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      Putting the “mental” back in “mental disorders”: a perspective from research on fear and anxiety


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          Mental health problems often involve clusters of symptoms that include subjective (conscious) experiences as well as behavioral and/or physiological responses. Because the bodily responses are readily measured objectively, these have come to be emphasized when developing treatments and assessing their effectiveness. On the other hand, the subjective experience of the patient reported during a clinical interview is often viewed as a weak correlate of psychopathology. To the extent that subjective symptoms are related to the underlying problem, it is often assumed that they will be taken care of if the more objective behavioral and physiological symptoms are properly treated. Decades of research on anxiety disorders, however, show that behavioral and physiological symptoms do not correlate as strongly with subjective experiences as is typically assumed. Further, the treatments developed using more objective symptoms as a marker of psychopathology have mostly been disappointing in effectiveness. Given that “mental” disorders are named for, and defined by, their subjective mental qualities, it is perhaps not surprising, in retrospect, that treatments that have sidelined mental qualities have not been especially effective. These negative attitudes about subjective experience took root in psychiatry and allied fields decades ago when there were few avenues for scientifically studying subjective experience. Today, however, cognitive neuroscience research on consciousness is thriving, and offers a viable and novel scientific approach that could help achieve a deeper understanding of mental disorders and their treatment.

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          Most cited references138

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          Diagnostic and Statistical Manual of Mental Disorders

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            Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

            Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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              Research domain criteria (RDoC): toward a new classification framework for research on mental disorders.


                Author and article information

                Mol Psychiatry
                Mol Psychiatry
                Molecular Psychiatry
                Nature Publishing Group UK (London )
                26 January 2022
                26 January 2022
                : 27
                : 3
                : 1322-1330
                [1 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Department of Psychiatry and Addictology, , Université de Montréal, ; Montreal, Canada
                [2 ]GRID grid.420732.0, ISNI 0000 0001 0621 4067, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, ; Montreal, Canada
                [3 ]GRID grid.137628.9, ISNI 0000 0004 1936 8753, Department of Philosophy, , New York University, ; New York, NY 1003 USA
                [4 ]GRID grid.474690.8, RIKEN Center for Brain Science, ; Wako, Japan
                [5 ]GRID grid.10253.35, ISNI 0000 0004 1936 9756, Department of Clinical Psychology, , Philipps-University Marburg, ; Marburg, Germany
                [6 ]GRID grid.189504.1, ISNI 0000 0004 1936 7558, Department of Psychological and Brain Sciences, , Boston University, ; Boston, MA USA
                [7 ]GRID grid.137628.9, ISNI 0000 0004 1936 8753, Center for Neural Science and Department of Psychology, , New York University, ; New York, NY 1003 USA
                [8 ]GRID grid.240324.3, ISNI 0000 0001 2109 4251, Department of Psychiatry, and Department of Child and Adolescent Psychiatry, , New York University Langone Medical School, ; New York, NY 1003 USA
                Author information
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                : 23 April 2021
                : 11 November 2021
                : 19 November 2021
                Funded by: FundRef https://doi.org/10.13039/501100000024, Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada);
                Funded by: FundRef https://doi.org/10.13039/501100011730, Templeton World Charity Foundation (Templeton World Charity Foundation, Inc.);
                Award ID: RA537-01
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/100005156, Alexander von Humboldt-Stiftung (Alexander von Humboldt Foundation);
                Award ID: U01MH108168
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/100000913, James S. McDonnell Foundation (McDonnell Foundation);
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                © The Author(s), under exclusive licence to Springer Nature Limited 2022

                Molecular medicine
                Molecular medicine
                psychology, neuroscience


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