Transdiagnostic psychiatry: a systematic review

Fusar‐Poli, Paolo; Solmi, Marco; Brondino, Natascia; Davies, Cathy; Chae, Chungil; Politi, Pierluigi; Borgwardt, Stefan; Lawrie, Stephen M.; Parnas, Josef; McGuire, Philip

doi:10.1002/wps.20631

Cited by 409Mental Health Research TopicsPersonality Disorders and PsychopathologyAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Transdiagnostic psychiatry: a systematic review

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Fusar‐Poli, Paolo, Solmi, Marco, Brondino, Natascia, Davies, Cathy, Chae, Chungil, Politi, Pierluigi, Borgwardt, Stefan, Lawrie, Stephen M. +2 more·2019·World Psychiatry

DOI 10.1002/wps.20631PMC PMC6502428

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Abstract

The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the “transdiagnostic” approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self‐defining transdiagnostic research meets such high expectations. A multi‐step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word “transdiagnostic” in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical “TRANSD”iagnostic recommendations are proposed here to guide future research in this field.

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The systematic review was performed following the PRISMA statement guidelines and the TRANSD recommendation to improve transdiagnostic research in psychiatry.
“We performed a systematic review following the PRISMA statement guidelines (Page et al., 2021) and the TRANSD recommendation to improve transdiagnostic research in psychiatry (Fusar-Poli, 2019; Fusar-Poli, Solmi, et al., 2019).”
From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Fusar-Poli, Solmi, et al., 2019
A systematic review and meta-analysis found a significant overlap in electrophysiological markers across ADHD, ASD, Tourette's syndrome, and obsessive-compulsive disorder.
“Furthermore, a systematic review and meta-analysis of electrophysiological correlates of performance monitoring in four common childhood disorders - attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Tourette's syndrome, and obsessive-compulsive disorder -found a significant overlap in electrophysiological markers across these disorders 13,14”
From Candidate diagnostic biomarkers for neurodevelopmental disorders in children and adolescents: a systematic review (2023) · cites this paper as [14]
The review’s table of included studies lists transdiagnostic neuroscience work, including visual evoked potentials, but does not report the claimed finding. Searches for Tourette’s syndrome, performance monitoring, and electrophysiological overlap found no passage addressing a significant overlap across ADHD, ASD, Tourette’s syndrome, and OCD. (LLM, conf=0.76)
Experimental — accuracy not yet measured
There are frequently reporting inconsistencies (e.g., definition of the gold-standard DSM/ICD diagnoses, outcome measures, and type of transdiagnostic approach) and low quality of studies, with few findings externally replicated.
“First, there are frequently reporting inconsistencies (e.g., definition of the gold-standard DSM/ICD diagnoses, outcome measures, and type of transdiagnostic approach) and low quality of studies, with few findings externally replicated 211”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [211]

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A transdiagnostic approach to examining the incremental predictive power of emotion regulation and basic personality dimensions.
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Transdiagnostic neural correlates of affective face processing in anxiety and depression
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Transdiagnostic differences in the resting-state functional connectivity of the prefrontal cortex in depression and schizophrenia
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Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial
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Transdiagnostic brain responses to disorder-related threat across four psychiatric disorders
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Classification of psychopathology: conceptual and historical background
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Mediators of transdiagnostic group cognitive behavior therapy
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“Throwing out the baby with the bathwater”? Conceptual and methodological limitations of the HiTOP approach
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M c L ean O n T rack: a transdiagnostic program for early intervention in first‐episode psychosis
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A randomized controlled trial of a transdiagnostic Internet intervention for individuals with panic and phobias – one size fits all
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Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment
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Improving classification of psychoses
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Changes in threat-related cognitions and experiential avoidance in group-based transdiagnostic CBT for anxiety disorders
Espejo, E. P., Gorlick, A., & Castriotta, N. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.006 · Cited by 29 · see citing works
Children with social anxiety and other anxiety disorders show similar deficits in habitual emotional regulation: evidence for a transdiagnostic phenomenon
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A real world dissemination and implementation of Transdiagnostic Behavior Therapy (TBT) for veterans with affective disorders
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Dimensions fit the data, but can clinicians fit the dimensions?
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Cognitive Behavioral Therapy for Postdisaster Distress: A Promising Transdiagnostic Approach to Treating Disaster Survivors
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Categorical and Dimensional Conceptions of Personality Pathology in DSM-5: Toward a Model-Based Synthesis
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The Transdiagnostic Nature of Metacognitions in Women With Eating Disorders
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Transdiagnostic internet-delivered cognitive-behaviour therapy (CBT) for adults with functional gastrointestinal disorders (FGID): A feasibility open trial
Dear, B. F., Fogliati, V. J., Fogliati, R., Gandy, M., McDonald, S., Talley, N. J., Holtmann, G., Titov, N., & Jones, M. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.02.015 · Cited by 23 · see citing works
Transdiagnostic emotional vulnerabilities linking obsessive-compulsive and depressive symptoms in a community-based sample of adolescents
Chasson, G. S., Bello, M. S., Luxon, A. M., Graham, T. A. A., & Leventhal, A. M. (2017) · Depression and Anxiety · doi:10.1002/da.22669 · Cited by 22 · see citing works
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The shared and specific relationships between exposure to potentially traumatic events and transdiagnostic dimensions of psychopathology
Sunderland, M., Carragher, N., Chapman, C., Mills, K. L., Teesson, M., Lockwood, E., Forbes, D., & Slade, T. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.001 · Cited by 21 · see citing works
Epistemological error and the illusion of phenomenological continuity
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Transdiagnostic cognitive behavioural treatment and the impact of co-morbidity: An open trial in a cohort of primary care patients
Kristjánsdóttir, H., Salkovskis, P. M., Sigurðsson, B. H., Sigurðsson, E., Agnarsdóttir, A., & Sigurðsson, J. F. (2015) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2015.1081404 · Cited by 19 · see citing works
Transdiagnostic Cognitive Behavioral Therapy and the Return of the Repressed
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Transdiagnostic neural markers of emotion–cognition interaction in psychotic disorders.
Sabharwal, A., Szekely, A., Kotov, R., Mukherjee, P., Leung, H., Barch, D. M., & Mohanty, A. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000196 · Cited by 18 · see citing works
The association between traumatic life events and psychological symptoms from a conservative, transdiagnostic perspective
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Examining a transdiagnostic measure of repetitive thinking in depressed, formerly depressed and never-depressed individuals
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Categorical and/or continuous? Learning from vascular surgery
Fulford, K. W. M., & Handa, A. I. (2018) · World Psychiatry · doi:10.1002/wps.20565 · Cited by 16 · see citing works
Transdiagnostic psychopathology mediates the relationship between childhood sexual abuse and HIV/AIDS and other sexually transmitted infections in adulthood
Latack, J. A., Rodriguez-Seijas, C. A., Stohl, M., Blanco, C., Hasin, D. S., & Eaton, N. R. (2015) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2015.06.002 · Cited by 15 · see citing works
Transdiagnostic assessment of anxiety symptoms using the Anxiety Disorder Diagnostic Questionnaire – weekly version
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Prospective cohort feasibility study of a transdiagnostic group intervention for common mental health problems: The <scp>T</scp> ake <scp>C</scp> ontrol <scp>C</scp> ourse
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HiTOP must meet the use requirements of the ICD before it can aspire to replace it
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Elucidating the transdiagnostic dimensional structure of trauma-related psychopathology: Findings from VA cooperative study 504 – risperidone treatment for military service related chronic post traumatic stress disorder
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The dialectic of quantity and quality in psychopathology
Jablensky, A. V. (2018) · World Psychiatry · doi:10.1002/wps.20562 · Cited by 12 · see citing works
Transdiagnostic psychiatric symptoms related to visual evoked potential abnormalities
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Delusions, epistemology and phenophobia
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Quality of Life Outcomes Following Transdiagnostic Group Cognitive-Behavioral Therapy for Anxiety
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Quantitative classification as (re‐)descriptive psychopathology
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Personal Meaning: A Neglected Transdiagnostic Construct
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Are plasma homocysteine and methionine elevated when binging and purging behavior complicates anorexia nervosa? Evidence against the transdiagnostic theory of eating disorders
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Research works printed but not linked: 22

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“A comprehensive transdiagnostic assessment in CHR-P individual is essential to inform preventive care.”
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Identification of transdiagnostic psychiatric disorder subtypes using unsupervised learning
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Anhedonia across borders: transdiagnostic relevance of reward dysfunction for noninvasive brain stimulation endophenotypes
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Real-world implementation of precision psychiatry: Transdiagnostic risk calculator for the automatic detection of individuals at-risk of psychosis
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“Therefore, a transdiagnostic approach (Fusar-Poli, 2019; Fusar-Poli et al., 2019c) which includes the CHR-P state as well as going beyond it, is essential to improve detection of psychosis risk in the larger scale.”
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Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes
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“A Kruskal322 Wallis H test showed that there is a statistically significant difference between the outer 323 cross-validation folds (CV2) BAC of the different models H(3)=22.”
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“However, the retrieved papers frequently contained the recollection of individuals’ past histories, thus indexing the prodromal (often transdiagnostic) features predating a formal psychiatric diagnosis 24 .”
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Golombek, K., Lidle, L. R., Tuschen‐Caffier, B., Schmitz, J., & Vierrath, V. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01359-9 · Cited by 53 · see citing works
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Minhas, M., Murphy, C. M., Balodis, I. M., Acuff, S. F., Buscemi, J., Murphy, J. G., & MacKillop, J. M. (2020) · Appetite · doi:10.1016/j.appet.2020.105052 · Cited by 47 · see citing works
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Allesøe, R. L., Thompson, W. K., Bybjerg‐Grauholm, J., HOUGAARD, D. M., Nordentoft, M., Werge, T. M., Rasmussen, S., & Benros, M. E. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2022.4076 · Cited by 43 · see citing works
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Transdiagnostic psychiatry goes above and beyond classification
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Authors: Fusar‐Poli, P., Solmi, M., Brondino, N., Davies, C., Chae, C., Politi, P., Borgwardt, S., Lawrie, S. M., Parnas, J., & McGuire, P.
Affiliations: King's College London (GB)
University of Padua (IT)
University of Pavia (IT)
Pennsylvania State University (US)
University of Basel (CH)
University of Edinburgh (GB)
University of Copenhagen (DK)
ORCID: Fusar‐Poli, Paolo
Solmi, Marco
Brondino, Natascia
Davies, Cathy
Chae, Chungil
Politi, Pierluigi
Borgwardt, Stefan
Lawrie, Stephen M.
Parnas, Josef
McGuire, Philip
Venue: World Psychiatry
Publisher: Wiley
Published: 2019-05-06
Volume: 18
Issue: 2
Pages: 192-207
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/wps.20631
PMC: PMC6502428
OpenAlex: W2944431228
Cited by: 409
References: 151
Citations by year: 2026: 59 · 2025: 70 · 2024: 48 · 2023: 52 · 2022: 52 · 2021: 67 · 2020: 40 · 2019: 20 · 2017: 1
FWCI: 6.68
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: World Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
Research Portal (King's College London) (submittedVersion, other-oa)
Padua Research Archive (University of Padova) (submittedVersion)
Funders: King's College London
Medical Research Council (MC_PC_16048)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: transdiagnostic psychiatry, psychiatric classification, DSM, ICD, mental illness, transdiagnostic features, anxiety disorders, depressive disorders, transdiagnostic treatment, research quality, research recommendations

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