The Dynamics of Subthreshold Psychopathology: Implications for Diagnosis and Treatment

Abstract

The article by Zammit et al. (1) in this issue of the Journal confirms that mental disorders appear to be continuous—phenomenologically and longitudinally— with subthreshold states, or extended phenotypes, of psychopathology. There is well-replicated evidence that major depression can be traced to subthreshold depressive states (2), common mental disorders to subthreshold neurotic symptoms (3), bipolar disorder to subthreshold mania (4), autism to subthreshold autistic traits (5), and psychotic disorders to subthreshold psychotic experiences (6). In addition, research indicates that normal variation and the extreme end of the distribution tend to share the same genetic and nongenetic causes (7–10), indicating at least a degree of etiological continuity in addition to psychometric and predictive continuity. Subthreshold extended phenotypes in the general population are conceptually quite different from the “ultrahigh risk ” or “at-risk mental state” populations in the psychosis literature. In the area of psychosis, ultrahigh risk or at-risk mental states refer The earliest expressions of psychopathology are a nonspecific, mixed bag of affective dysregulation, aberrant salience, motivational alterations, anxiety states, and other early symptoms. to individuals with subthreshold psychosis who seek help at mental health services. Given that individuals with subthreshold psychosis who present to services have more severe psychopathology than those with subthreshold psychosis in th…