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April 7, 2021

A New Consensus Framework for Phenotyping and Treatment Selecting in Addiction and Obsessive-Compulsive–Related Disorders

Author Affiliations
  • 1BrainPark, The Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia
  • 2D’Or Institute for Research and Education and Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
JAMA Psychiatry. 2021;78(7):699-700. doi:10.1001/jamapsychiatry.2021.0243

Since Kraepelin,1 clinicians have focused on the art of differential diagnosis. Yet almost a century after the final edition of his seminal text, the lack of clear boundaries between nosologies, characterized by within-disorder heterogeneity, arbitrary thresholds, poor diagnosis-to-treatment validity, and increased comorbidity,2 still confounds psychiatric classification. We are now witnessing an exponential growth in initiatives probing common etiologic processes to facilitate the development of novel treatments that specifically target pathophysiologic mechanisms irrespective of diagnostic silos. In keeping with this paradigm shift, 90 world experts in addiction and compulsions with at least 5 years of clinical or research experience and 50 peer-reviewed publications, among other criteria, were brought together to determine the transdiagnostic dimensions most relevant for understanding and treating addictive and compulsive behaviors. Guided by the National Institute of Mental Health Research Domain Criteria,3 experts iteratively examined the existing evidence base to form a unifying consensus framework of biologically validated initiators of addictions and obsessive-compulsive–related disorders (OCRDs).

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