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Whither Research Domain Criteria (RDoC)?  The Good, the Bad, and the Ugly

Daniel R. Weinberger, MD1,2; Ira D. Glick, MD3; Donald F. Klein, MD4,5
[+] Author Affiliations
1Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, Maryland
2Departments of Psychiatry, Neurology, and Neuroscience and the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
4Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York
5Nathan Kline Institute, Orangeburg, New York
JAMA Psychiatry. 2015;72(12):1161-1162. doi:10.1001/jamapsychiatry.2015.1743.
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This Viewpoint opposes adoption of the Research Domain Criteria (RDoC) initiative to replace categorical with dimensional diagnoses.

Do we need to replace categorical with dimensional diagnoses to make progress in psychiatry research? No.

The release of Research Domain Criteria (RDoC), which occurred coincident with publication of the DSM-5, has been touted as offering a superior classification system for psychiatric disorders. Its advantage is supposedly based on mechanisms rather than symptoms. Pushback from clinicians and researchers13 has led to partial refashioning of RDoC goals, from initial emphasis on improved diagnosis to revised claims of a scientific nosology for clinical research. For any new scheme for patient categorization to be an advance, it has to prove superior on multiple levels to the consensus clinical tactics of DSM-5. We doubt that this will occur with RDoC because it lacks the very scientific foundation that it proclaims. We lay out our “con” argument in homage to Sergio Leone.

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