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Transdiagnostic psychiatry: a systematic review
Open accessAbstract
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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“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
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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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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Disorder of Selfhood in Schizophrenia: A Symptom or a Gestalt?
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Self-citationAllesøe, 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 47
Prioritization of Psychopathological Symptoms and Clinical Characterization in Psychiatric Diagnoses
Leucht, S., van Os, J., Jäger, M., & Davis, J. M. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.2652 · Cited by 53
TRANSD recommendations: improving transdiagnostic research in psychiatry
Fusar‐Poli, P. (2019) · World Psychiatry · doi:10.1002/wps.20681 · Cited by 43
Self-citationTanaka, M. (2025) · Biomedicines · doi:10.3390/biomedicines13010167 · Cited by 53
“Rather than grouping disorders solely by clinical symptom clusters, RDoC and HiTOP focus on core domains of functioning—such as cognition, emotion, and arousal—linked to measurable biological constructs, behavioral data, and neural circuits [258,259].”
Muñoz‐Navarro, R., Medrano, L. A., Limonero, J. T., González‐Blanch, C., Moriana, J. A., Ruiz‐Rodríguez, P., & Vindel, A. C. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.029 · Cited by 54
Antibiotic resistant bacteria: A bibliometric review of literature
Sun, G., Zhang, Q., Dong, Z., Dong, D., Fang, H., Wang, C., Dong, Y., Wu, J., Tan, X., Zhu, P., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1002015 · Cited by 46
Antuña‐Camblor, C., Gómez-Salas, F. J., Burgos-Julián, F. A., González, A., Juarros‐Basterretxea, J., & Rodríguez‐Díaz, F. J. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2997 · Cited by 46
Fusar‐Poli, P., Oliver, D., Spada, G., Patel, R., Stewart, R. J., Dobson, R., & McGuire, P. K. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00109 · Cited by 39
Self-citationPatten, R. V., Mulhauser, K. R. W., Austin, T. A., Bellone, J. A., Cotton, E., Chan, L. C. N., Twamley, E. W., Sawyer, K., & LaFrance, W. C., Jr. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102648 · Cited by 44
Exercise as a transdiagnostic intervention for improving mental health: An umbrella review
Solmi, M., Basadonne, I., Bodini, L., Rosenbaum, S., Schuch, F. B., Smith, L., Stubbs, B., Firth, J., Vancampfort, D., Ashdown‐Franks, G., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.02.024 · Cited by 44
Self-citationFusar‐Poli, P., Stringer, D., Durieux, A. M. S., Rutigliano, G., Bonoldi, I., Micheli, A. D., & Stahl, D. R. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0600-9 · Cited by 37
““transdiagnostic” (29) because it can be applied at scale across several ICD-10 index”
BackgroundMethodSelf-citationHumphreys, G., Evans, R. K., Makin, H., Cooke, R. W. I., & Jones, A. (2020) · Journal of Medical Internet Research · doi:10.2196/22694 · Cited by 37
“The identification of common underlying behavioral mechanisms suggests that interventions targeting these broad behaviors, rather than tailoring them to specific symptoms, may be beneficial for a greater number of individuals [25,26].”
Uher, R., Pavlová, B., Najafi, S., Adepalli, N., Ross, B., Vallis, E. H., Freeman, K., Parker, R. M. N., Propper, L., & Palaniyappan, L. K. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105625 · Cited by 36
Wang, T., Oliver, D., Msosa, Y. J., Colling, C., Spada, G., Roguski, Ł., Folarin, A., Stewart, R. J., Roberts, A., Dobson, R., et al. (2020) · Journal of Visualized Experiments · doi:10.3791/60794 · Cited by 36
“…of at-risk individuals, we developed an automated, lifespan-inclusive (i.e., across all ages), transdiagnostic (i.e., across different diagnoses) 13 , clinically-based individualized risk calculator, which can detect individuals at-risk of psychosis in secondary mental health care at scale,…”
MethodSelf-citationFord, J. D. (2021) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00415-4 · Cited by 43
Wen, J., Antoniades, M., Yang, Z., Hwang, G., Skampardoni, I., Wang, R., & Davatzikos, C. A. (2024) · Biological Psychiatry · doi:10.1016/j.biopsych.2024.04.017 · Cited by 38
Genesis, modelling and methodological remedies to autism heterogeneity
Rabot, J., Rødgaard, E.-M., Joober, R., Dumas, G., Bzdok, D., Bernhardt, B., Jacquemont, S., & Mottron, L. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105201 · Cited by 31
EMDR Therapy as a Transdiagnostic Psychotherapy
Dominguez, S. K. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780192898357.013.18 · Cited by 32
Psychological flexibility and cognitive-affective processes in young adults’ daily lives
Westhoff, M., Heshmati, S., Siepe, B. S., Vogelbacher, C., Ciarrochi, J., Hayes, S. C., & Hofmann, S. G. (2024) · Scientific Reports · doi:10.1038/s41598-024-58598-3 · Cited by 40
Pan, N., Wang, S., Qin, K., Li, L., Chen, Y., Zhang, X., Lai, H., Suo, X., Long, Y., Yu, Y., et al. (2022) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2022.06.003 · Cited by 33
“Thus, ADHD and BPD may have shared neural substrates 90 apart from those behavioral similarities, indicating a transdiagnostic phenotype 91 following a common psychopathological pathway (7,26).”
BackgroundSantos‐Carrasco, D., & la Casa, L. G. D. (2023) · BMC Psychology · doi:10.1186/s40359-023-01253-9 · Cited by 34
“This model contributes to the understanding of psychopathological comorbidity, and allows the generalization of knowledge between disorders [2].”
BackgroundMethodFonseca‐Pedrero, E., Pérez‐Albéniz, A., Al‐Halabí, S., Lucas‐Molina, B., Sierra, J. O., Díez-Gómez, A., Pérez‐Sáenz, J., Inchausti, F., Valero-García, A. V., García, A. G., et al. (2023) · Clínica y Salud · doi:10.5093/clysa2023a3 · Cited by 37
Shared and distinct developmental pathways to ASD and ADHD phenotypes among infants at familial risk
Miller, M. R., Austin, S., Iosif, A., de la Paz, L., Chuang, A., Hatch, B., & Ozonoff, S. J. (2020) · Development and Psychopathology · doi:10.1017/s0954579420000735 · Cited by 30
“Person-centered approaches better recognize the overlap of symptoms and may help explain some of the heterogeneity inherent to clinical classification systems (Fusar-Poli et al., 2019).”
BackgroundKim, H. S. A., Hodgins, D. C., Kim, B. B., & Wild, T. C. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9020334 · Cited by 32
“Yet, empirical studies testing transdiagnostic conceptualizations of disorders in general are rare, particularly in the addiction field [14].”
BackgroundSchirmbeck, F. N., van der Burg, N. C., Blankers, M., Vermeulen, J. M., McGuire, P. K., Valmaggia, L., Kempton, M. J., van der Gaag, M., Riecher‐Rössler, A., Bressan, R. A., et al. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbab088 · Cited by 29
Self-citationReal-world digital implementation of the Psychosis Polyrisk Score (PPS): A pilot feasibility study
Oliver, D., Spada, G., Englund, A., Chesney, E., Radua, J., Reichenberg, A., Uher, R., McGuire, P., & Fusar-Poli, P. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.04.015 · Cited by 27
“This allows for transdiagnostic detection of individuals at risk for psychosis beyond the CHR-P approach (Fusar-Poli, 2019; Fusar-Poli et al., 2019c).”
Self-citationXie, J., Fang, P., Zhang, Z., Luo, R., & Dai, B. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.644882 · Cited by 27
Luciano, M., Sampogna, G., Vecchio, V. D., Giallonardo, V., Palummo, C., Andriola, I., Amore, M., Rossi, R., Carmassi, C., Siracusano, A., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.114073 · Cited by 31
“This finding may be explained by the fact that physical health in patients with SMI is not influenced by any specific psychiatric diagnostic category but by certain psychopathological dimensions, supporting the importance of a transdiagnostic approach to mental health care (Reininghaus et al., 2019; Fusar-Poli et al.,…”
BackgroundTransdiagnostic psychiatry goes above and beyond classification
Mansell, W. (2019) · World Psychiatry · doi:10.1002/wps.20680 · Cited by 26
Culturally diverse families of young children with ASD in Sweden: Parental explanatory models
Engstrand, R. Z., Hirvikoski, T., Allodi, M. W., & Roll‐Pettersson, L. (2020) · PLoS ONE · doi:10.1371/journal.pone.0236329 · Cited by 27
Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults
Rumball, F., Antal, K., Happe, F. G. E., & Grey, N. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2020.103836 · Cited by 29
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Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review.
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“…this is the first systematic review to synthesize findings from case-control studies investigating predictive coding paradigms across different diagnostic clusters following the TRANSD recommendation to improve trans-diagnostic research in psychiatry (Fusar-Poli, 2019; Fusar-Poli et al., 2019).”
Self-citationVink, J. M., Treur, J. L., Pasman, J. A., & Schellekens, A. (2020) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.32822 · Cited by 23
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Păsărelu, C.-R., Dobrean, A., Andersson, G., & Zaharie, G. C. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100479 · Cited by 23
Transdiagnostic structural neuroimaging features in depression and psychosis: A systematic review
Lalousis, P. A., Wood, S. J., Reniers, R. L. E. P., Schmaal, L., Azam, H., Mazziota, A., Saeed, H., Wragg, C., & Upthegrove, R. (2023) · NeuroImage Clinical · doi:10.1016/j.nicl.2023.103388 · Cited by 22
Schäfer, S. K., Kunzler, A. M., Lindner, S., Broll, J., Stoll, M., Stoffers-Winterling, J. M., & Lieb, K. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2196762 · Cited by 23
Metadata
- 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
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-05-06
- Volume
- 18
- Issue
- 2
- Pages
- 192-207
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- 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
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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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