Week 1 - Introduction

Psychopathology

The field of psychology which aims to understand the aetiology, nature and treatment of mental disorders

Developmental psychopathology

Aims to understand how psychopathology emerges over the lifespan, the study of developmental processes that contribute to, or protect against, psychopathology

Which terms are problematic and shouldn’t be used

“disorder”, “atypical”, “problems”

Which terms are neutral and recommended to use

“conditions”, “presentations”, “differences”

Brofenbrenner’s ecological systems theory (1979)

Microsystem, mesosystem, exosystem, macrosystem

Neuro-constructivism (Karmiloff-Smith)

Expression of certain genetic traits affect how we engage with the environment → the starting state is not the same across individuals.

Developmental trajectories result from the interaction between neural systems development/functioning and environmental factors.

Problems with categories and dimensions

• You cannot “have” or “not have at all” a certain condition

• Co-occurrence (primary vs secondary diagnoses)

• Interventions for certain diagnoses may not match the needs of those asking for support

• Categorical approaches ignore diversity in socio-cultural context in which conditions may emerge and evolve

• Conditions not static: clinicians only see a snapshot capturing behavioural patterns at a particular time

Diagnosis

Scoring above a threshold/at least X symptoms (DSM/ICD)

Transdiagnostic

Cutting across traditional diagnostic boundaries

Participatory research

Individuals with lived experiences of neurodevelopmental/mental health conditions are actively involved in many (if not all) aspects of the research

Co-design

Designing with, not for, people, to align research priorities with the real needs of individual and society

Neurodiversity

We are all different in how we think, feel and learn because our brains process information differently

Neurotypical

The majority of people who process information in a similar way and based on which systems and approaches are generally designed

Neurodivergent

People who process information in a different way to the majority

Neuro-affirmative

Being aware that systems must be changed to consider the needs of all individuals and ensure that everyone is represented. When designing systems and services, people who are not represented by the majority must be consulted and understood

Intersectionality and developmental psychopathology

• Assessment and diagnosis

• Interventions and support

• Research and knowledge generation

• Policymaking and societal views

Benefits of DSM and ICD (Dalgleish et al., 2020)

• Sociopolitical - diagnoses offer a biomedical legitimacy to discourse about mental health

• Pragmatic - diagnostic paradigm offers clear benefits to clinical and research practice, and medical model at heart of it brings a legitimacy to the suffering experienced, reducing stigma

Challenges for the diagnostic paradigm (Dalgleish et al., 2020)

1. Underlying biopsychosocial processes are transdiagnostic - mental conditions emerge from biological, behavioural, and environmental processes that do not respect diagnostic boundaries

2. Symptom space is dimensional - binary notions of present versus absent, but mental conditions are not all or none phenomena, and someone experiencing distress may fall short of diagnosis and not receive support

3. Heterogeneity within diagnoses - e.g. 16,400 different symptom profiles for MDD (Fried & Nesse, 2015)

4. Incomplete symptom capture - assessment instruments differ markedly in signs and symptoms

5. Diagnosis-driven clinical intervention - diagnostic paradigm facilitated clinical intervention, but this has led to single-disorder approaches which are endorsed by NICE, glossing over co-morbid conditions

What is HiTOP? (Dalgleish et al., 2020)

A hierarchical framework that emerged from multiple data sets with a combined sample of over 100,000. It includes a general factor of psychopathology followed by a number of broad dimensions

Advantages of dimensional frameworks like HiTOP (Dalgleish et al., 2020)

• Grounded in empirical science

• Greater reliability than discrete diagnoses, both between raters and across time

• Dimensional structure maps more closely onto underlying biopsychosocial processes

• Dimensions provide more compelling framework for thinking about course of mental health conditions over time, compared to imprecise notions of remission, recovery, in episode

Issues with dimensional frameworks like HiTOP (Dalgleish et al., 2020)

• Focus of these approaches is to reorganise the same symptom space that is scope of the diagnostic approach

• No theory, which makes it hard to see how dimensional models can translate into clinical approaches

What is the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders? (Dalgleish et al., 2020)

Promotes a one-size-fits-all approach where all clients receive the same set of therapeutic elements that have been carefully selected to have the broadest applicability across diagnoses

Advantages of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Dalgleish et al., 2020)

• Clinical application easier as there is no bespoke selection of intervention elements

• Clinical training facilitated so minimises barriers to dissemination, compared with standard training models that involve learning multiple treatment protocols for different disorders

Disadvantages of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Dalgleish et al., 2020)

• Their universality precludes tailored selection of treatment elements to the particular presentations of individual clients

What are modular approaches? (Dalgleish et al., 2020)

Comprise sets of evidence-based self-contained functional units (therapy modules) that can operate independently and be delivered flexibly so that module selection and order are tailored to needs of each client, e.g. The Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) for children

Advantages of modular approaches (Dalgleish et al., 2020)

• Better goodness-of-fit between the therapy and the individual clinical presentation

Disadvantages of modular approaches (Dalgleish et al., 2020)

• More challenging to deliver than universal protocols, requires algorithm to match module delivery to the separate requirements of each client

Challenges for transdiagnostic science (Dalgleish et al., 2020)

• Development of relevant theory - most of the transdiagnostic field rests on atheoretical foundations, must develop theories that transcend diagnosis-specific frameworks that currently drive clinical intervention

What did Morris et al. (2025) propose?

That neurodevelopmental conditions should no longer be under the mental health disorder classification, but reclassified as neurodevelopmental, making a diagnostic and statistical manual of neurodevelopmental and mental disorders. This is to accurately reflect differences between neurodevelopmental conditions and mental health conditions and recognise their high co-occurence

What does including neurodevelopmental conditions in the DSM imply? (Morris et al., 2025)

Pathology and the need for treatment, but neurodevelopmental conditions are not pathological