Revisiting the seven pillars of RDoC.

BACKGROUND: In 2013, a few years after the launch of the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative, Cuthbert and Insel published a paper titled "Toward the future of psychiatric diagnosis: the seven pillars of RDoC." The RDoC project is a translational research effort to encourage new ways of studying psychopathology through a focus on disruptions in normal functions (such as reward learning or attention) that are defined jointly by observable behavior and neurobiological measures. The paper outlined the principles of the RDoC research framework, including emphases on research that acquires data from multiple measurement classes to foster integrative analyses, adopts dimensional approaches, and employs novel methods for ascertaining participants and identifying valid subgroups. DISCUSSION: To mark the first decade of the RDoC initiative, we revisit the seven pillars and highlight new research findings and updates to the framework that are related to each. This reappraisal emphasizes the flexible nature of the RDoC framework and its application in diverse areas of research, new findings related to the importance of developmental trajectories within and across neurobehavioral domains, and the value of computational approaches for clarifying complex multivariate relations among behavioral and neurobiological systems. CONCLUSION: The seven pillars of RDoC have provided a foundation that has helped to guide a surge of new studies that have examined neurobehavioral domains related to mental disorders, in the service of informing future psychiatric nosology. Building on this footing, future areas of emphasis for the RDoC project will include studying central-peripheral interactions, developing novel approaches to phenotyping for genomic studies, and identifying new targets for clinical trial research to facilitate progress in precision psychiatry.

DSM-5 and RDoC: progress in psychiatry research?

Neuroscience studies into psychiatric disorders generally rely on disease definitions that are based on the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), the fifth edition of which (DSM-5) was released earlier this year. Designed as a purely diagnostic tool, the DSM considers different disorders as distinct entities. However, boundaries between disorders are often not as strict as the DSM suggests. To provide an alternative framework for research into psychiatric disorders, the US National Institute of Mental Health (NIMH) has recently introduced its Research Domain Criteria (RDoC) project. In the RDoC, five 'domains' each reflect a brain system in which functioning is impaired, to different degrees, in different psychiatric conditions. Nature Reviews Neuroscience asked six leading investigators for their thoughts on how DSM-5 and the RDoC will influence neuroscience research into psychiatric disorders.

Symptoms of Posttraumatic Stress Rather Than Mild Traumatic Brain Injury Best Account for Altered Emotional Responses in Military Veterans.

Emotional dysfunction is evident in posttraumatic stress disorder (PTSD), yet it is unclear what aspects of the disorder most directly relate to aberrant emotional responding. Also, the frequent co-occurrence of blast-related mild traumatic brain injuries (mTBIs) among recently deployed U.S. military personnel complicates efforts to understand the basis for emotional disruption. We studied a cross-sectional sample (enriched for PTSD and mTBI) of 123 U.S. veterans of wars in Iraq and Afghanistan. We measured subjective affective evaluations and peripheral psychophysiological responses to images with pleasant, neutral, unpleasant, and combat-related aversive content. When compared with other postdeployment participants, those who had combat-related PTSD rated pleasant image content as less positive (ηp2 = .04) and less arousing (ηp2 = .06), and exhibited heightened physiological responsivity to combat image content (ηp2 = .07). Symptoms of PTSD were associated with elevated skin conductance responses (ß = .28), reduced heart rate deceleration (ß = .44 to .47), and increased corrugator facial muscle electromyography (ß = .47). No effects for blast-related mTBI were observed across any affective modulation measures. These findings point to a greater impact of PTSD symptomatology than blast-related mTBI on emotional functioning and highlight the utility of dimensional assessments of psychopathology for understanding the effects of combat-stress conditions on adjustment to civilian life.

Toward the future of psychiatric diagnosis: the seven pillars of RDoC.

BACKGROUND: Current diagnostic systems for mental disorders rely upon presenting signs and symptoms, with the result that current definitions do not adequately reflect relevant neurobiological and behavioral systems--impeding not only research on etiology and pathophysiology but also the development of new treatments. DISCUSSION: The National Institute of Mental Health began the Research Domain Criteria (RDoC) project in 2009 to develop a research classification system for mental disorders based upon dimensions of neurobiology and observable behavior. RDoC supports research to explicate fundamental biobehavioral dimensions that cut across current heterogeneous disorder categories. We summarize the rationale, status and long-term goals of RDoC, outline challenges in developing a research classification system (such as construct validity and a suitable process for updating the framework) and discuss seven distinct differences in conception and emphasis from current psychiatric nosologies. SUMMARY: Future diagnostic systems cannot reflect ongoing advances in genetics, neuroscience and cognitive science until a literature organized around these disciplines is available to inform the revision efforts. The goal of the RDoC project is to provide a framework for research to transform the approach to the nosology of mental disorders.

Research Domain Criteria (RDoC): Progress and Potential.

The National Institute of Mental Health (NIMH) addressed in its 2008 Strategic Plan an emerging concern that the current diagnostic system was hampering translational research, as accumulating data suggested that disorder categories constituted heterogeneous syndromes rather than specific diseases. However, established practices in peer review placed high priority on extant disorders in evaluating grant applications for mental illness. To provide guidelines for alternative study designs, NIMH included a goal to develop new ways of studying psychopathology based on dimensions of measurable behavior and related neurobiological measures. The Research Domain Criteria (RDoC) project is the result, intended to build a literature that informs new conceptions of mental illness and future revisions to diagnostic manuals. The framework calls for the study of empirically-derived fundamental dimensions as characterized by related behavioral/psychological and neurobiological data (e.g., reward valuation, working memory). RDoC also emphasizes full-range dimensional approaches (from typical to increasingly abnormal), neurodevelopment and environmental effects, and research designs that integrate data across behavioral, biological, and self-report measures. This commentary provides an overview of the project's first decade and its potential future directions. RDoC remains grounded in experimental psychopathology perspectives, and its progress is strongly linked to psychological measurement and integrative approaches to brain-behavior relationships.

Development and environment in the National Institute of Mental Health (NIMH) Research Domain Criteria.

The integration of developmental processes is essential for a full understanding of psychopathology. The National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) provide a scaffold on which to organize the components and processes of psychopathology and to detail behavioral and biological disruptions in developmental processes gone awry. This special section on Integrating Developmental Psychopathology With the RDoC Framework provides the opportunity to comment on five extraordinary developmental psychopathology articles that report results and theory integral to RDoC. An introductory overview provides context for RDoC's approach to developmental issues. This is followed by brief summaries of each article and points regarding its particularly salient aspects, and concludes with broader comments about the import of the articles as a set. Collectively, the work by these eminent translational scholars illustrates how to conduct significant research on developmental psychopathology using RDoC, and simultaneously raises important questions and future directions to integrate development and environment in RDoC-framed research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Affective antecedents of the perceived effectiveness of antidrug advertisements: an analysis of adolescents' momentary and retrospective evaluations.

Perceived message effectiveness is often used as a diagnostic tool to determine whether a health message is likely to be successful or needs modification before use in an intervention. Yet, published research on the antecedents of perceived effectiveness is scarce and, consequently, little is known about why a message is perceived to be effective or ineffective. The present study's aim was to identify and test the affective antecedents of perceived effectiveness of antidrug television messages in a sample of 190 adolescents in the 15-19 year age range. Factor-analytical tests of retrospective message evaluation items suggested two dimensions of perceived effectiveness, one that contained items such as convincingness whereas the other contained pleasantness items. Using retrospective data as well as real time valence and arousal ratings, we found that arousal underlies perceived convincingness and valence underlies perceived pleasantness. The results indicated activation of appetitive and defensive motivational systems, which suggests a clear motivational component to the concept of perceived message effectiveness.

Evolving Concepts of the Schizophrenia Spectrum: A Research Domain Criteria Perspective.

Several trends intersecting over the past two decades have generated increasing debate as to how the concepts of schizophrenia, the schizophrenia spectrum, and the psychotic disorders spectrum should be regarded. These trends are reflected in various areas of research such as genomics, neuroimaging, and data-driven computational studies of multiple response systems. Growing evidence suggests that schizophrenia represents a broad and heterogenous syndrome, rather than a specific disease entity, that is part of a multi-faceted psychosis spectrum. Progress in explicating these various developments has been hampered by the dependence upon sets of symptoms and signs for determining a diagnosis, and by the reliance on traditional diagnostic categories in reviewing clinical research grants. To address these concerns, the U.S. National Institute of Mental Health initiated the Research Domain Criteria (RDoC) project, a translational research program that calls for studies designed in terms of empirically-based functions (such as cognitive control or reward learning) rather than diagnostic groups. RDoC is a research framework rather than an alternative diagnostic system, intended to provide data that can inform future nosological manuals. This commentary includes a brief summary of RDoC as it pertains to schizophrenia and psychotic spectra, examples of recent data that highlight the utility of the approach, and conclusions regarding the implications for evolving conceptualizations of serious mental illness.

Posttraumatic stress symptom dimensions and brain responses to startling auditory stimuli in combat veterans.

Posttraumatic stress disorder (PTSD) is marked by alterations in emotional functioning, physiological reactivity, and attention. Neural reactivity to acoustic startle stimuli can be used to understand brain functions related to these alterations. Investigations of startle reactivity in PTSD have yielded inconsistent findings, which may reflect the heterogeneity of the disorder. Furthermore, little is known of how the common co-occurrence of mild traumatic brain injury (mTBI; i.e., concussion) may influence neural reactivity. We examined the event-related potentials (ERPs) of combat veterans (n = 102) to acoustic startle probes delivered during viewing of pleasant, neutral, unpleasant, and combat-related pictures. Interview-based assessments yielded dimensional characterizations of PTSD and mTBI. The P3 ERP response to startle probes was reduced during all affective relative to neutral pictures but failed to be associated with a PTSD diagnosis. However, two separable domains of PTSD symptomatology were associated with startle ERPs regardless of the picture conditions. Maladaptive avoidance was associated with smaller N1, P2, and P3 amplitudes, while intrusive reexperiencing was associated with larger P2 amplitudes. There were no main effects of mTBI. Findings suggest that level of symptomatology rather than a formal diagnosis of PTSD better explains alterations in neural reactivity after traumatic events, while mild brain injuries have little impact. Avoidance symptoms of PTSD may dampen neural functions that facilitate reorientation to threat while intrusive reexperiencing of traumatic events appears to heighten sensory reactivity. Considering specific aspects of symptomatology provides insight into the neural basis of trauma-related psychopathology and may help guide individualization of clinical interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of RDoC in future classification of mental disorders
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The Research Domain Criteria (RDoC) project constitutes a translational framework for psychopathology research, initiated by the National Institute of Mental Health in an attempt to provide new avenues for research to circumvent problems emerging from the use of symptom-based diagnostic categories in diagnosing disorders. The RDoC alternative is a focus on psychopathology based on dimensions simultaneously defined by observable behavior (including quantitative measures of cognitive or affective behavior) and neurobiological measures. Key features of the RDoC framework include an emphasis on functional dimensions that range from normal to abnormal, integration of multiple measures in study designs (which can foster computational approaches), and high priority on studies of neurodevelopment and environmental influences (and their interaction) that can contribute to advances in understanding the etiology of disorders throughout the lifespan. The paper highlights key implications for ways in which RDoC can contribute to future ideas about classification, as well as some of the considerations involved in translating basic behavioral and neuroscience data to psychopathology.
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El proyecto Research Domain Criteria (Criterios de Dominio de Investigación, CDI) constituye un marco traslacional para la investigación en psicopatología y fue iniciado por el Instituto Nacional de Salud Mental en un intento por proporcionar nuevas alternativas de investigación para sortear los problemas que surgen del uso de categorías diagnósticas basadas en síntomas para el diagnóstico de los trastornos mentales. La propuesta CDI se centra en la psicopatología basada en dimensiones, las cuales se definen simultáneamente por el comportamiento observable (incluyendo las mediciones cuantitativas del comportamiento cognitivo o afectivo) y las mediciones neurobiológicas. Las características clave de los CDI incluyen un énfasis en las dimensiones funcionales que van de lo normal a lo anormal, la integración de múltiples mediciones en los diseños de estudio (que pueden fomentar enfoques computacionales) y una alta prioridad en los estudios del neurodesarrollo y de las influencias ambientales (y de su interacción), todo lo cual puede contribuir a los avances en la comprensión de la etiología de los trastornos a lo largo de la vida. Este artículo destaca las consecuencias clave de las formas en que los CDI pueden contribuir a futuras ideas acerca de la clasificación, así como a algunas de las consideraciones involucradas en la traducción de datos básicos del comportamiento y de la neurociencia para la psicopatología.

Le National Institute of Mental Health a créé le projet des Critères de domaines de recherche (RDoC, Research Domain Criteria) comme cadre de recherche en psychopathologie, dans le but d'ouvrir les champs de recherche en contournant les problèmes issus des catégories diagnostiques basées sur les symptômes des maladies. Le RDoC est centré sur la psychopathologie et s'appuie sur un comportement observable (y compris des données quantitatives de comportement cognitif ou affectif) comme sur des données neurobiologiques. Structuré autour de caractéristiques essentielles, le RDoC valorise les dimensions fonctionnelles (de normales à anormales), les études de conceptions différentes (pouvant favoriser les méthodes numériques), et prioritairement les études de neurodéveloppement, les influences environnementales et leurs interactions qui peuvent améliorer la compréhension de l'étiologie des maladies au cours de la vie. Cet article souligne les principaux messages concernant les apports du RDoC aux nouvelles méthodes de classification, ainsi que certaines observations en lien avec la traduction des données fondamentales neuroscientifiques et comportementales en psychopathologie.

The PRISM project: Social withdrawal from an RDoC perspective.

The PRISM (Psychiatric Ratings using Intermediate Stratified Markers) project was funded under the auspices of the European Union Innovative Medicine Initiative (EU-IMI) to explore quantitative approaches to the biological and behavioral aspects of neuropsychiatric disorders. PRISM focuses specifically on social withdrawal, although its principles are applicable to a wide range of disorders. This commentary explores some of the major aspects of the PRISM design from the perspective of the Research Domain Criteria (RDoC) project initiated by the National Institute of Mental Health. PRISM represents an apt exemplar of the principles developed in the RDoC framework, with the potential to contribute palpable advances in precision diagnosis and innovative approaches to treatment development.

The Research Domain Criteria (RDoC) and the historical roots of psychopathology: A viewpoint.

In this article we aim at conceptual reconstruction of the historical background behind RDoC project. It incorporates some elements that have not heretofore been included in frameworks for psychopathology research. At the same time, however, RDoC - like any approach to mental illness - must grapple with longstanding challenges in addressing issues about the roles and relationships of mind, brain, and patients' reports in considering the nature of disorder. In this respect, the historical roots of psychopathology remain as relevant as ever.

The NIH Cognitive and Emotional Health Project. Report of the Critical Evaluation Study Committee.

BACKGROUND: The Cognitive and Emotional Health Project (CEHP) seeks to identify the demographic, social, and biological determinants of cognitive and emotional health in the older adult. As part of the CEHP, a critical evaluation study committee was formed to assess the state of epidemiological research on demographic, social, and biological determinants of cognitive and emotional health. METHODS: Criteria for inclusion in the survey were large cohort studies, longitudinal in design, participants predominantly 65 years or older, with measurements of both cognition and emotion, and information on a wide variety of demographic, psychosocial, and biological factors. North American and European studies, which met these criteria, were selected for the review. Outcome measures included cognition, cognitive decline, and cognitive function. For emotion, symptoms included depression and anxiety, positive and negative affect, subjective well being, mastery, and resilience. RESULTS: Ninety-six papers were identified that addressed cognitive and emotional outcomes. A large variety of risk factors were consistently identified with cognitive outcomes, particularly those previously associated with increased risk of cardiovascular disease. There was considerable overlap between risk factors for cognitive and emotional outcomes. CONCLUSION: This review identifies a large number of lifestyle and health behaviors that alter the risk for maintenance of cognitive and emotional health. Large longitudinal cohort studies are a unique source to explore factors associated with cognitive and emotional health. Secondary analyses of these studies should be encouraged as should the development of standardized questionnaires to measure cognitive and emotional health. Future research in this field should study cognitive and emotional health simultaneously.

The NIMH Research Domain Criteria Initiative: Background, Issues, and Pragmatics.

This article describes the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative. The description includes background, rationale, goals, and the way the initiative has been developed and organized. The central RDoC concepts are summarized and the current matrix of constructs that have been vetted by workshops of extramural scientists is depicted. A number of theoretical and methodological issues that can arise in connection with the nature of RDoC constructs are highlighted: subjectivism and heterophenomenology, desynchrony and theoretical neutrality among units of analysis, theoretical reductionism, endophenotypes, biomarkers, neural circuits, construct "grain size," and analytic challenges. The importance of linking RDoC constructs to psychiatric clinical problems is discussed. Some pragmatics of incorporating RDoC concepts into applications for NIMH research funding are considered, including sampling design.

Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life.

OBJECTIVES: To review progress made during the past decade in late-life mood disorders and to identify areas of unmet need in health care delivery and research. PARTICIPANTS: The Consensus Development Panel consisted of experts in late-life mood disorders, geriatrics, primary care, mental health and aging policy research, and advocacy. EVIDENCE: (1) Literature reviews addressing risk factors, prevention, diagnosis, treatment, and delivery of services and (2) opinions and experiences of primary care and mental health care providers, policy analysts, and advocates. CONSENSUS PROCESS: The Consensus Development Panel listened to presentations and participated in discussions. Workgroups considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed and edited to incorporate input from the entire Consensus Development Panel. CONCLUSIONS: Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.

Dimensional models of psychopathology: research agenda and clinical utility.

This commentary emphasizes the implications for a mental health research agenda that stem from the papers in this special section on dimensional models of psychopathology. These include the need to extend dimensional models to a wider range of psychopathology; the relationship of the dimensions described in these papers, largely based on symptom and self-report measures, to findings from current research in genetics, neuroimaging, and other domains of neuroscience; the need for new scales that can assess the entire range of relevant dimensions with modern psychometric techniques; and ways to employ these dimensions in applied clinical situations. It is concluded that hierarchical dimensional models offer powerful ways of organizing our thinking about psychopathology and will serve to guide many promising avenues of future research.

Research Domain Criteria: toward future psychiatric nosologies.

The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health (NIMH) in early 2009 as the implementation of Goal 1.4 of its just-issued strategic plan. In keeping with the NIMH mission, to "transform the understanding and treatment of mental illnesses through basic and clinical research," RDoC was explicitly conceived as a research-related initiative. The statement of the relevant goal in the strategic plan reads: "Develop, for research purposes, new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures." Due to the novel approach that RDoC takes to conceptualizing and studying mental disorders, it has received widespread attention, well beyond the borders of the immediate research community. This review discusses the rationale for the experimental framework that RDoC has adopted, and its implications for the nosology of mental disorders in the future.

A comienzos de 2009 el Instituto Nacional de Salud Mental (NIMH) lanzó el proyecto Criterios del Ámbito de la Investigación (RDoC) como parte de la implementación del Objetivo 1.4 de su recién publicado plan estratégico. En conformidad con la misión del NIMH, para "transformar la comprensión y el tratamiento de las en-fermedades mentales a través de la investigación básica y clínica" el RDoC fue concebido explícitamente como una iniciativa relacionada con la investigación. La declaración del objetivo pertinente en el plan estratégico señala: "Desarrollar, para propósitos de investigación nuevas vías de clasificación de los trastornos mentales en base a dimensiones observables de la conducta y mediciones neurobiológicas". Debido al novedoso enfoque que tiene el RDoC para conceptualizar y estudiar los trastornos mentales, ha recibido gran atención, mucho más allá de las fronteras de la comunidad de investigación inmediata. Esta revisión discute los fundamentos del marco experimental que ha adoptado el RDoC y sus repercusiones futuras para la nosología de los trastor-nos mentales.

Le NIMH (National Institute of Mental Health) a lancé le projet de « Critères de domaines de recherche ¼ (CDoR) début 2009, en tant qu'application de l'objectif 1.4 de son plan stratégique venant d'être publié. Les CDoR ont été conçus explicitement comme une initiative liée à la recherche, en phase avec la mission du NIMH pour « transformer la compréhension et le traitement des maladies mentales par la recherche fondamentale et clinique ¼. L'objectif exposé dans le plan stratégique est le suivant: « Développer, aux fins de recherche, de nouvelles façons de classifier des troubles mentaux selon des critères de comportements observables et des mesures neurobiologiques ¼. Cette nouvelle approche des CDoR pour concevoir et étudier les troubles mentaux a reçu une grande attention, bien au-delà des frontières des communautés de chercheurs. Cet article analyse le fondement du cadre expérimental adopté par les CDoR et ses implications dans l'avenir pour la nosologie des troubles mentaux.

Psychophysiological science and the research domain criteria: A commentary.

The current special issue, devoted to the Research Domain Criteria (RDoC) initiative of the US National Institute of Mental Health, showcases a variety of empirical and review articles that address issues related to this dimensional and multi-method approach to research on mental disorders. Here, we provide an integrative perspective on various aspects of these articles, focused around the primary principles of the RDoC approach and the practical and methodological issues related to conducting RDoC-informed research. The chief point we wish to highlight is that these articles demonstrate the ways in which the field of psychophysiology already thinks along the lines of RDoC in terms of using biobehavioral constructs, looking for convergence among constructs using various methodologies, and utilizing dimensional measurements in studies. In this sense, RDoC is not novel; however, by specifying a formal research platform it provides explicit encouragement and guidance for using such principles in understanding psychiatric phenomena, rather than continuing to focus research efforts on traditional diagnostic categories alone.

Assessment of late life depression.

This article focuses on diagnostic and nosologic challenges intrinsic to geriatric depression, including characteristics interfering with symptom and syndrome ascertainment, the impact of medical and cognitive disorders, the usefulness of screening instruments, and barriers imposed by treatment settings. The article also identifies gaps in existing knowledge and outlines a research agenda. Nosologic characterization of depressives syndromes contributed by specific medical disorders may lead to effective strategies for prevention and treatment of depression. Studies need to examine whether treatment of depression can improve the outcome of medical illnesses requiring active patient involvement in treatment. Considering disability a distinct aspect of health status may add an important dimension to the assessment of depression and result in complementary interventions aimed at depression and disability concurrently. The provisional criteria for depression of Alzheimer's disease, if validated, may facilitate treatment research. Studies need to characterize cognitive dysfunctions associated with later development of dementia or poor treatment response in patients with depression. Care managers working together with primary care physicians can improve the recognition and treatment of depressed elderly patients by obtaining the training in using validated instruments and treatment algorithms.

Overcoming barriers to research in early serious mental illness: issues for future collaboration.

Several methodological barriers impede discovery of early illness pathways in schizophrenia, including small samples, elongated study periods, and failure to integrate procedures and data across prodromal and first episode projects. A compounding factor is the tendency for single-site studies to focus narrowly on schizophrenia risk factors, rather than exploring vulnerability mechanisms that may cut across DSM-IV boundaries. To address these concerns, we discuss the merits of an integrated multisite approach to research that promotes large-scale investigation into the earliest phases of serious mental illness. The distinctive characteristics of this collaborative approach to early serious mental illness research could include (1) subject recruitment across several sites; (2) a broad diagnostic focus; (3) a core clinical and neuroscience assessment protocol; (4) longitudinal evaluation of subjects through a range of outcomes; and (5) an iterative approach to psychopathology research. This model represents a method for exploring prodromal phenotypes, for discovering causal risk mechanisms, and for investigating the biological and environmental interactions that define the early course of several disorders, including schizophrenia, bipolar illness, and borderline personality disorder. This strategy could speed discovery of clinical tools most relevant to the earliest stages of serious mental illness; i.e., better methods of screening, diagnosing, and treating mental disorders before symptoms and impairments solidify into chronic disabilities.