title: The Network Structure of Symptoms of the Diagnostic and Statistical Manual of Mental Disorders.
abstract: Although current classification systems have greatly contributed to the reliability of psychiatric diagnoses, they ignore the unique role of individual symptoms and, consequently, potentially important information is lost. The network approach, in contrast, assumes that psychopathology results from the causal interplay between psychiatric symptoms and focuses specifically on these symptoms and their complex associations. By using a sophisticated network analysis technique, this study constructed an empirically based network structure of 120 psychiatric symptoms of twelve major DSM-IV diagnoses using cross-sectional data of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, second wave; N = 34,653). The resulting network demonstrated that symptoms within the same diagnosis showed differential associations and indicated that the strategy of summing symptoms, as in current classification systems, leads to loss of information. In addition, some symptoms showed strong connections with symptoms of other diagnoses, and these specific symptom pairs, which both concerned overlapping and non-overlapping symptoms, may help to explain the comorbidity across diagnoses. Taken together, our findings indicated that psychopathology is very complex and can be more adequately captured by sophisticated network models than current classification systems. The network approach is, therefore, promising in improving our understanding of psychopathology and moving our field forward.
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Lynn
authors.initials: L
authors.lastname: Boschloo
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Claudia D
authors.initials: CD
authors.lastname: van Borkulo
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mijke
authors.initials: M
authors.lastname: Rhemtulla
authors.affiliation: Department of Psychiatry / Department of Epidemiology, Columbia University, New York City, New York, United States of America.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
authors.affiliation: Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Denny
authors.initials: D
authors.lastname: Borsboom
authors.affiliation: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
mesh_terms: D000342:Affective Symptoms; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology; D011599:Psychopathology