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The RDoC Controversy: Alternate Paradigm or Dominant Paradigm?

While DSM and ICD are diagnostic manuals, RDoC is not. What RDoC is, instead, is a set of principles for deriving and studying biobehavioral constructs implicated in psychiatric disorders. Current diagnostic categories are valid for many purposes and represent the best effort to relate science to nosology. There is no better alternative at present for clinical application. However, there are very significant limitations in the scientific application of heterogeneous syndromes where the defining psychopathologies are not unique to the diagnostic class and vary within categories between cases. Consider the limitations of schizophrenia as the phenotype in genome-wide association studies,where individuals in a study cohort differ on virtually every clinical variable. Hence, results from such studies yield mostly weak findings with unknown relation to specific pathology and false negative exclusion of genes based on failure to apply robust phenotypes to select relevant individuals. RDoC provides one of several paradigms addressing syndrome heterogeneity. DSM-5 provides eight symptom dimensions for psychotic disorders in section 3. These psychopathology domains require clinical attention and are targets for research. Translational research involving animals is used to generate knowledge hypothesized to relate to specific pathologies relevant to diagnostic class but not to represent the range of pathologies associated with the class. The Consortium on the Genetics of Schizophrenia (4, 5)and theBipolar-SchizophreniaNetworkonIntermediate Phenotypes (6) endophenotype programs are outstanding examples of the deconstruction of clinical syndromes. Scienceresultinginadvancesinclinicalcarehasbeenmodest. In this context, NIMH gave emphasis to RDoC as a paradigm with the hypothesis that research based on already defined behavioral constructswithknownneural circuitswill accelerate the development of fundamental knowledge applicable to psychopathology while reducing problems associated with heterogeneous clinical syndromes.TheRDoCinitiativeneither replaces nor excludes other paradigms, but it is an NIMH strategic plan priority and competes for resources. In this regard it will eventually be judged by whether knowledge generated within this paradigm is validated in relation to human pathology and whether clinically relevant innovations are produced. The issue is not whether RDoC is an alternative diagnostic approach but whether the paradigm will promote information that informs nosology and facilitates application of brain science in clinical diagnostic concepts. In addition to freeing investigators from theapproachofdiagnostic class versus normal control, possible outcomes relevant to DSM and ICD are that: