Goldstein Ferber S, Shoval G, Weller A, Zalsman G. Not one thing at a time: When concomitant multiple stressors produce a transdiagnostic clinical picture. World J Psychiatry 2023; 13(7): 402-408 [PMID: 37547732 DOI: 10.5498/wjp.v13.i7.402]
Corresponding Author of This Article
Sari Goldstein Ferber, PhD, Affiliate Associate Professor, Department of Psychology and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States. sgf@udel.edu
Research Domain of This Article
Psychiatry
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Jul 19, 2023; 13(7): 402-408 Published online Jul 19, 2023. doi: 10.5498/wjp.v13.i7.402
Not one thing at a time: When concomitant multiple stressors produce a transdiagnostic clinical picture
Sari Goldstein Ferber, Gal Shoval, Aron Weller, Gil Zalsman
Sari Goldstein Ferber, Department of Psychology and Brain Sciences, University of Delaware, Newark, DE 19716, United States
Sari Goldstein Ferber, Aron Weller, Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
Gal Shoval, Department of Neuroscience, Princeton University, New Jersey, NJ 08544, United States
Gal Shoval, Gil Zalsman, Geha Mental Health Center, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 77096, Israel
Gil Zalsman, Department of Psychiatry, Columbia University, New York, NY 10032, United States
Author contributions: Goldstein Ferber S led the diagnostic conceptualization and writing of the different versions of this paper and its final version; Shoval G, Weller A, and Zalsman G contributed to the developing versions of this paper.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sari Goldstein Ferber, PhD, Affiliate Associate Professor, Department of Psychology and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE 19716, United States. sgf@udel.edu
Received: April 27, 2023 Peer-review started: April 27, 2023 First decision: May 25, 2023 Revised: June 7, 2023 Accepted: June 19, 2023 Article in press: June 19, 2023 Published online: July 19, 2023 Processing time: 82 Days and 4.6 Hours
Abstract
A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.
Core Tip: Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes.
