Borsboom Denny
Department of Psychology, University of Amsterdam, Amsterdam, 1018, XA, The Netherlands.
World Psychiatry. 2017 Feb;16(1):5-13. doi: 10.1002/wps.20375.
In recent years, the network approach to psychopathology has been advanced as an alternative way of conceptualizing mental disorders. In this approach, mental disorders arise from direct interactions between symptoms. Although the network approach has led to many novel methodologies and substantive applications, it has not yet been fully articulated as a scientific theory of mental disorders. The present paper aims to develop such a theory, by postulating a limited set of theoretical principles regarding the structure and dynamics of symptom networks. At the heart of the theory lies the notion that symptoms of psychopathology are causally connected through myriads of biological, psychological and societal mechanisms. If these causal relations are sufficiently strong, symptoms can generate a level of feedback that renders them self-sustaining. In this case, the network can get stuck in a disorder state. The network theory holds that this is a general feature of mental disorders, which can therefore be understood as alternative stable states of strongly connected symptom networks. This idea naturally leads to a comprehensive model of psychopathology, encompassing a common explanatory model for mental disorders, as well as novel definitions of associated concepts such as mental health, resilience, vulnerability and liability. In addition, the network theory has direct implications for how to understand diagnosis and treatment, and suggests a clear agenda for future research in psychiatry and associated disciplines.
近年来，精神病理学的网络方法已被提出，作为一种概念化精神障碍的替代方式。在这种方法中，精神障碍源于症状之间的直接相互作用。尽管网络方法已经带来了许多新颖的方法和实质性应用，但它尚未作为一种精神障碍的科学理论得到充分阐述。本文旨在通过假设一组关于症状网络结构和动态的有限理论原则来发展这样一种理论。该理论的核心观点是，精神病理学症状通过无数的生物、心理和社会机制因果相连。如果这些因果关系足够强大，症状可以产生一定程度的反馈，使其自我维持。在这种情况下，网络可能会陷入紊乱状态。网络理论认为，这是精神障碍的一个普遍特征，因此可以将精神障碍理解为强连接症状网络的替代稳定状态。这一观点自然地引出了一个全面的精神病理学模型，包括一个针对精神障碍的通用解释模型，以及对诸如心理健康、恢复力、易感性和易患性等相关概念的新定义。此外，网络理论对如何理解诊断和治疗有直接影响，并为精神病学及相关学科的未来研究提出了明确的议程。
