A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment
Open accessAbstract
A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM-IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM-IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Although extant dimensional proposals may address some drawbacks associated with the DSM nosology (e.g., inadequate assessment of individual differences in disorder severity), these proposals do not reconcile key problems in current classification, such as modest reliability and high comorbidity. This article considers an alternative approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features.
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Emotional disorders involve sharp increases in affect in response to environmental triggers and interpreting those experiences as harmful.
“Emotional disorders are characterized by a tendency to experience steep increases in affect in response to environmental stimuli and, subsequently, interpret these emotional experiences as harmful (Andrews, 1990; Andrews, 1996; Brown & Barlow, 2009).”
From The role of negative affectivity and negative reactivity to emotions in predicting outcomes in the unified protocol for the transdiagnostic treatment of emotional disorders (2012) · cites this paper as Brown & Barlow, 2009
In “A New Proposal for a Dimensional Classification System” (page unavailable), the paper describes discrete eruptions of emotion, including fear triggered by internal or external cues, and apprehension about anxiety or panic symptoms. These examples support parts of the claim, but the paper does not characterize emotional disorders generally as a sequence of sharp affective increases in response to environmental stimuli followed by interpreting those experiences as harmful. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPsychological inflexibility as a transdiagnostic process has been described as a continuum or dimension that could contribute to most psychological disorders, with a growing body of research increasingly supporting this parsimonious approach.
“psychological inflexibility as a transdiagnostic process has been described as a continuum or dimension that could contribute to most psychological disorders (Hayes et al., 2011), with a growing body of research increasingly supporting this parsimonious approach (Levin et al., 2014;Brown & Barlow, 2009).”
From Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness (2016) · cites this paper as Brown & Barlow, 2009
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe transdiagnostic approach posits that emotional disorders are manifestations of a common psychopathological vulnerability, with neuroticism/negative affect/behavioral inhibition and low extraversion/positive affect/behavioral activation as key transdiagnostic factors.
“This approach posits that ED are manifestations of a common psychopathological vulnerability underlying these disorders, with neuroticism/negative affect/behavioral inhibition and low extraversion/positive affect/behavioral activation as key transdiagnostic factors (Brown and Barlow, 2009).”
From Feasibility, acceptability, and preliminary efficacy of a blended transdiagnostic group CBT for the treatment of emotional disorders (2025) · cites this paper as Brown and Barlow, 2009
In “Alternative Classification Systems” (page unavailable), the paper describes emotional disorders as manifestations of shared vulnerabilities and identifies neuroticism/negative affect and extraversion/positive affect as core temperament dimensions related to behavioral inhibition and activation. But it says low positive affect is associated particularly with depression and social anxiety, while mania is associated with high positive affect; the claim overgeneralizes low extraversion/positive affect/behavioral activation across emotional disorders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCross-sectional covariation of emotional disorders can be accounted for by a small set of latent variables, including high negative affectivity/neuroticism, low positive affectivity, and high autonomic arousal.
“cross-sectional covariation of emotional disorders can be accounted for by a small set of latent variables, including high negative affectivity/neuroticism, low positive affectivity, and high autonomic arousal.[26][27][28][29]”
From The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11 (2016) · cites this paper as [26]
The Abstract and Alternative Classification Systems section report that negative affectivity/neuroticism and positive affectivity account for substantial cross-sectional covariation among emotional disorders. The Limitations to the Current DSM System section describes high autonomic arousal as characteristic of PTSD and panic disorder/agoraphobia, but does not identify it as a higher-order variable accounting for that broader covariation. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNeuroticism has been shown to underlie the origin of EDs, as well as the high comorbidity present in these disorders.
“and has been shown to underlie the origin of EDs, as well as the high comorbidity present in these disorders (Brown and Barlow, 2009).”
From Unified Protocol for the transdiagnostic treatment of emotional disorders in people with post COVID-19 condition: study protocol for a multiple baseline n-of-1 trial (2023) · cites this paper as Brown and Barlow, 2009
The Abstract and Alternative Classification Systems section (page not supplied) describe neuroticism as etiologically relevant to emotional disorders and report that shared dimensions, including neuroticism, account for much of their covariation. But the paper says the correlational findings preclude firm conclusions about direction of effect, so the claim that neuroticism has been shown to underlie the disorders’ origin and comorbidity overstates the evidence. (LLM, conf=0.86)
Experimental — accuracy not yet measured
People with emotional disorders have higher levels of neuroticism/negative affect/behavioral inhibition than people who do not have any emotional disorder.
“people with EDs have higher levels of N/NA/BI [8]”
From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [8]
The Alternative Classification Systems section describes neuroticism/negative affect as relevant to emotional disorders and closely related to behavioral inhibition. It also reports substantial covariance between N/BI and emotional disorders. However, the passages do not establish the stated comparison with people who have no emotional disorder. (LLM, conf=0.81)
Experimental — accuracy not yet measuredNeuroticism/negative affect and extraversion/positive affect have been closely related to Gray's constructs of behavioral inhibition and behavioral activation, and these terms are often used interchangeably as the most stable measures of temperament.
“N/NA and E/PA have been closely related to Gray’s (1987) constructs of BI and BA, respectively [24-26], and these terms are often used interchangeably as the most stable measures of temperament [8,15,26,27].”
From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [8]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredTransdiagnostic approaches offer a pragmatic and parsimonious response to complexity and facilitate the translation of evidence-based protocols into practice.
“Transdiagnostic approaches, therefore, offer a pragmatic and parsimonious response to complexity and facilitate the translation of evidence-based protocols into practice (Barlow et al., 2004; Brown and Barlow, 2009; Mitchell, 2011; Bearman and Weisz, 2015; Norton and Paulus, 2015; Marchette and Weisz, 2017).”
From An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study (2021) · cites this paper as Brown and Barlow, 2009
The “Transdiagnostic treatment protocols” section (page unavailable) describes a unified approach that distills common procedures from evidence-based treatments and may avoid repeated, narrowly targeted interventions. This supports the pragmatic, parsimonious response to complexity, but the paper does not establish that the approach facilitates translating those protocols into clinical practice. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeople with emotional disorders experience more intense emotion in dealing with environmental stimuli and interpret their emotional experiences as threats.
“People with emotional disorders experience more intense emotion in dealing with environmental stimuli and interpret their emotional experiences as threats. 33”
From Emotion regulation as the mediator of reductions in anxiety and depression in the Unified Protocol (UP) for transdiagnostic treatment of emotional disorders: double-blind randomized clinical trial (2019) · cites this paper as [33]
In “Alternative Classification Systems” (page unavailable), the paper describes learning to regard some situations, objects, or internal bodily states as dangerous even when they are not. “A New Proposal for a Dimensional Classification System” (page unavailable) also describes fear triggered by relatively non-dangerous cues and apprehension about anxiety symptoms. These passages support the threat-interpretation aspect in specific circumstances, but do not establish that people with emotional disorders generally experience more intense emotions when dealing with environmental stimuli. (LLM, conf=0.80)
Experimental — accuracy not yet measuredThere is strong empirical and theoretical support for development of transdiagnostic treatment approaches because many cognitive, emotional, behavioural and interpersonal factors that drive symptomatology are consistent across disorders.
“There is strong empirical and theoretical support for development of transdiagnostic treatment approaches, as many of the cognitive, emotional, behavioural and interpersonal factors which drive symptomatology are consistent across disorders.12 13”
From The HARMONIC trial: Study protocol for a randomised controlled feasibility trial of Shaping Healthy Minds - A modular transdiagnostic intervention for mood, stressor-related and anxiety disorders in adults (2018) · cites this paper as [12]
The “Transdiagnostic treatment protocols” section (page unavailable) says research supports a unified approach to emotional disorders because they share features and therapeutic procedures. The discussion of the unified protocol identifies shared cognitive, emotional and behavioural targets, but our copy does not establish shared interpersonal factors or extend the argument beyond emotional disorders. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIf intolerance of uncertainty is a shared factor, it should appear in emotional disorders beyond generalized anxiety disorder and obsessive-compulsive disorder, which may help explain comorbidity.
“If this is the case for IU, then it should be present as a shared factor in not just GAD and OCD, but other emotional disorders as well, which may help to explain the high degree of comorbidity observed across different emotional disorders (Brown & Barlow, 2009).”
From Intolerance of Uncertainty: A Common Factor in the Treatment of Emotional Disorders (2013) · cites this paper as Brown & Barlow, 2009
Disorder-specific symptomatology observed in categorical models is thought to emerge from the interaction between common vulnerability factors with select psychological or biological influences.
“Disorder-specific symptomatology observed in categorical models is thought to emerge from the interaction between common vulnerability factors with select psychological or biological influences.[26,33]”
From The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11 (2016) · cites this paper as [26]
The unified protocol aims to address temperamental characteristics, particularly neuroticism and resulting emotion dysregulation, which are argued to be a common factor underlying all emotional disorders.
“The UP aims to address temperamental characteristics, particularly neuroticism and resulting emotion dysregulation, which are argued to be a common factor underlying all emotional disorders [46].”
From Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder—study protocol for a randomized controlled trial (2023) · cites this paper as [46]
Transdiagnostic approaches address the common characteristics found in cognitive, behavioral, emotional, and other dysregulation areas underlying different emotional disorders.
“transdiagnostic approaches have emerged that address the common characteristics found in cognitive, behavioral, emotional, and other dysregulation areas underlying different EDs, that is, the biological and psychological vulnerabilities shared by different mental disorders [7,8].”
From Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: Randomized controlled trial (2021) · cites this paper as [8]
Certain disorders cluster together reliably (e.g., anxiety and depression).
“certain disorders cluster together reliably (e.g., anxiety and depression; Brown and Barlow, 2009)”
From An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study (2021) · cites this paper as Brown and Barlow, 2009
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Self-citationUnified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide
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Big five personality factors and cigarette smoking: A 10-year study among US adults
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- Authors
- Brown, T. A., & Barlow, D. H.
- Affiliations
- Boston University (US)
- Venue
- Psychological Assessment
- Published
- 2009
- Volume
- 21
- Issue
- 3
- Pages
- 256-271
- ISSN
- 1040-3590 (ISSN-L)
- 1939-134X
- PMC
- PMC2845450
- OpenAlex
- W1999696094
- Cited by
- 639
- References
- 96
- Citations by year
- 2026: 17 · 2025: 18 · 2024: 30 · 2023: 47 · 2022: 38 · 2021: 47 · 2020: 43 · 2019: 48 · 2018: 42 · 2017: 64 · 2016: 36 · 2015: 39 · 2014: 50 · 2013: 30 · 2012: 38
- FWCI
- 37.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Assessment (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH039096)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- dimensional classification, anxiety disorders, mood disorders, DSM-IV, transdiagnostic treatment, diagnostic reliability, generalized anxiety disorder, panic disorder, specific phobia
- MeSH terms
- Anxiety Disorders, Humans, Longitudinal Studies, Male, Middle Aged, Models, Psychological, Psychotherapy, Temperament, Comorbidity, Mood Disorders, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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