A study led by Trinity Psychologist Dr. Claire Gillan has found that current approaches to the diagnosis of mental illness may not always provide the best way of understanding the underlying neurobiology of mental illness.
Compulsive elements of mental health were found not to align with the rigid criteria usually applied by experts for diagnosis, instead such behavioural elements are flexible and vary greatly between individuals and are therefore harder to pin down. It is this capacity for flexibility which is thought to be largely responsible for controlling our habits. Habits have been the subject of study before, since they manifest themselves in abnormal ways in several mental health conditions such as binge eating and obsessive compulsive disorder (OCD), with the latter having been the focus of Gillan’s study.
Under the current system, mental disorders are defined in terms of diagnostic and statistical manual (DSM) diagnoses. Under DSM diagnoses patients are categorically defined as either having or not having the disorder depending on whether they meet the criteria of symptoms, which is decisive in whether or not treatment is provided or not. This paper adds to growing evidence that the current categorical frameworks for diagnoses are in need of revision to account for cases where patients are provided with inadequate treatment due to the broad nature of diagnoses which can encompass many different symptoms and do not account for variation between individuals.
Many disorders have a lot of overlap in their symptoms, as is the case with compulsive behaviours and so, patients will often meet the criteria for multiple disorders which blurs the lines even further. The study found that on average patients met the criteria for 3.7 concurrent diagnoses. Even within disorders patients exhibit a wide range of symptoms which often don’t overlap and so the response to treatment can vary substantially between individuals who, on paper, share the same diagnoses. In light of this study OCD, it is suggested that self-reporting of compulsive behaviours characteristic of OCD may provide a better way of predicting alteration in cognitive flexibility and ultimately provide for a more individualised approach to diagnoses and treatment, which in turn could lead to improvements in health outcomes.
The study was done in collaboration with researchers and clinicians from academic and medical institutions across the Atlantic, including Harvard Medical School. The findings were published in JAMA Psychiatry, a renowned peer-reviewed medical journal. Commenting on the significance of the findings Gillan said “…it is hoped that we are charting a path towards a future where treatments can be prescribed on a more individualised basis, based on well-defined brain systems and circuits and crucially, with a higher rate of success.”