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Moving beyond descriptive nosology: an argument for negative valence systems disorder

Neuropsychopharmacology volume 49, pages 323–324 (2024)Cite this article

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How does anxiety get diagnosed? There is no blood test, brain scan, or specific biomarker. If you come into the emergency room with chest pain, troponin levels are checked, an EKG is performed, and the patient typically gets aspirin and oxygen. If cardiac and GI causes are ruled out, the diagnosis of exclusion is often anxiety (i.e. a panic attack). This type of care narrative led the field to develop the Research Domain Criteria Initiative (RDoC) to develop constructs that transcend nosological boundaries to focus research on behavioral signatures with a common biology [1]. The RDoC framework has been in place since 2009, leading to potential diagnostic biomarkers across the mental health continuum, including anxiety disorders.

In an examination of well-established assessments and the RDoC constructs of negative valence systems (NVS), positive valence systems (PVS), cognitive systems, and social processes representing a diverse transnosological population (n = 1431), a four factor model showed a good fit across the studied sample suggesting a universal latent structure that spans across mental disorders [2]. Another comprehensive assessment of PVS and NVS processing in subjects (n = 120) from primary care clinics with anxiety or mood disorders found the top component was NVS [3]. These studies (plus hundreds of others) suggest that NVS represents an independent, brain-based dimension in clinical populations.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, Heersink School of Medicine, 1719 6th Ave S, CIRC 593, Birmingham, AL, 35233, USA

    Elizabeth K. Lucas

  2. Department of Neurosciences, University of Toledo, College of Medicine & Life Sciences, 179 Block Health Science Building, Toledo, OH, 43606, USA

    Robert E. McCullumsmith

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  1. Elizabeth K. Lucas
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  2. Robert E. McCullumsmith
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EKL and REM wrote, edited, and approved the manuscript.

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Correspondence to Robert E. McCullumsmith.

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The authors declare no competing interests.

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Lucas, E.K., McCullumsmith, R.E. Moving beyond descriptive nosology: an argument for negative valence systems disorder. Neuropsychopharmacol. 49, 323–324 (2024). https://doi.org/10.1038/s41386-023-01694-1

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