patient cohorts compiled
according to diagnoses but, instead, should focus on assessing cohorts
grouped according to chief complaints or predominant psychopathological
symptoms.
Conclusions: The linkage of the RDoC concept and symptom-based
psychiatric research might probably speed up the definition of
biologically or symptom-based psychiatric diagnoses, which might replace
the auxiliary constructs of "traditional'' diagnoses such as full and
subthreshold PTSD, and promote the development of novel psychological
and pharmacological treatments.
