Research Domain Criteria (RDoC) vs. DSM 'taxonomy' - pick one

Pick one. Why? Because the battle for grant money is ON! And the two paradigms seem so fundamentally at odds that it’s hard to see their co-existing.

RDoC is a project launched by the National Institute of Mental Health (NIMH) which will attempt to understand psych pathologies by taking a bottom up approach which specifically means starting from the biochemistry, then the neurology and finally how identifiable organic abnormalities correlate with pathologies.

If you think that executing such an approach might be less linear than it sounds, you’re not alone. But here’s their announcement.

The DSM series takes the top down approach. It’s like a taxonomy of psychiatric symptoms just like you would classify plants by the shape of their leaves, type of flower, etc.

Both approaches have merit and both are flawed. RDoC will (optimistically) take many years to fully quantify any disorders as we know them from the DSM. It doesn’t recognize any pathology for which a specific, reproducible neuro/biological basis cannot be identified. Finally it doesn’t even start to deal with intangible and unquantifiable issues. An article in Time gives a good overview of the conflict and concludes that we shouldn’t choose. As a clinician, in this in other passages, he adds the necessary human element.

Of course the DSM approach is also flawed as is often pointed out. The relationship between symptoms and and disease isn’t sharply defined and sometimes wrong. This can be misleading for research if you think you have one disorder that actually has 3 or 4 or more actual causes.

So it seems obvious that we need both approaches, but it’s equally obvious that the battle lines have been drawn - and by none other than the head of NIMH.