Abstract
BackgroundMental disorders are highly comorbid: people having one disorder are likely to have another as well. We explain empirical comorbidity patterns based on a network model of psychiatric symptoms, derived from an analysis of symptom overlap in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV).Principal FindingsWe show that a) half of the symptoms in the DSM-IV network are connected, b) the architecture of these connections conforms to a small world structure, featuring a high degree of clustering but a short average path length, and c) distances between disorders in this structure predict empirical comorbidity rates. Network simulations of Major Depressive Episode and Generalized Anxiety Disorder show that the model faithfully reproduces empirical population statistics for these disorders.ConclusionsIn the network model, mental disorders are inherently complex. This explains the limited successes of genetic, neuroscientific, and etiological approaches to unravel their causes. We outline a psychosystems approach to investigate the structure and dynamics of mental disorders.
Highlights
One of the major discoveries in the past century of psychopathology research is that comorbidity is the rule rather than the exception [1]
The DSM-IV lists 201 distinct mental disorders, which are diagnosed through 522 criteria
Sometimes the same symptoms function as criteria for distinct disorders, sometimes one symptom is a special case of another symptom, and sometimes two symptoms only differ with respect to their antecedent causes
Summary
One of the major discoveries in the past century of psychopathology research is that comorbidity (the joint occurrence of two or more mental disorders) is the rule rather than the exception [1]. Comorbidity is often investigated by analyzing the association between composite measures defined on two sets of items (i.e., a correlation between total scores on checklists) or between two diagnoses. This methodology has yielded important insights into which disorders co-occur more frequently than chance [1,4,5] and into risk factors that predispose towards comorbidity [6,7,8]. Shared genes or a general predisposition towards negative affect have been put forward as common causes of comorbidity between Major Depressive Episode (MDE) and Generalized Anxiety Disorder (GAD; [11,12]). We explain empirical comorbidity patterns based on a network model of psychiatric symptoms, derived from an analysis of symptom overlap in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)
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