Dispatches From the Field: RDoC Framework Explainer

Rethinking Diagnosis: The Role of the RDoC

Traditionally, mental health conditions such as schizophrenia are diagnosed based on symptom-based criteria from manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) or International Classification of Diseases, Eleventh Revision. These manuals offer a reliable framework for diagnosis but primarily rely on subjective symptoms and observable signs, leading to concerns about symptom-based heterogeneity, comorbidity, and inadequately studied dimensions across mental health conditions.^1–3 High rates of symptom overlap may result in simultaneous diagnoses of multiple mental health conditions.² The Research Domain Criteria (RDoC), spearheaded by the National Institute of Mental Health, offers a new set of research principles for investigating mental health conditions.¹

The RDoC is not a diagnostic guide or a replacement for current diagnostic systems, such as the DSM-5; rather, it is meant to inform the development of mental health assessment tools, revisions to diagnostic systems, and preventative treatment interventions.¹ It offers a set of research principles focusing on major systems of emotion, cognition, motivation, and higher-order domains.⁴ The RDoC diverges from traditional approaches by emphasizing disruptions in normal functioning through observable behavior, neurobiological measures, and cognitive measures.^3,4

Translating RDoC in Clinical Practice: Advancing Multidimensional Research and Diagnosis

The RDoC framework categorizes domains into negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal/regulatory systems.⁴ It encourages research into validated biomarkers and endophenotypes using different units of analysis such as neural systems, genetics, behavior, and self-report measures.^1,4,5 Preliminary studies using cognitive testing, imaging, and genomic panels have already identified biologically meaningful subgroups within psychotic or mood disorders.^3,6,7

By integrating lifespan, developmental considerations, domains, units of analysis, and environmental factors, the RDoC offers a comprehensive approach to understanding mental health conditions.¹ Clinical researchers and scientists have the opportunity to reconsider aspects of clinical assessment, including diagnosis, case formulation, and treatment planning.⁴ This approach has the potential to advance our understanding of mental healthcare and could lead to more targeted therapeutic interventions to improve patient outcomes.^3,5

Further Reading

• Dalgleish T, et al. Transdiagnostic approaches to mental health problems: Current status and future directions. J Consult Clin Psychol 2020;88:179–195.
  This review highlights the history of mental health diagnosis, the challenges associated with this approach, and recent transdiagnostic approaches focusing on classification, biopsychosocial processes, and clinical interventions.

• Michelini G, et al. Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience. Clin Psychol Rev 2021;86:102025.
  The potential of the RDoC–Hierarchical Taxonomy of Psychopathology interface to inform the development of a unified, dimensional, and biobehaviorally grounded psychiatric nosology is reviewed in this study. 

SC-US-77218

August 2024