Explanatory Models for Psychiatric Illness

Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, Richmond, VA 23298-0126, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 07/2008; 165(6):695-702. DOI: 10.1176/appi.ajp.2008.07071061
Source: PubMed


How can we best develop explanatory models for psychiatric disorders? Because causal factors have an impact on psychiatric illness both at micro levels and macro levels, both within and outside of the individual, and involving processes best understood from biological, psychological, and sociocultural perspectives, traditional models of science that strive for single broadly applicable explanatory laws are ill suited for our field. Such models are based on the incorrect assumption that psychiatric illnesses can be understood from a single perspective. A more appropriate scientific model for psychiatry emphasizes the understanding of mechanisms, an approach that fits naturally with a multicausal framework and provides a realistic paradigm for scientific progress, that is, understanding mechanisms through decomposition and reassembly. Simple subunits of complicated mechanisms can be usefully studied in isolation. Reassembling these constituent parts into a functioning whole, which is straightforward for simple additive mechanisms, will be far more challenging in psychiatry where causal networks contain multiple nonlinear interactions and causal loops. Our field has long struggled with the interrelationship between biological and psychological explanatory perspectives. Building from the seminal work of the neuronal modeler and philosopher David Marr, the author suggests that biology will implement but not replace psychology within our explanatory systems. The iterative process of interactions between biology and psychology needed to achieve this implementation will deepen our understanding of both classes of processes.

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    • "To address this issue, some investigators have recently broadened the scope of research on vulnerability for affective lability to account for the fact that cognitive factors interact with biological processes and socialenvironmental exposures to shape risk for affective disorders . Indeed, several multi-factorial models of psychopathology have now been proposed (e.g., Gibb et al. 2013; Kendler 2008; Slavich and Irwin 2014; Slavich et al 2010). The most rapidly growing body of research in this context focuses on how genetic factors interact with environmental exposures to shape risk for affective disorders (e.g., Caspi et al. 2010; Munafó et al. 2009). "
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    ABSTRACT: Despite decades of research examining diathesis-stress models of emotional disorders, it remains unclear whether dysfunctional attitudes interact with stressful experiences to shape affect on a daily basis and, if so, how clinical and genetic factors influence these associations. To address these issues, we conducted a multi-level daily diary study that examined how dysfunctional attitudes and stressful events relate to daily fluctuations in negative and positive affect in 104 young adults. Given evidence that clinical and genetic factors underlie stress sensitivity, we also examined how daily affect is influenced by internalizing and externalizing symptoms and brain-derived neurotrophic factor (BDNF) genotype, which have been shown to influence neural, endocrine, and affective responses to stress. In multivariate models, internalizing symptoms and BDNF Val66Met genotype independently predicted heightened negative affect on stressful days, but dysfunctional attitudes did not. Specifically, the BDNF Met allele and elevated baseline internalizing symptomatology predicted greater increases in negative affect in stressful circumstances. These data are the first to demonstrate that BDNF genotype and stress are jointly associated with daily fluctuations in negative affect, and they challenge the assumption that maladaptive beliefs play a strong independent role in determining affective responses to everyday stressors. The results may thus inform the development of new multi-level theories of psychopathology and guide future research on predictors of affective lability.
    Cognitive Therapy and Research 06/2015; 39(3):366-377. DOI:10.1007/s10608-014-9657-1 · 1.70 Impact Factor
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    • "I remarked above that combining the perspectives of different levels into coherent explanations of mental illness is a difficult task. Whilst impressive work has been done—particularly by Kenneth Kendler (e.g. 2008, 2012) and by Kendler and John Campbell (e.g. 2009, 2014)—to demonstrate the need for multi-level explanations in psychiatry and to consider how they are best formulated, the question of what makes a good explanation for a given purpose has been ignored. We know, for example, that some cases of depression are best explained primarily in"
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    ABSTRACT: Multilevel explanations abound in psychiatry. However, formulating useful such explanations is difficult or (some argue) impossible. I point to several ways in which Lane et al. successfully use multilevel explanations to advance understanding of psychotherapeutic effectiveness. I argue that the usefulness of an explanation depends largely on one's purpose, and conclude that this point has been inadequately recognised in psychiatry. How to Cite This Article Link to This Abstract Blog This Article Copy and paste this link Highlight all Citation is provided in standard text and BibTeX formats below. Highlight all BibTeX Format @article{BBS:9749968,author = {Roache,Rebecca},title = {How does psychotherapy work? A case study in multilevel explanation},journal = {Behavioral and Brain Sciences},volume = {38},month = {1},year = {2015},issn = {1469-1825},doi = {10.1017/S0140525X14000284},URL = {},} Click here for full citation export options. Blog This Article Copy and paste this code to insert a reference to this article in your blog or online community profile: Highlight all How does psychotherapy work? A case study in multilevel explanation Rebecca Roache (2015). Behavioral and Brain Sciences , Volume 38 , January 2015e23 The code will display like this How does psychotherapy work? A case study in multilevel explanation Rebecca Roache (2015) Behavioral and Brain Sciences, , Volume 38, January 2015e23 Rebecca Roache (2015). How does psychotherapy work? A case study in multilevel explanation. Behavioral and Brain Sciences, 38, e23 doi:10.1017/S0140525X14000284 Metrics Related Content Related Articles
    Behavioral and Brain Sciences 05/2014; Forthcoming. DOI:10.1017/S0140525X14000284 · 20.77 Impact Factor
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    • "But, it is unclear to me that it is “valid” to conceive of mental disorders primarily in terms of simplistic singularly determining etiologies when accumulating empirical evidence indicates that the signs and symptoms of mental disorders develop in a highly contingent manner through complex interactions between biological factors and the environment. As Kendler [43] notes, social and cultural factors and the agency of the person with illness become entwined in their own right as pertinent, but not singular, explanatory factors. "
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    ABSTRACT: In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM--whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
    Philosophy Ethics and Humanities in Medicine 04/2012; 7:8. DOI:10.1186/1747-5341-7-8
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