A complex network approach to clinical science
Abstract
Contemporary classification systems assume that psychiatric disorders are expressions of latent disease entities. However, some critics point to the comorbidity problem and other issues that question the validity of the latent disease model. An alternative to this traditional view is the complex network approach. This approach assumes that disorders exist as systems of inter‐connected elements, without requiring that the elements are expressions of latent disease entities. Depending on the structure of the network, change can occur abruptly once the network reaches a tipping point. A dynamic complex network approach could be used to develop a functional analytic case conceptualization that may predict treatment change, relapse and recovery, thereby linking nosology and treatment. In conclusion, the complex network perspective offers an alternative and less restrictive approach to the latent disease model, while offering exciting new directions for future research in psychiatry.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Instead of a monocausal latent disease model for understanding illnesses, a network approach is recommended, conceptualizing mental illness from a multicausal network of interacting symptoms and associated processes, where specific syndromes are the result of dynamically self-reinforcing clusters.
“Instead of a monocausal latent disease model for understanding illnesses, a network approach is recommended, conceptualizing mental illness from a multicausal network of interacting symptoms and associated processes, where specific syndromes are the result of dynamically self-reinforcing clusters [120, 121].”
From Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. (2024) · cites this paper as [120]
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Early-warning signals for critical transitions
Scheffer, M., Bascompte, J., Brock, W. A., Brovkin, V., Carpenter, S. R., Dakos, V., Held, H., van Nes, E. H., Rietkerk, M., & Sugihara, G. (2009) · Nature · doi:10.1038/nature08227 · Cited by 4,854 · see citing works
Qgraph: Network visualizations of relationships in psychometric data
Epskamp, S., Cramer, A., Waldorp, L., Schmittmann, V., & Borsboom, D. (2012) · Journal of Statistical Software · doi:10.18637/jss.v048.i04 · Cited by 4,844 · see citing works
Network analysis: An integrative approach to the structure of psychopathology
Borsboom, D., & Cramer, A. O. J. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185608 · Cited by 4,359 · see citing works
International Statistical Classification of Diseases and Related Health Problems
(2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_3055 · Cited by 4,181 · see citing works
Conventional wisdom on measurement: A structural equation perspective.
Bollen, K., & Lennox, R. (1991) · Psychological Bulletin · doi:10.1037/0033-2909.110.2.305 · Cited by 3,618 · see citing works
Anticipating Critical Transitions
Scheffer, M., Carpenter, S. R., Lenton, T. M., Bascompte, J., Brock, W., Dakos, V., van de Koppel, J., van de Leemput, I. A., Levin, S. A., van Nes, E. H., et al. (2012) · Science · doi:10.1126/science.1225244 · Cited by 2,208 · see citing works
On the nature and direction of relationships between constructs and measures.
Edwards, J. R., & Bagozzi, R. P. (2000) · Psychological Methods · doi:10.1037/1082-989x.5.2.155 · Cited by 1,747 · see citing works
Comorbidity: a network perspective
Cramer, A. O. J., Waldorp, L. J., van der Maas, H. L. J., & Borsboom, D. (2010) · Behavioral and Brain Sciences · doi:10.1017/s0140525x09991567 · Cited by 1,575 · see citing works
The Diagnosis of Mental Disorders: The Problem of Reification
Hyman, S. E. (2010) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091532 · Cited by 1,052 · see citing works
Moving Forward: Challenges and Directions for Psychopathological Network Theory and Methodology
Fried, E. I., & Cramer, A. O. J. (2017) · Perspectives on Psychological Science · doi:10.1177/1745691617705892 · Cited by 957 · see citing works
The Future of Intervention Science: Process-Based Therapy
Hofmann, S. G., & Hayes, S. C. (2019) · Clinical Psychological Science · doi:10.1177/2167702618772296 · Cited by 888 · see citing works
Self-citationCritical slowing down as early warning for the onset and termination of depression
van de Leemput, I. A., Wichers, M., Cramer, A. O. J., Borsboom, D., Tuerlinckx, F., Kuppens, P., van Nes, E. H., Viechtbauer, W., Giltay, E. J., Aggen, S. H., et al. (2013) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1312114110 · Cited by 773 · see citing works
Psychometric perspectives on diagnostic systems
Borsboom, D. (2008) · Journal of Clinical Psychology · doi:10.1002/jclp.20503 · Cited by 691 · see citing works
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012) · Depression and Anxiety · doi:10.1002/da.21888 · Cited by 630 · see citing works
Self-citationKrueger, R. F., & Markon, K. E. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032813-153732 · Cited by 605 · see citing works
Mental Disorders as Causal Systems: A Network Approach to Posttraumatic Stress Disorder
McNally, R. J., Robinaugh, D. J., Wu, G. W. Y., Wang, L., Deserno, M. K., & Borsboom, D. (2015) · Clinical Psychological Science · doi:10.1177/2167702614553230 · Cited by 592 · see citing works
Barlow, D. H., Ellard, K. K., Sauer-Zavala, S., Bullis, J. R., & Carl, J. R. (2014) · Perspectives on Psychological Science · doi:10.1177/1745691614544528 · Cited by 491 · see citing works
Epskamp, S., van Borkulo, C. D., van der Veen, D. C., Servaas, M. N., Isvoranu, A.-M., Riese, H., & Cramer, A. O. J. (2018) · Clinical Psychological Science · doi:10.1177/2167702617744325 · Cited by 448 · see citing works
Critical Slowing Down as a Personalized Early Warning Signal for Depression
Wichers, M., Groot, P. C., & Psychosystems, E. G. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000441458 · Cited by 399 · see citing works
Exploring the idiographic dynamics of mood and anxiety via network analysis
Fisher, A. J., Reeves, J. W., Lawyer, G., Medaglia, J. D., & Rubel, J. A. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000311 · Cited by 385 · see citing works
A complex network perspective on clinical science
Hofmann, S. G., Curtiss, J., & McNally, R. J. (2016) · Perspectives on Psychological Science · doi:10.1177/1745691616639283 · Cited by 366 · see citing works
Self-citationFried, E. I., Nesse, R. M., Zivin, K., Guille, C., & Sen, S. (2013) · Psychological Medicine · doi:10.1017/s0033291713002900 · Cited by 302 · see citing works
Complex network analysis of time series
Gao, Z., SMALL, M. P., & Kurths, J. (2016) · Europhysics Letters (EPL) · doi:10.1209/0295-5075/116/50001 · Cited by 302 · see citing works
Bridging the Nomothetic and Idiographic Approaches to the Analysis of Clinical Data
Beltz, A. M., Wright, A. G. C., Sprague, B. N., & Molenaar, P. C. M. (2016) · Assessment · doi:10.1177/1073191116648209 · Cited by 293 · see citing works
Network analysis of persistent complex bereavement disorder in conjugally bereaved adults.
Robinaugh, D. J., LeBlanc, N. J., Vuletich, H. A., & McNally, R. J. (2014) · Journal of Abnormal Psychology · doi:10.1037/abn0000002 · Cited by 219 · see citing works
Cramer, A. O. J., Borsboom, D., Aggen, S. H., & Kendler, K. S. (2012) · Psychological Medicine · doi:10.1017/s003329171100211x · Cited by 168 · see citing works
Accessibility in complex networks
Travençolo, B. A. N., & Costa, L. D. F. (2008) · Physics Letters A · doi:10.1016/j.physleta.2008.10.069 · Cited by 129 · see citing works
Using network science and text analytics to produce surveys in a scientific topic
Silva, F. N., Amancio, D. R., Bardosova, M., Costa, L. D. F., & Oliveira, O. N. (2016) · Journal of Informetrics · doi:10.1016/j.joi.2016.03.008 · Cited by 128 · see citing works
Using network science and text analytics to produce surveys in a scientific topic
Silva, F. N., Amancio, D. R., Bardosova, M., Costa, L. D. F., & Oliveira, O. N. (2016) · RePEc: Research Papers in Economics · Cited by 117 · see citing works
Why psychiatry is a branch of medicine
Guzé, S. B. (1992) · Medical Entomology and Zoology · Cited by 100 · see citing works
The ontology of posttraumatic stress disorder: Natural kind, social construction, or causal system?
McNally, R. J. (2012) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12001 · Cited by 94 · see citing works
A Complex Network Approach to Stylometry
Amancio, D. R. (2015) · PLoS ONE · doi:10.1371/journal.pone.0136076 · Cited by 89 · see citing works
Knowledge acquisition: A Complex networks approach
de Arruda, H. F., Silva, F. N., Costa, L. D. F., & Amancio, D. R. (2017) · Information Sciences · doi:10.1016/j.ins.2017.08.091 · Cited by 75 · see citing works
Amancio, D. R., Oliveira, O. N., & Costa, L. D. F. (2012) · Physica A Statistical Mechanics and its Applications · doi:10.1016/j.physa.2012.04.011 · Cited by 60 · see citing works
Curtiss, J. E., & Klemanski, D. H. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.04.007 · Cited by 52 · see citing works
Self-citationLongitudinal Network Stability of the Functional Impairment of Anxiety and Depression
Curtiss, J. E., Ito, M., Takebayashi, Y., & Hofmann, S. G. (2017) · Clinical Psychological Science · doi:10.1177/2167702617745640 · Cited by 19 · see citing works
Self-citationComplex Networks and Systems Biology
Roy, U., Grewal, R. K., & Roy, S. (2014) · Systems and Synthetic Biology · doi:10.1007/978-94-017-9514-2_7 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Robinaugh, D. J., Hoekstra, R. H. A., Toner, E. R., & Borsboom, D. (2020) · Psychological Medicine · doi:10.1017/s0033291719003404 · Cited by 861 · see citing works
Jusup, M., Holme, P., Kanazawa, K., Takayasu, M., Romić, I., Wang, Z., Geček, S., Lipić, T., Boris Podobnik, A., Wang, L., et al. (2022) · Physics Reports · doi:10.1016/j.physrep.2021.10.005 · Cited by 662 · see citing works
The role of the individual in the coming era of process-based therapy
Hayes, S. C., Hofmann, S. G., Stanton, C. E., Carpenter, J. K., Sanford, B. T., Curtiss, J. E., & Ciarrochi, J. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.10.005 · Cited by 295 · see citing works
Self-citationHayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104155 · Cited by 234 · see citing works
Self-citationThe Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients With Chronic Pain
Penedo, J. M. G., Rubel, J. A., Blättler, L., Schmidt, S. J., Stewart, J., Egloff, N., & Holtforth, M. G. (2019) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000797 · Cited by 100 · see citing works
The Complex Interplay of Pain, Depression, and Anxiety Symptoms in Patients with Chronic Pain
Gomez Penedo, J. M., Rubel, J. A., Blättler, L. T., Schmidt, S. J., Stewart, J. A., Egloff, N., & Holtforth, M. G. (2020) · Bern Open Repository and Information System (University of Bern) · doi:10.7892/boris.138276 · Cited by 75 · see citing works
Kratzer, L., Heinz, P., Schennach, R., Knefel, M., Schiepek, G. K., Biedermann, S. V., & Büttner, M. (2020) · Psychological Medicine · doi:10.1017/s0033291720001750 · Cited by 50 · see citing works
Personalised depression forecasting using mobile sensor data and ecological momentary assessment
Kathan, A., Harrer, M., Küster, L., Triantafyllopoulos, A., He, X., Milling, M., Gerczuk, M., Yan, T., Rajamani, S. T., Heber, E., et al. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.964582 · Cited by 47 · see citing works
Scholten, S., Lischetzke, T., & Glombiewski, J. A. (2021) · Psychotherapy Research · doi:10.1080/10503307.2021.1916639 · Cited by 41 · see citing works
Jiao, L., Luo, Q., Lu, H. X., Huo, X., Zhang, Y., & Wu, Y. (2024) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2024.104258 · Cited by 39 · see citing works
Brakemeier, E., & Herpertz, S. C. (2019) · Der Nervenarzt · doi:10.1007/s00115-019-00808-9 · Cited by 36 · see citing works
Kraft, B., Jonassen, R., Heeren, A., Harmer, C. J., Stiles, T. C., & Landrø, N. I. (2019) · Clinical Psychological Science · doi:10.1177/2167702618822480 · Cited by 33 · see citing works
Ruissen, G. R., Zumbo, B. D., Rhodes, R. E., Puterman, E. M., & Beauchamp, M. R. (2021) · Health Psychology Review · doi:10.1080/17437199.2021.1987953 · Cited by 34 · see citing works
Depressive symptoms and loneliness among early adolescents: a psychometric network analysis approach
Grygiel, P., Dolata, R., Humenny, G., & Muszyński, M. A. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13876 · Cited by 30 · see citing works
Curtiss, J. E., & DiPietro, C. P. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102593 · Cited by 23 · see citing works
Self-citationSchreuder, M. J., Hartman, C. A., Groen, R. N., Smit, A. C., Wichers, M., & Wigman, J. T. W. (2022) · Clinical Psychological Science · doi:10.1177/21677026221103138 · Cited by 18 · see citing works
Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review.
van de Leur, J. C., Jovicic, F., Åhslund, A., McCracken, L. M., & Buhrman, M. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10185-y · Cited by 16 · see citing works
“…monocausal latent disease model for understanding illnesses, a network approach is recommended, concep-tualizing mental illness from a multicausal network of inter-acting symptoms and associated processes, where specific syndromes are the result of dynamically self-reinforcing clusters [120, 121].”
BackgroundQuantifying the Resilience of a Healthcare System: Entropy and Network Science Perspectives
Klemann, D., Winasti, W., Tournois, F., Mertens, H. J. M. M., & van Merode, F. (2023) · Entropy · doi:10.3390/e26010021 · Cited by 14 · see citing works
Li, Y., Wan, Z., Gong, X., Li, W., Sun, T., Liu, J., Xie, X., Zhang, C., & Cai, Z. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06041-2 · Cited by 15 · see citing works
Estrada, J. A. C., Carriedo, A., Mendez‐Giménez, A., & Fernández‐Río, J. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57 · Cited by 13 · see citing works
Curtiss, J. E., Wallace, B., Fisher, L. B., Nyer, M., Jain, F. A., Cusin, C., & Pedrelli, P. (2020) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2020.100040 · Cited by 12 · see citing works
Self-citationCurtiss, J. E., Pinaire, M., Fulford, D., McNally, R. J., & Hofmann, S. G. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.07.061 · Cited by 13 · see citing works
Self-citationNetwork analysis of cognitive, oculomotor and speech parameters in schizophrenia
Shmukler, A. B., Kostyuk, G. P., Латанов, А. В., Сидорова, М. Ю., Anisimov, V. N., Zakharova, N. V., Karyakina, M., Reznik, A. M., Sokolov, A., Spektor, V. A., et al. (2020) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202012006254 · Cited by 9 · see citing works
Heeren, A., Hoebeke, Y., & Coussement, C. (2019) · Cognitive and Behavioral Neurology · doi:10.1097/wnn.0000000000000187 · Cited by 9 · see citing works
Fan, W., Zhang, H., Peng, L., Tang, Y., Du, J., & Li, J. (2025) · BMC Psychology · doi:10.1186/s40359-025-02731-y · Cited by 9 · see citing works
Bortolon, C., & Raffard, S. (2019) · L Encéphale · doi:10.1016/j.encep.2019.06.001 · Cited by 8 · see citing works
Li, Y., & Qiu, H. (2025) · Scientific Reports · doi:10.1038/s41598-025-12580-9 · Cited by 7 · see citing works
Zhang, J., Zhao, X., Wu, Y., Cao, P., Wang, X., Shi, F., & Niu, Y. (2020) · Mathematical Problems in Engineering · doi:10.1155/2020/7397169 · Cited by 6 · see citing works
A Process-Based Approach to Cognitive Behavioral Therapy
Moskow, D. M., Barthel, A. L., Hayes, S. C., & Hofmann, S. G. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00183-7 · Cited by 7 · see citing works
Self-citationHofmann, V. E., Glombiewski, J. A., Kininger, F., & Scholten, S. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-089319 · Cited by 5 · see citing works
Network Analysis of PTSD Symptoms in a Sample of Polyvictimized Youth
Bridges‐Curry, Z., Christian, C., & Levinson, C. A. (2021) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2021.1989115 · Cited by 4 · see citing works
Grygiel, P., & Dąbrowska, A. (2025) · Scientific Reports · doi:10.1038/s41598-025-06541-5 · Cited by 2 · see citing works
Must We Always Go Idiographic?
Kaiser, T., Herzog, P., Brakemeier, E.-L., & Golino, H. F. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10672-4 · Cited by 2 · see citing works
Talask, G., Paveltchuk, F. D. O., Diogo, C. A. S. C., de Lemos, V. D. C. O., Carreras, L. S., Costa, R. T. D., Nardi, A. E., Neufeld, C. B., & de Carvalho, M. R. (2024) · Revista Interamericana de Psicología/Interamerican Journal of Psychology · doi:10.30849/ripijp.v58i3.2028 · Cited by 1 · see citing works
Young, G. C. (2019) · Springer eBooks · doi:10.1007/978-3-030-02493-2_8
Social physicsPreprint
Jusup, M., Holme, P., Kanazawa, K., Takayasu, M., Romić, I., Wang, Z., Geček, S., Lipić, T., Boris Podobnik, A., Wang, L., et al. (2021) · arXiv (Cornell University)
Sets of numbers from complex networks perspective
Hernández, P. A. S. (2021) · doi:10.4995/thesis/10251/176015
The Transition Law of Sepsis Patients’ Illness States Based on Complex Network
Wang, R., Liu, J., Chen, Z., Gong, M., Li, C., & Guo, W. (2022) · Lecture notes in computer science · doi:10.1007/978-3-031-09342-5_31
Panorama da Abordagem de Rede e Contribuições para a Pesquisa e Prática Clínica
Talask, G., de Lemos, V. D. C. O., Costa, R. T. D., Nardi, A. E., & de Carvalho, M. R. (2022) · Revista Interamericana de Psicología/Interamerican Journal of Psychology · doi:10.30849/ripijp.v56i3.1662
Li, B., Tang, H., & Zhang, X. (2023) · Chinese Control Conference (CCC) · doi:10.23919/ccc58697.2023.10240065
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr9
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr8
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr7
Carriedo, A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr6
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr5
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr3
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr4
(2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr2
Carriedo, A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.57.pr1
Grygiel, P., Opozda-Suder, S., & Dolata, R. (2026) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe16060078
Wang, J., Gong, F., Gan, Q., He, H., Li, X., Xu, T., Yang, X. L., & Hu, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1751101
Kornacka, M., Barnes, S., Skorupski, J., Skorupski, M. S., Jaskulska, A., Para, M., & Szastok, M. (2026) · Psychiatria i Psychologia Kliniczna · doi:10.15557/pipk.2026.0018
- Authors
- Hofmann, S. G., & Curtiss, J.
- Affiliations
- Boston University (US)
- Corresponding author
- Hofmann, Stefan G.
- Venue
- European Journal of Clinical Investigation
- Publisher
- Wiley
- Published
- 2018-07-05
- Volume
- 48
- Issue
- 8
- Pages
- e12986-e12986
- ISSN
- 0014-2972 (ISSN-L)
- 1365-2362
- OpenAlex
- W2808769647
- Cited by
- 52
- References
- 38
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 14 · 2022: 7 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 1
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Investigation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Alexander von Humboldt-Stiftung
- National Institutes of Health (R01AT007257, R01MH099021, U01MH108168)
- James S. McDonnell Foundation
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Keywords
- complex networks, psychiatric classification, psychiatric comorbidity, tipping points, recurrence prediction, treatment response prediction, recovery prediction, network dynamics
- MeSH terms
- Mental Disorders, Humans, Models, Psychological, Psychiatry, Psychology, Clinical, Biomedical Research
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.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
