TRANSD recommendations: improving transdiagnostic research in psychiatry
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There is no doubt that transdiagnostic research in psychiatry has gained momentum over recent years. However, what is meant by transdiagnostic research, and the impact it has on current psychiatric practice, is much less clear. The adjective "transdiagnostic" itself does not exist in English dictionaries, and even online medical dictionaries recommend searching the words "trans" and "diagnostic" separately. The word "transdiagnostic" is not only a neologism, but it also exclusively applies to psychiatry. While diagnoses are ubiquitous in medical research and practice, there are no consolidated exemplars of transdiagnostic research in other branches of medicine. To characterize the actual meaning and the clinical impact of transdiagnostic research in psychiatry, a systematic review was recently conducted following state-of-the-art evidence synthesis guidelines1. Although, as a matter of fact, the word "transdiagnostic" has been historically introduced by cognitive behavioral theories and treatments for eating disorders2, in that review1 there was no restriction on any a priori definition of transdiagnostic research. On the contrary, the review focused on articles reporting on any transdiagnostic topics: interventions (45%), cognition and psychological processes (28%), neuroscientific topics (13%), classification (4%) and prediction studies (10%). To systematically appraise the evidence without superimposing a priori conceptual schemata of transdiagnostic research, the review performed an epistemological test and empirically included and interrogated articles that self-proclaimed transdiagnostic by explicitly using the word "transdiagnostic" in their title1. High-order conceptual reviews of research initiatives that have implicitly adopted a transdiagnostic approach, such as the Research Domain Criteria (RDoC) project, the Hierarchical Taxonomy of Psychopathology (HiTOP) approach, the p-factor construct (none of which have yet replaced the current classification systems in clinical routine), and the clinical staging model, have been recently presented and fully debated in this3-5 or other6 journals, and as such were not the main focus of the systematic review1. The core finding of this review was that transdiagnostic designations in psychiatry are applied in a loose and unstandardized way, encompassing several different and often incoherent conceptualizations1. For example, one would expect studies that self-proclaim transdiagnostic to somewhat address issues relating to the diagnosis of mental disorders. Paradoxically, some of the studies reviewed were intrinsically incompatible with a transdiagnostic framework because they investigated symptoms and not disorders or, to the extreme, reported no diagnostic information at all1. Another illustrative example is the fact that authors themselves disagree on the ultimate aim of transdiagnostic research. Some of them claim that transdiagnostic research is a fundamental pathway to clinical utility for improving psychiatric classification and diagnosis7, while others argue that the transdiagnostic approach does not primarily target the improvement of psychiatric classification and diagnosis, but rather tests a general theory of psychopathology8. A further example is the fact that, until the publication of this systematic review1, the empirical limitations and reporting quality of transdiagnostic research remained unaddressed: appraising and acknowledging the specific limitations of a certain domain of knowledge is equally, if not more, important as celebrating its successes. It may well be that some versions of a transdiagnostic approach are going to be necessary to improve psychiatric classification and care7. What is certain is that, until studies continue to loosely and incoherently self-proclaim transdiagnostic without acknowledging any diagnostic information, it is unlikely that transdiagnostic research will bear any real-world meaning for clinicians, patients, and medical practice. Similarly, poor reporting on the number and type of (trans)diagnostic spectra prevents the appraisal, refinement, and eventual integration of categorical and dimensional approaches in psychiatric classification. The systematic review acknowledged that transdiagnostic categorical approaches that respect dimensionality are possible in organic medicine as well as in psychiatry1, but this requires transparent reporting of the results. For example, the largest transdiagnostic study published to date demonstrated that it is possible to report the diagnostic information for almost all ICD-10 mental disorders9. Furthermore, while it is possible that transdiagnostic interventions may display superior efficiency, cost-effectiveness, accessibility, and patient-reported satisfaction compared to specific-diagnostic interventions8, demonstrating this would require robust comparative analyses specifically conducted to test the non-inferiority or superiority of the transdiagnostic approach. These ana
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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, 2019
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- Authors
- Fusar‐Poli, P.
- Affiliations
- King's College London (GB)
- Corresponding author
- Fusar‐Poli, Paolo
- ORCID
- Fusar‐Poli, Paolo
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2019-09-09
- Volume
- 18
- Issue
- 3
- Pages
- 361-362
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6732677
- OpenAlex
- W2973034624
- Cited by
- 43
- References
- 9
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 11 · 2020: 10
- FWCI
- 7.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Decision Sciences › Information Systems and Management › Interdisciplinary Research and Collaboration
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- psychiatric diagnosis, Research Domain Criteria, Hierarchical Taxonomy of Psychopathology, p-factor, clinical staging model, psychiatric classification, conceptualization of mental disorders, epistemology of psychiatry, eating disorders, cognitive behavioral therapy, depression, anxiety disorders, schizophrenia, bipolar disorder
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