Transdiagnostic Perspectives
As a means to actively work to remove bias from assessment, a transdiagnostic approach to assessment and treatment is recommended and central to Numinus Training courses and clinical operations.
A transdiagnostic perspective is characterized by the identification of symptoms or traits that underlie human suffering across diagnostic categories (Koçárová et al., 2021).
Transdiagnostic Approaches
There are two primary approaches to transdiagnostics.
Descriptively Transdiagnostic
A construct is descriptively transdiagnostic when it can be found in several disorders (Dalgleish, 2020).
Mechanically Transdiagnostic
A construct is mechanically transdiagnostic when it is causally related to several disorders (Dalgleish, 2020).
Example
Anhedonia is a criterion for the diagnosis of major depressive disorder and also experienced by those with anxiety or substance use disorders. In addition, oppression, poverty, trauma, and other psychosocial factors can result in anhedonia (Dalgleish, 2020).
Descriptively Transdiagnostic
Anhedonia is descriptively transdiagnostic because it is a criterion for diagnosis across categories (even though it’s only included once in the DSM under major depressive disorder) (Dalgleish, 2020).
Mechanically Transdiagnostic
Anhedonia may mechanically be transdiagnostic since it could explain the development or maintenance of not just major depressive disorder but also anxiety or substance use disorders (Dalgleish, 2020).
Health Professional Tip
A trauma- and violence-informed care and JEDI approach to psychedelic-assisted therapy includes applying a mechanically transdiagnostic approach to diagnosis and treatment planning.
Justice, Equity, Dignity, and Inclusion
As discussed in the Fundamentals of Psychedelic-Assisted Therapy course, healthcare has historically (and presently) been unsafe for Black, Indigenous, and Peoples of Colour to access. A transdiagnostic approach works to combat racism, discrimination, and bias by encouraging health professionals to acknowledge the multiple factors that go beyond distinct diagnostic categories, like in the DSM, which allow room for racism, discrimination, and bias (Riquino et al., 2021).
Additional Perspectives
Complementary to a transdiagnostic approach are a sociological and a strengths-based perspective on diagnosis and treatment.
Socioecological Perspective
A socioecological perspective situates individual pathological understanding beyond decontextualized individual-level variables (such as individual risk factors or symptoms). As such, consideration is given to systemic forces that may result in maladaptive behaviour and functioning on an individual level, such as racism and other systems of oppression. This practice acknowledges the role of intersectionality when meeting with clients.
Strengths-Based Perspective
A strengths-based perspective aligns with trauma- and violence-informed care in the sense that it emphasizes how suffering is informed by systems of privilege and oppression. Assessment is also considered an opportunity to explore potential sources of power available to clients through identifying internal strengths and family, neighbourhood, and community resources and networks, rather than only relating to clients as persons experiencing psychological stress and burden.
Health Professional Tip
Given most clinicians’ requirement to be familiar with DSM categorical conceptualization of mental illness, we recommend balancing the application of DSM-based diagnostic familiarity with both TVIC strengths-based, and JEDI-informed socioecological perspectives, while also considering transdiagnostic perspectives discussed below.
Until a decision is made to reject the DSM by the mental health community as a whole, we aim to prepare health professionals to operate in a field that relies on diagnostic labels both clinically and in research, while also operating from a broader perspective that is less inclined to perpetuate the harms of categorical norms created by historically male-dominated White Supremacist institutions.
Learn More
More recently, a self-report measure, the Multidimensional Emotional Disorder Inventory (MEDI), was developed with seven empirically derived dimensional categories for generating a profile approach to categorizing symptom presentations based on transdiagnostic vulnerabilities and phenotypes (e.g., neurotic temperament, positive temperament, autonomic arousal, intrusive cognitions) (Rosellini et al., 2015). This tool provides a possible model for developing an inventory of symptoms so that they can be approached transdiagnostically.
To learn more, please read Rosellini et al. (2015).
References
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of consulting and clinical psychology, 88(3), 179–195.
Riquino, M. R., Nguyen, V. L., Reese, S. E., & Molly, J. (2021). Using a transdiagnostic perspective to disrupt white supremacist applications of the DSM. Advances in Social Work, 21(3), 766-778.