Leadership through the National Institute of Mental Health (NIMH)

The NIMH is the country’s foremost institution of mental health research.  It has recently separated itself from any further research based on old research conventions. Starting in 2010, NIMH Director Thomas Insel, MD and Dr. Bruce Cuthbert launched a new research initiative called Research Domain Criteria (RDoC), which will redefine our ideas about brain disorders. The hope is that this new initiative will usher in a system which makes possible valid, reliable and predictable diagnosis and treatment.

In this section we have posted blogs and articles which describe the important concerns and intentions behind the formation of RDoC.

A Bit About RDoC

An underlying premise of RDoC is that a primary focus on symptoms can be confusing and unhelpful. As has been demonstrated in medical research, symptoms which look similar to each other can come from different sources and other symptoms, which actually come from the same source, can seem unrelated. Therefore, our symptom-based system of disorders should be replaced with disorders defined by specific biological markers and data based on experimentation rather than theory.

Dr. Insel is quick to underscore that RDoC will not bring clinical results soon. Rather, it sets an ambitious goal of accumulating information related to brain pathways which function within broad domains of human behavior. Picture a chart with the following rows:

  • Negative” (which includes fear, anxiety threat, frustration),
  • “Positive” (which includes reward learning and response, decision making, action),
  • “Cognitive” (which includes attention, perception, memory, control),
  • “Social Processes” (which includes attachment, socializing, self-awareness, understanding others)
  • “Arousal” (which includes circadian rhythms, sleep/wakefulness and arousal).

And now picture the following columns:

  • Molecule
  • Cell
  • Gene
  • Pathway
  • Physiology
  • Behavior
  • Assessments

Research will occur within any of the intersections of these rows and columns. (The actual matrix is a bit more complex and will change as research demands.) Approached this way, investigators will not gather subjects with “depression” in order to try to find what causes it. Instead they may gather patients with anxiety that also show significant activation in a specified brain area on a neuroimaging task – and compare these to other patients not meeting the criterion. These building blocks of information will eventually put together a bank of knowledge that will reveal much of how our brains work…and how they might vary from working well.

Ultimately a new classification system of brain disorders will emerge from this initiative. It is likely that disorders with familiar names like bipolar, OCD, autism and ADHD will disappear from the psychiatric vocabulary.