Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-20T05:43:54.680Z Has data issue: false hasContentIssue false

Brain disorders? Not really: Why network structures block reductionism in psychopathology research

Published online by Cambridge University Press:  24 January 2018

Denny Borsboom
Affiliation:
Department of Psychology, University of Amsterdam, 1018 WT Amsterdam, The Netherlands. [email protected]://www.dennyborsboom.com
Angélique O. J. Cramer
Affiliation:
Department of Methodology and Statistics, Tilburg University, 5000 LE Tilburg, The Netherlands. [email protected]://www.aojcramer.com
Annemarie Kalis
Affiliation:
Department of Philosophy and Religious Studies, Utrecht University, 3512 BL Utrecht, The Netherlands. [email protected]://www.uu.nl/staff/AKalis

Abstract

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why reductionist approaches in psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion of real patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders.

Type
Target Article
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S., Khandker, M., Nelson, C., Deacon, B. J. & Rygwall, R. (2006) The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behaviour Research and Therapy 44:1361–74.Google Scholar
Adam, D. (2013) Mental health: On the spectrum. [Editorial]. Nature 496:416–18.Google Scholar
Aizawa, K. & Gillett, C. (2009) The (multiple) realization of psychological and other properties in the sciences. Mind and Language 24:181208.Google Scholar
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). American Psychiatric Association.Google Scholar
Andreasen, N. C. (1984) The broken brain: The biological revolution in psychiatry. Harper and Row.Google Scholar
Anonymous. (2013) No dishonour in depression. [Editorial]. Nature 498: article 137. (Posted on 12 June, 2013). Available at: http://www.nature.com/news/no-dishonour-in-depression-1.13170.Google Scholar
Baker, L. R. (1995) Explaining attitudes: A practical approach to the mind. Cambridge University Press.Google Scholar
Barabási, A.-L. (2012) The network takeover. Nature Physics 8:1416. doi:10.1038/nphys2188.Google Scholar
Beard, C., Millner, A. J., Forgeard, M. J., Fried, E. I., Hsu, K. J., Treadway, M. T., Leonard, C. V., Kertz, S. J. & Björgvinsson, T. (2016) Network analysis of depression and anxiety symptom relationships in a psychiatric sample. Psychological Medicine 46:3359–69.Google Scholar
Bechtel, W. & Mundale, J. (1999) Multiple realizability revisited: Linking cognitive and neural states. Philosophy of Science 66:175207.Google Scholar
Beck, A. T. (2008) The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry 165:969–77.Google Scholar
Bentall, R. (2003) Madness explained: Psychosis and human nature. Penguin.Google Scholar
Bickle, J. (1998) Psychoneural reduction: The new wave. MIT Press.Google Scholar
Borsboom, D. (2008) Psychometric perspectives on diagnostic systems. Journal of Clinical Psychology 9:10891108.Google Scholar
Borsboom, D. (2017) A network theory of mental disorders. World Psychiatry 16(1):513. doi:10.1002/wps.20375.Google Scholar
Borsboom, D. & Cramer, A. O. J. (2013) Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology 9:91121.Google Scholar
Borsboom, D., Epskamp, S., Kievit, R. A., Cramer, A. O. J. & Schmittmann, V. D. (2011) Transdiagnostic networks: A comment on Watkins and Nolen-Hoeksema. Perspectives on Psychological Science 6:610–14.Google Scholar
Bortolotti, L. (2010) Delusions and other irrational beliefs. Oxford University Press.Google Scholar
Boschloo, L., van Borkulo, C. D., Rhemtulla, M., Keyes, K. M., Borsboom, D. & Schoevers, R. A. (2015) The network structure of symptoms of the diagnostic and statistical manual of mental disorders. PLoS ONE 10:e0137621. doi:10.1371/journal.pone.0137621.Google Scholar
Boyd, R. (1991) Realism, antifoundationalism and the enthusiasm for natural kinds. Philosophical Studies 61:127–48.Google Scholar
Boyd, R. (1999) Homeostasis, species, and higher taxa. In: Species: New interdisciplinary essays, ed. Wilson, R. A., pp. 141–85. MIT Press.Google Scholar
Brentano, F. (1874) Psychology from an empirical standpoint. Routledge & Kegan Paul.Google Scholar
Bringmann, L. F., Vissers, N., Wichers, M., Geschwind, N., Kuppens, P., Peeters, F., Borsboom, D. & Tuerlinckx, F. (2013) A network approach to psychopathology: New insights into clinical longitudinal data. PLoS ONE 8(4):e60188.Google Scholar
Campbell, J. (2009) What does rationality have to do with psychological causation? Propositional attitudes as mechanisms and as control variables. In: Psychiatry as cognitive neuroscience: Philosophical perspectives, ed. Broome, M. & Bortoletti, L., pp. 137–49. Oxford University Press.Google Scholar
Clark, A. & Chalmers, D. (1998) The extended mind. Analysis 58:719.Google Scholar
Cramer, A. O. J., Kendler, K. S. & Borsboom, D. (2011) Where are the genes? The implications of a network perspective on gene hunting in psychopathology. European Journal of Personality 25:270–71.Google Scholar
Cramer, A. O. J., van Borkulo, C. D., Giltay, E. J., van der Maas, H. L. J., Kendler, K. S., Scheffer, M. & Borsboom, D. (2016) Major depression as a complex dynamic system. PLoS ONE 11:e0167490. doi:10.1371/journal.pone.0167490.Google Scholar
Cramer, A. O. J., Waldorp, L. J., van der Maas, H. L. J. & Borsboom, D. (2010) Comorbidity: A network perspective. Behavioral and Brain Sciences 33:137–50; discussion 150–93.Google Scholar
Davidson, D. (1984) Inquiries into truth and interpretation. Clarendon Press.Google Scholar
Deboer, T., Détári, L. & Meijer, J. H. (2007) Long-term effects of sleep deprivation on the mammalian circadian pacemaker. Sleep 30:257–62.Google Scholar
Dennett, D. C. (1987) The intentional stance. MIT Press.Google Scholar
Dennett, D. C. (1991) Real patterns. The Journal of Philosophy 88:2751.Google Scholar
Dennett, D. C. (1997) Kinds of minds. Towards an understanding of consciousness. Basic Books.Google Scholar
Dori, G. A. & Overholser, J. C. (1999) Depression, hopelessness, and self-esteem: Accounting for suicidality in adolescent psychiatric inpatients. Suicide and Life-Threatening Behavior 29:309–18.Google Scholar
Dretske, F. I. (1997) Naturalizing the mind. MIT Press.Google Scholar
Elton, M. (2003) Daniel Dennett. Reconciling science and our self-conception. Polity Press.Google Scholar
Endicott, R. P. (1993) Species-specific properties and more narrow reductive strategies. Erkenntnis 38(3):303–21.Google Scholar
Epskamp, S., Maris, G., Waldorp, L. J. & Borsboom, D. (2018) Network psychometrics. In: Handbook of Psychometrics, ed. Irwing, P., Hughes, D. & Booth, T., pp. 953–87. Wiley.Google Scholar
Eronen, M. I. (2013) No levels, no problems: Downward causation in neuroscience. Philosophy of Science 80:1042–52.Google Scholar
Eronen, M. I. (2017) Interventionism for the intentional stance: True believers and their brains. Topoi. (Published Online, 2nd December, 2017). Available at: https://doi.org/10.1007/s11245-017-9513-5.Google Scholar
Fodor, J. A. (1974) Special sciences (or: The disunity of science as a working hypothesis). Synthese 28:97115.Google Scholar
Francken, J. C. & Slors, M. (2014) From commonsense to science, and back: The use of cognitive concepts in neuroscience. Consciousness and Cognition 29:248–58. Available at: https://doi.org/10.1016/j.concog.2014.08.019.Google Scholar
Franić, S., Dolan, C. V., Borsboom, D. & Boomsma, D. I. (2012) Structural equation modeling in genetics. In: Handbook of structural equation modeling, ed. Hoyle, R. H., pp. 617–35. Guilford Press.Google Scholar
Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A., Epskamp, S., Tuerlinckx, F., Carr, D. & Stroebe, M. (2015) From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of Abnormal Psychology 124:256–65.Google Scholar
Fried, E. I. & Cramer, A. O. J. (2017) Moving forward: Challenges and directions for psychopathological network theory and methodology. Perspectives on Psychological Science 12(6):9991020. Available at: https://doi.org/10.1177/174569161770589 and at: http://journals.sagepub.com/doi/abs/10.1177/1745691617705892.Google Scholar
Fried, E. I., van Borkulo, C. D., Cramer, A. O. J., Boschloo, L. B., Schoevers, R. A. & Borsboom, D. (2017) Mental disorders as networks of problems: A review of recent insights. Social Psychiatry and Psychiatric Epidemiology 52:110.Google Scholar
Gillett, C. (2003) The metaphysics of realization, multiple realization and the special sciences. Journal of Philosophy 100:591603.Google Scholar
Greenberg, G. (2013) The book of woe: The DSM and the unmaking of psychiatry. Penguin.Google Scholar
Guloksuz, S., Pries, L. K. & van Os, J. (2017) Application of network methods for understanding mental disorders: Pitfalls and promise. Psychological Medicine 47(16):2743–52. doi: 10.1017/S0033291717001350.Google Scholar
Guze, S. B. (1989) Biological psychiatry: Is there any other kind? Psychological Medicine 19:315–23.Google Scholar
Hacking, I. (1999) The social construction of what? Harvard University Press.Google Scholar
Haroz, E. E, Bolton, P., Gross, A., Chan, K. S, Michalopoulos, L. & Bass, J. (2016) Depression symptoms across cultures: An IRT analysis of standard depression symptoms using data from eight countries. Social Psychiatry and Psychiatric Epidemiology 51:981–91.Google Scholar
Haroz, E. E., Ritchey, M., Bass, J. K., Augustinavicius, J., Michalopoulos, L., Burkey, M. D. & Bolton, P. (2017) How is depression experienced around the world? A systematic review of qualitative literature. Social Science and Medicine 183:151–62.Google Scholar
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S. J., van Hulzen, K. J. E., Medland, S. E., Shumskaya, E., Jahanshad, N., Zeeuw, P., Szekely, E., Sudre, G., Wolfers, T., Onnink, A. M. H., Dammers, J. T., Mostert, J. C., Vives-Gilabert, Y., Kohls, G., Oberwelland, E., Seitz, J., Schulte-Rüther, M., Ambrosino, S., Doyle, A. E., Høvik, M. F., Dramsdahl, M., Tamm, L., van Erp, T. G. M., Dale, A., Schork, A., Conzelmann, A., Zierhut, K., Baur, R., McCarthy, H., Yoncheva, Y. N., Cubillo, A., Chantiluke, K., Mehta, M. A., Paloyelis, Y., Hohmann, S., Baumeister, S., Bramati, I., Mattos, P., Tovar-Moll, F., Douglas, P., Banaschewski, T., Brandeis, D., Kuntsi, J., Asherson, P., Rubia, K., Kelly, C., Martino, A. D., Milham, M. P., Castellanos, F. X., Frodl, T., Zentis, M., Lesch, K. P., Reif, A., Pauli, P., Jernigan, T. L., Haavik, J., Plessen, K. J., Lundervold, A. J., Hugdahl, K., Seidman, L. J., Biederman, J., Rommelse, N., Heslenfeld, D. J., Hartman, C. A., Hoekstra, P. J., Oosterlaan, J., Polier, G. V., Konrad, K., Vilarroya, O., Ramos-Quiroga, J. A., Soliva, J. C., Durston, S., Buitelaar, J. K., Faraone, S. V., Shaw, P., Thompson, P. M. & Franke, B. (2017) Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: A cross-sectional mega-analysis. The Lancet Psychiatry 4:310–19.Google Scholar
Horgan, T. (1993) Nonreductive materialism and the explanatory autonomy of psychology. In: Naturalism: A critical appraisal, ed. Wagner, S. & Warner, R., pp. 295320. University of Notre Dame Press.Google Scholar
Hurn, J. D. (1998) The history of general paralysis of the insane in Britain 1830 to 1950. Doctoral dissertation. University College London. Available at: http://discovery.ucl.ac.uk/1349281/1/339949.pdf.Google Scholar
Hyland, M. E. (2011) The origins of health and disease. Cambridge University Press.Google Scholar
Insel, T. R. & Cuthbert, B. N. (2015) Brain disorders? Precisely. Science 348:499500.Google Scholar
Isvoranu, A. M., van Borkulo, C. D., Boyette, L. L., Wigman, J. T. W., Vinkers, C. H. & Borsboom, D. (2017) A network approach to psychosis: Pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin 43:187–96.Google Scholar
Jaspers, K. (1923/1963) General psychopathology. Manchester University Press.Google Scholar
Kalis, A. (2011) Failures of agency: Irrational behavior and self-understanding. Lexington Books.Google Scholar
Kalis, A. (2014) Mentale toestanden in de psychologie. [Mental states in psychology.] Algemeen Nederlands Tijdschrift voor Wijsbegeerte 106:197206.Google Scholar
Kendler, K. S. (2005) Toward a philosophical structure for psychiatry. American Journal of Psychiatry 162:433–40.Google Scholar
Kendler, K. S. (2008) Explanatory models for psychiatric illness. The American Journal of Psychiatry 165(6):695702. doi:10.1176/appi.ajp.2008.07071061.Google Scholar
Kendler, K. S. (2012a) Levels of explanation in psychiatric and substance use disorders: Implications for the development of an etiologically based nosology. Molecular Psychiatry 17:1121.Google Scholar
Kendler, K. S., Zachar, P. & Craver, C. (2011) What kinds of things are psychiatric disorders? Psychological Medicine 41:1143–50.Google Scholar
Kievit, R. A., Romeijn, J. W., Waldorp, L. J., Wicherts, J. M., Scholte, H. S. & Borsboom, D. (2011) Mind the gap: A psychometric approach to the reduction problem. Psychological Inquiry 22:6787.Google Scholar
Kim, J. (1982) Psychophysical supervenience. Philosophical Studies 41:5170.Google Scholar
Kim, J. (1984) Concepts of supervenience. Philosophy and Phenomenological Research 45:153–76.Google Scholar
Kraepelin, E. & Lange, J. (1927) Psychiatrie, vol. I, 9th edition. J. A. Barth.Google Scholar
Lacasse, J. R. & Leo, J. (2005) Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine 2:e392. Available at: https://doi.org/10.1371/journal.pmed.0020392.Google Scholar
Ledford, H. (2014) Medical research: If depression were cancer. [Editorial]. Nature 515:182–84.Google Scholar
Lewis, D. K. (1966) An argument for the identity theory. The Journal of Philosophy 63:1725.Google Scholar
Ma-Kellams, C. (2014) Cross-cultural differences in somatic awareness and interoceptive accuracy: A review of the literature and directions for future research. Frontiers in Psychology 5: article 1379. (Online publication). doi: 10.3389/fpsyg.2014.01379. Available at: https://www.frontiersin.org/articles/10.3389/fpsyg.2014.01379/full.Google Scholar
Marmanidis, H., Holme, G. & Hafner, R. J. (1994) Depression and somatic symptoms: A cross cultural study. Australian and New Zealand Journal of Psychiatry 28:274–78.Google Scholar
Marsman, M., Borsboom, D., Kruis, J., Epskamp, S., van Bork, R., Waldorp, L. J., van der Maas, H. L. J. & Maris, G. K. J. (2017) An introduction to network psychometrics: Relating Ising network models to item response theory models. Multivariate Behavioral Research 7:121. doi:10.1080/00273171.2017.1379379.Google Scholar
McDowell, J. (1996) Mind and world. Harvard University Press.Google Scholar
McGinn, C. (1982) The character of mind. Oxford University Press.Google Scholar
McNally, R. J. (1990) Psychological approaches to panic disorder: A review. Psychological Bulletin 108:403–19.Google Scholar
McNally, R. J. (2002) Anxiety sensitivity and panic disorder. Biological Psychiatry 52:938–46.Google Scholar
McNally, R. J. (2016) Can network analysis transform psychopathology? Behaviour Research and Therapy 86:95104.Google Scholar
McNally, R. J., Heeren, A. & Robinaugh, D. J. (2017a) A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse. European Journal of Psychotraumatology 8 (Suppl. 3):e1341276. Available at: http://doi.org/10.1080/20008198.2017.1341276.Google Scholar
McNally, R. J., Mair, P., Mugno, B. & Riemann, B. (2017b) Co-morbid obsessive–compulsive disorder and depression: A Bayesian network approach. Psychological Medicine 47:1204–14. doi:10.1017/S0033291716003287.Google Scholar
Menary, R., ed. (2010) The extended mind. MIT Press.Google Scholar
Mölder, B. (2010) Mind ascribed: An elaboration and defence of interpretivism. John Benjamins.Google Scholar
Murphy, D. (2005) Psychiatry in the scientific image. MIT Press.Google Scholar
Nagel, E. (1961) The structure of science: Problems in the logic of scientific explanation. Routledge & Kegan Paul.Google Scholar
Nolen-Hoeksema, S. & Watkins, E. R. (2011) A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on Psychological Science 6:589609.Google Scholar
Nordenfeld, L. (2007) Rationality and compulsion. Oxford University Press.Google Scholar
Oppenheim, P. & Putnam, H. (1958) Unity of science as a working hypothesis. Minnesota Studies in the Philosophy of Science 2:336.Google Scholar
Partch, C. L., Green, C. B. & Takahashi, J. S. (2013) Molecular architecture of the mammalian circadian clock. Trends in Cell Biology 24:9099.Google Scholar
Putnam, H. W. (1967) Psychological predicates. In: Art, mind, and religion, ed. Capitan, W. H. & Merrill, D. D.. University of Pittsburgh Press.Google Scholar
Pylyshyn, Z. (1984) Computation and cognition. MIT Press.Google Scholar
Rachman, S. (1998) A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy 36:385401.Google Scholar
Redei, E. E., Andrus, B. M., Kwansy, M. J., Seok, J., Ho, J. & Mohr, D. C. (2014) Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy. Translational Psychiatry 4:e442. doi:10.1038/tp.2014.66. Available at; http://www.nature.com/articles/tp201466.Google Scholar
Reise, S. P. & Waller, N. G. (2009) Item response theory and clinical measurement. Annual Review of Clinical Psychology 5:2748.Google Scholar
Reiss, S. (1991) Expectancy model of fear, anxiety, and panic. Clinical Psychology Review 11:141–53.Google Scholar
Robinaugh, D. J., LeBlanc, N. J., Vuletich, H. J. & McNally, R. J. (2014) Network analysis of persistent complex bereavement disorder in conjugally bereaved adults. Journal of Abnormal Psychology 123:510–22.Google Scholar
Salkovskis, P. M., Wroe, A. L., Gledhill, A., Morrison, N., Forrester, E., Richards, C., Reynolds, M. & Thorpe, S. (2000) Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder. Behaviour Research and Therapy 38:347–72.Google Scholar
Schaffner, K. (1974) Reductionism in biology: Prospects and problems. Proceedings of the Biennial Meeting of the Philosophy of Science Association 32:613–32.Google Scholar
Schaffner, K. (2006) Reduction: The Cheshire cat problem and a return to roots. Synthese 151:377402.Google Scholar
Schaffner, K. F. & Tabb, K. (2014) Varieties of social constructionism and the problem of progress in psychiatry. In: Philosophical issues in psychiatry III: The nature and sources of historical change. Oxford University Press.Google Scholar
Scheffer, M., Bascompte, J., Brock, W. A., Brovkin, V., Carpenter, S. R., Dakos, V., Held, H., van Nes, E. H., Rietkerk, M. & Sugihara, G. (2009) Early-warning signals for critical transitions. Nature 461(7260):5359.Google Scholar
Searle, J. R. (1983) Intentionality. Cambridge University Press.Google Scholar
Searle, J. R. (1998) Mind language and society: Philosophy in the real world. Basic Books.Google Scholar
Solomon, A. (2014) The noonday demon. Scribner.Google Scholar
Tabb, K. & Schaffner, K. F. (2017) Causal pathways, random walks and tortuous paths: Moving from the descriptive to the etiological in psychiatry. In: Philosophical issues in psychiatry IV: Nosology, ed. Kendler, K. S. & Parnas, J., pp. 342–60. Oxford University Press.Google Scholar
Thornton, T. (2010) Psychiatric explanation and understanding. European Journal of Analytic Philosophy 6:95111.Google Scholar
Tolin, D. F., Brady, R. E. & Hannan, S. (2008) Obsessional beliefs and symptoms of obsessive–compulsive disorder in a clinical sample. Journal of Psychopathology and Behavioral Assessment 30:3142.Google Scholar
Van Borkulo, C. D., Borsboom, D., Epskamp, S., Blanken, T. F., Boschloo, L., Schoevers, R. A. & Waldorp, L. J. (2014) A new method for constructing networks from binary data. Scientific Reports 4: article 5918. Available at: https://www.nature.com/articles/srep05918.Google Scholar
Van de Leemput, I. A., Wichers, M., Cramer, A. O. J., Borsboom, D., Tuerlinckx, F., Kuppens, P., Van Nes, E. H., Viechtbauer, W., Giltay, E. J., Aggen, S. H., Derom, C., Jacobs, N., Kendler, K. S., Van der Maas, H. L. J., Neale, M. C., Peeters, F., Thiery, E., Zachar, P. & Scheffer, M. (2013) Critical slowing down as early warning for the onset and termination of depression. Proceedings of the National Academy of Sciences USA 111:8792. doi:10.1073/pnas.1312114110.Google Scholar
Van der Maas, H. L. J., Dolan, C. V., Grasman, R. P. P. P., Wicherts, J. M., Huizenga, H. M. & Raijmakers, M. E. J. (2006) A dynamical model of general intelligence: The positive manifold of intelligence by mutualism. Psychological Review 113:842–61.Google Scholar
Van Os, J. (2009) “Salience syndrome” replaces “schizophrenia” in DSM-V and ICD-11: Psychiatry's evidence-based entry into the 21st century? ACTA Psychiatrica Scandinavica 120:363–72.Google Scholar
White, K. S., Brown, T. A., Somers, T. J. & Barlow, D. H. (2006) Avoidance behavior in panic disorder: The moderating influence of perceived control. Behaviour Research and Therapy 44:147–57.Google Scholar
Wichers, M. (2014) The dynamic nature of depression: A new micro-level perspective of mental disorder that meets current challenges. Psychological Medicine 44(7):1349–60.Google Scholar
Wild, L. G., Flisher, A. J. & Lombard, C. (2004) Suicidal ideation and attempts in adolescents: Associations with depression and six domains of self-esteem. Journal of Adolescence 27:611–24.Google Scholar
Wimsatt, W. C. (2007) Re-engineering philosophy for limited beings: Piecewise approximations to reality. Harvard University Press.Google Scholar