Functional Psychopathology: A Diagnostic Approach to Enhance the Return of Human Brain and Behaviour Research

Abstract

Diagnosis is the very bedrock of psychiatric research, particularly biological psychiatric research. If one aspires to elucidate the neurobiological underpinnings of abnormal mental phenomena precise definition of those phenomena is essential. It is hard to imagine that diagnostic constructs of substantial heterogeneity and unproven validity will turn out to have a definable pathophysiology. But that is just what the nosological constructs that psychiatry is so attached to are: crude and global, indications of abnormal mental conditions, each with substantial variability in terms of symptomatology, aetiology, course, outcome and treatment response and mostly of unproven validity. Hence the nosological model of mental disorders is ill-suited for (biological) psychiatric research. An alternative diagnostic model, called the functional psychopathological model, is formulated. An essential component of this approach forms the analysis of the psychic dysfunctions underlying psychopathological symptoms. With this model as a starting point, biological research is less geared towards the pathophysiology of categorical entities, or syndromes, but towards well-defined and carefully measured psychic dysfunctions, such as disturbances in anxiety, aggression and mood regulation, in impulse control and in particular cognitive functions, to mention only a few. Development and application of the functional approach in psychiatric diagnosing will not only enhance the chance of finding meaningful relations between neurobiological and psychic dysfunctions, but will provide psychiatric diagnosing, at last, with a solid scientific foundation.