Beyond DSM and ICD: introducing “precision diagnosis” for psychiatry using momentary assessment technology

In medicine, a diagnostic system should ideally be mechanism-based rather than symptom-based. Although attempts to create diagnostic entities in psychiatry that are based on specific biological mechanisms have failed 1, new evidence suggests that an alternative mechanistic approach, based on mental mechanisms, can be readily implemented in psychiatry, complementing the widely criticized categorical systems of DSM and ICD. Below, we describe the contours of a novel system of diagnosis in psychiatry based on: a) the need for a more individualized approach, based on causal influences in symptom circuits (“precision diagnosis”); b) the need to take into account the fact that symptoms reflect responses to context (“context diagnosis”); c) the need to take into account that syndromes develop over time and have recognizable stages of expression (“staging diagnosis”) 2; and d) the need for the diagnostic process to become collaborative rather than unidirectional, reflecting the first stage of collaboration between patient and professional, and the first stage of treatment. The proposed diagnostic system is based on novel digital momentary assessment technology, which allows the patient to collect data on symptoms and contexts in the flow of daily life, from which detailed contextual symptom circuits can be constructed, that serve as a diagnostic and therapeutic tool, as well as an instrument to assess change.