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Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.
Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.
can be applied to study within-person changes over time in both the short term and across the lifespan, and we discuss their potential clinical applications. We conclude with future directions for the classification of mental disorders at the intersection of the three approaches. Transdiagnostic dimensional approachesTransdiagnostic dimensional approaches apply continuous (versus categorical or dichotomous) dimensions to psychopathology data, which represent unbroken spectra (also referred to as factors) that range from very low to very high levels (and all levels in between). Further, these spectra are transdiagnostic: these dimensions are not simply continuous reflections of official dichotomous diagnoses but instead cut across the diagnostic boundaries separating disorders 23,24 . In doing so, these dimensions are interpreted as reflecting core 'building blocks' of variation that characterize multiple disorders. Thus, a single transdiagnostic dimension, such as 'internalizing', can include psychiatric phenomena from different diagnoses of the same type (in this case, major depressive disorder and dysthymic disorder, both of which are mood disorders) as well as from different groupings of disorders (in this case, mood disorders and anxiety disorders) 24 .Transdiagnostic dimensions overcome many of the problems with official nosologies. First, their dimensionality (versus a present/ absent dichotomy) captures the structure of real-world data, where samples of individuals report levels of psychopathology that generally range widely -above and below DSM-5 diagnostic thresholds -and have no clear points of discontinuity across severity levels 25 . Further empirical support for dimensionality comes from taxometric research that finds little evidence for discrete groups within a spectrum 26 , and genetic evidence suggests that liability to mental illness is continuously distributed 27 .Second, although diagnostic comorbidity is viewed as a problem in traditional classification frameworks, transdiagnostic dimensional models explicitly embrace comorbidity by modelling these relationships among mental health variables. These models explicitly allow for greater-than-chance correlations among different forms of psychopathology and for overlap among them.Third, dimensionality overcomes the need for largely arbitrary diagnostic criterion thresholds. As an example, using the official nosologies' threshold of at least five of nine criteria being present to support the diagnosis of a given mental disorder, individuals with similar levels of psychopathology (such as a person meeting four criteria and another meeting five criteria) would be described as being totally different (in this case, diagnosis absent and diagnosis present, respectively), whereas individuals with notably different levels of psychopathology (such as a person meeting five criteria and another meeting nine criteria) would be described as exactly the same (both receiving a diagnosis). Thus, thresholds obscure important similarities and differences within diag...
In clinical psychology, burnout is regarded as a mental disorder assessed in patients who apply for psychological treatment and no longer work because of their symptoms or experience of serious problems in functioning at work. This definition of burnout is mostly referred to as 'clinical burnout'. The purpose of this article is to provide insight into how clinicians in The Netherlands establish a diagnosis of clinical burnout and how they fit it in their classification systems. An outline is given on how psychological interventions for burnout are applied in therapies. The different phases in the treatment of clinical burnout -crisis, recovery, prevention, and post burnout growth, as well as their accompanying interventions are described. It may be relevant for work and organizational psychologists to realize that biological processes may play a role in the development of clinical burnout. For the physiology of stress, it does not matter whether the stress is work-related or the result of stress in private life or both. Central to understanding clinical burnout is the lack of recovery of the (physiological) stress system. It is also argued that the relevance of questionnaires, for detecting who is at serious health risk, is limited.
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