A Network Approach to Mental Disorders Could Supplant the DSM
精神障礙的網絡方法優先治療相互關聯的症狀，而不是單一的診斷。
The network approach to mental disorders prioritizes treating interconnected symptoms rather than singular diagnoses.
利亞姆·巴赫-2022 年 4 月 27 日
By Liam G. Bach -April 27, 2022

目前的精神病診斷方法面臨著廣泛的批評。在一篇新文章中，Anne Roefs 和一組研究人員探索了一種將網絡方法應用於精神障礙的不同框架。網絡方法是根據個人的獨特症狀而不是“共同原因”方法來告知的，後者試圖標記導致個人經歷的症狀的疾病或狀況。
Current approaches to psychiatric diagnosis have faced widespread criticism. In a new article, Anne Roefs and a team of researchers explore a different framework applying a network approach to mental disorders. The network approach is informed by an individual’s unique symptoms rather than the “common cause” approach, which attempts to label a disorder or a condition that leads to the symptoms experienced by the individual.

值得注意的是，研究人員強調，網絡方法將合併症視為一個常數，而不是不幸的病例或煩惱。這就是框架之間的主要區別。他們解釋說：
Notably, the researchers emphasize that the network approach views comorbidity as a constant rather than an unfortunate case or annoyance. Herein lies a main difference between the frameworks. They explain:

“首先，DSM 和 ICD 源於醫學，並基於一個‘共同原因’框架，假設精神障礙由一個或多個潛在原因引起的症狀組成。這解釋了對特定精神障礙的潛在（主要是生物學）原因和最終共同途徑的持續搜索。對 ICD 和 DSM 中不同疾病的關注導致科學和治療都專注於不同的臨床診斷及其獨特原因。”
“First, the DSM and ICD have their roots in medicine and are based on a ‘common cause’ framework, assuming that a mental disorder consists of symptoms that all follow from one or more underlying causes. This explains the persistent search for underlying, mainly biological causes and final common pathways for specific mental disorders. The focus on separate disorders in ICD and DSM leads both science and treatments to concentrate on separate clinical diagnoses and their unique causes.”

“第二，合併症是規則而不是例外：精神障礙經常同時發生；至少有一半的精神障礙患者接受了兩次或兩次以上的診斷。”
“Second, comorbidity is the rule rather than the exception: Mental disorders frequently co-occur; at least half of the people with mental disorders receive two or more diagnoses.”

DSM 治療精神障礙的方法因試圖將完全健康/正常的行為病態化而受到批評。其他人則擔心誰會從這些可疑的說法中獲利。因此，DSM 及其作者經常因其方法而受到批評。這就是 Roefs 和她的團隊所做的研究發揮作用的地方。
The DSM approach to mental disorders has faced criticism for attempting to pathologize completely healthy/normal behaviors. Others have raised concerns about who profits from these questionable claims. Thus, the DSM and its authors are frequently criticized for their methods. This is where the research done by Roefs and her team comes into play.

網絡診斷方法將流行的診斷和隨後的治療過程視為本末倒置。也就是說，通過 DSM 進行的診斷試圖將一個人和他們的疾病放入一個盒子中，因此治療可能會變得不協調。另一方面，網絡方法不是根據診斷來治療個體，而是根據症狀來治療。
The network approach to diagnosis sees popular diagnosis and subsequent treatment processes as putting the cart before the horse. That is, diagnosis via the DSM attempts to put a person and their disorder into a box, and treatment can potentially become dissonant as a consequence. On the other hand, the network approach does not treat an individual based on a diagnosis but instead treats symptoms for what they are.

然而，Roefs 和她的團隊並不認為共同原因方法與網絡方法是相互排斥的。他們認為，症狀的原因不必被嚴厲地標記為一件事，嚴格來說不是另一件事——相反，症狀可能有近端原因和遠端原因。近端原因將是症狀的直接驅動因素。相反，遠端原因將是影響您的症狀的間接或相關條件，但不僅僅是導致它們，例如個性或社會經濟地位。
However, Roefs and her team don’t see the common cause approach as mutually exclusive with the network approach. They suggest that causes of symptoms need not be labeled harshly as just one thing and strictly not another thing—instead, symptoms may have proximal causes and distal causes. A proximal cause would be a direct driver of symptoms. In contrast, distal causes would be indirect or related conditions that affect your symptoms but don’t solely cause them, such as personality or socioeconomic status.

研究人員討論了網絡方法具有三個主要步驟：映射、縮放和定位。在映射中，症狀的列表和疾病的其他元素（元素等同於例如生活事件或環境）將被放置為斷開連接的節點。然後，在縮放中，將在節點之間繪製鏈接，以試圖找到症狀、元素和彼此之間的因果關係。最後，瞄準。
The researchers discuss that the network approach has three main steps: mapping, zooming, and targeting. In mapping, a list of symptoms and other elements of a disorder (elements being equivalent to, for example, life events or circumstances) would be placed as disconnected nodes. Then, in zooming, links would be drawn between nodes in an attempt to find causal relationships between symptoms, elements, and each other. Finally, targeting.

這就是它聽起來的樣子——以一種針對一個人的症狀和要素網絡進行個性化的方式來治療症狀，而不是遵循診斷指南。這就是合併症在診斷中不被視為不幸或煩人的因素，而是被視為精神病理學的一個完全可對抗甚至典型的方面的方式。從網絡方法的角度來看，合併症只是重疊/相互作用的症狀。
It is what it sounds like—treatment of the symptoms in a fashion that would be personalized to a person’s network of symptoms and elements, rather than adhering to the guidelines of a diagnosis. This is how comorbidity is treated not as an unlucky or annoying factor in diagnosis but as a wholly confrontable and even typical aspect of psychopathology. From the point of view of the network approach, comorbidity is simply symptoms that overlap/interact.

“網絡方法還為精神障礙為何高度共病這一問題提供了完全不同的視角。這些網絡本質上是跨診斷的；如果兩種疾病有共同的症狀，例如神經性厭食症和焦慮症之間共有的恐懼，則該症狀可以作為兩種疾病之間的橋樑，將兩個或多個網絡連接成一個單一的系統。從這個角度來看，高水平的合併症不是方法論的假象，而是由不尊重診斷界限的複雜關係的真實模式造成的：從這個意義上說，合併症是精神障礙的內在特徵，而不是令人討厭的東西。”
“The network approach also sheds an entirely different light on the question of why mental disorders are highly comorbid. These networks are transdiagnostic by nature; if two disorders share a symptom, such as, for example, fear that is shared between anorexia nervosa and anxiety disorders, the symptom may operate as a bridge between the two disorders, connecting two or more networks into one single system. From this point of view, high levels of comorbidity are not methodological artifacts but result from real patterns of complex relations that do not respect diagnostic boundaries: In this sense, comorbidity is an intrinsic feature of mental disorders, rather than a nuisance.”

雖然作者認為網絡方法對心理治療具有潛在的革命性意義，但也存在挑戰。一方面，網絡方法可能會延長某人開始治療所需的時間。這是因為繪製出症狀和元素網絡是一個比識別預先構建的診斷更複雜的過程。
While the authors see the network approach as potentially revolutionary for psychotherapy, there are challenges. For one, the network approach may extend the time it takes for someone to begin treatment. This is because mapping out a network of symptoms and elements is a more involved process than identifying a pre-constructed diagnosis.

此外，只有在充分了解症狀和網絡方法干預措施的情況下，才能創建網絡。治療策略將更加個性化，每個病例都可能是新的和獨特的。即使整個世界的治療師和心理學家都立即相信網絡方法的好處，仍然需要一個學習曲線才能有效地使用它。
Also, networks can only be created with a great understanding of symptoms and network-approach interventions. Treatment strategies would be far more personalized, and every case may be new and unique. Even if the entire world of therapists and psychologists were to be instantly convinced of the benefits of the network approach, there would still be a learning curve for it to be used effectively.

“為了在臨床實踐中採用網絡方法，必須為治療師配備工具和培訓，以便相對快速地獲得客戶自己的網絡，並使用這些來指導他們的網絡知情診斷和治療。治療師也應該接受教育和培訓，以進行適當的基於網絡的干預。”
“For the network approach to be adopted in clinical practice, it is essential to equip therapists with tools and training to relatively quickly obtain networks of their clients themselves and to use these to guide their network-informed diagnoses and treatments. Therapists should also be educated and trained in the performance of adequate network-based interventions.”

作者說，如果他們的研究表明他們的主張是正確的，他們的目標是在臨床實踐中實施網絡方法進行診斷和治療。
The authors say that if their research shows validity in their claims, they aim to implement the network approach to diagnosis and treatment in clinical practice.

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Roefs, A., Fried, EI, Kindt, M., Martijn, C., Elzinga, B., Evers, AWM, Wiers, RW, Borsboom, D., & Jansen, A. (2022)。精神障礙的新科學：使用個性化的、跨診斷的、動態的系統來理解、建模、診斷和治療精神病理學。行為研究與治療，104096。https ://doi.org/10.1016/j.brat.2022.104096 （鏈接）
Roefs, A., Fried, E. I., Kindt, M., Martijn, C., Elzinga, B., Evers, A. W. M., Wiers, R. W., Borsboom, D., & Jansen, A. (2022). A new science of mental disorders: Using personalised, transdiagnostic, dynamical systems to understand, model, diagnose and treat psychopathology. Behaviour Research and Therapy, 104096. https://doi.org/10.1016/j.brat.2022.104096 (Link)

利亞姆·巴赫Liam 於 2021 年畢業於巴德學院，獲得生物學/心理學雙學位，擁有生態學和藝術背景。利亞姆感興趣的是關注主導話語如何運作以構建更廣泛的社會問題，包括氣候變化和社會正義努力，作為需要個人管理的個人問題。他打算在 2022 年繼續攻讀博士學位——同時，他將閱讀、寫作、繪畫和睡覺。

Liam G. BachLiam graduated from Bard College as a Biology/Psychology double major in 2021 and has a background in ecology and art. Liam brings an interest in attending to how dominant discourses operate to construct broader social issues, including climate change and social justice efforts, as individual problems in need of individual management. He intends to pursue doctoral studies in 2022—in the meantime, he will be reading, writing, drawing, and sleeping.