Creating an Alternative to Syndromal Diagnosis: Needed Features of Processes of Change and the Models that Organize Them

In plain language

For decades, mental health care has been organized around syndromes: checklists of signs and symptoms (like "five out of nine" criteria) that define disorders in the DSM and ICD, matched to approved treatment protocols. This opening chapter of the book Beyond the DSM argues that this "protocols-for-syndromes" strategy, whatever it once achieved, has reached a dead end — a conclusion echoed by the DSM-5 planning committee itself, which admitted that refining DSM-defined syndromes may never uncover their underlying causes.

The authors ask what a genuine alternative would need to look like. They argue that the field should shift from labeling collections of symptoms to identifying processes of change — the dynamic, theory-based mechanisms that move people toward or away from wellbeing. Good process models, they argue, must have precision, scope, and depth (coherence with findings at other levels of analysis, from physiology to culture). They also highlight a striking mathematical problem: because of the ergodic theorem, statistics based on differences between people cannot be assumed to describe change within any individual person — so processes of change must be studied repeatedly at the level of the individual over time.

The chapter proposes an organizing "model of models" — an extended evolutionary meta-model in which variation, selection, retention, and context operate across six psychological dimensions (affect, cognition, attention, self, motivation, and overt behavior), nested within sociocultural and physiological levels. This framework sets the agenda for process-based diagnosis and therapy: the more of this matrix a clinical model can specify and target, the more useful it will be for understanding and helping the individual person.

Key findings

• Syndromal (DSM/ICD) diagnosis has failed to identify functional entities; the DSM-5 planning committee itself concluded that research focused on refining DSM syndromes may never uncover their etiologies.
• The NIMH, through its Research Domain Criteria initiative, has already turned away from the protocols-for-syndromes strategy toward a process-oriented direction.
• Useful models of processes of change must combine precision, scope, and depth — coherence with established findings at other levels of analysis such as physiology and culture.
• Because people are not identical or unchanging, the ergodic theorem shows that statistics based on between-person variation cannot properly model within-person change; processes must be identified idiographically, across time, before making nomothetic generalizations.
• The chapter proposes an extended evolutionary meta-model: variation, selection, retention, and context operating across affect, cognition, attention, self, motivation, and overt behavior, nested in sociocultural and physiological levels of selection.
• Process-based models are judged more adequate the more of this multidimensional, multilevel matrix they specify in targeted processes of change and intervention kernels.

How to cite

APA

Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2020). Creating an alternative to syndromal diagnosis: Needed features of processes of change and the models that organize them. In S. C. Hayes & S. G. Hofmann (Eds.), Beyond the DSM: Toward a process-based alternative for diagnosis and mental health treatment. Context Press.

BibTeX

@incollection{hayes2020creating,
  title     = {Creating an Alternative to Syndromal Diagnosis: Needed Features of Processes of Change and the Models that Organize Them},
  author    = {Hayes, Steven C. and Hofmann, Stefan G. and Ciarrochi, Joseph},
  booktitle = {Beyond the DSM: Toward a Process-Based Alternative for Diagnosis and Mental Health Treatment},
  editor    = {Hayes, Steven C. and Hofmann, Stefan G.},
  publisher = {Context Press},
  address   = {Oakland, CA},
  year      = {2020}
}

Related work

• All publications by Joseph Ciarrochi (searchable, with free PDFs)
• Process-Based Therapy & Idionomic Analysis
• The Process-Based Assessment Tool (free download)

Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version.