Where is RDoC headed? A look at the eating disorders FOA

Thomas Insel, director of NIMH, made a splash recently with the announcement that NIMH funding will be less strictly tied to the DSM. That by itself would be good news, given all the problems with DSM. But the proposed replacement, the Research Domain Criteria (RDoC), has worried some people that NIMH is pursuing biology to the exclusion of other levels of analysis, as opposed to taking a more integrated approach.

We can try to divine NIMH future directions from RDoC description and the director’s blog post, but it’s hard to tell whether mentions of behavior and phenomenology reflect real priorities or just lip service. Likewise for social and cultural factors. They come up in a discussion of “environmental aspects” that might interact with neural circuits, but they do not appear as focal units of analysis in the RDoC matrix, leaving them in a somewhat ambiguous state.

Another approach is to look at revealed preferences. Regardless of what anybody is saying, how is NIMH actually going to spend its money?

As an early indication, the NIMH RDoC overview page links to 2 funding opportunity announcements (FOAs) that are based on RDoC. Presumably these are examples of where RDoC-driven research is headed. One of the FOAs is for eating disorders. Here is the overview:

Eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and their variants, are a major source of physical and psychological morbidity and constitute the major contribution to excess mortality from psychiatric disorders.  Clinical presentations of eating disorders are highly heterogeneous, involving broad and often overlapping symptomatology, which is often further complicated by metabolic and nutritional challenges that result from restricted food intake, excessive exercise, and repeated binge and/or purge episodes.  The recognition that relatively specific behaviors, cognitive operations, and affective processes are primarily implemented by particular neural circuits suggests that dysregulated functions and associated neural circuits should be a critical focus of study, and, ultimately, the target of assessment and treatment for eating disorders.

Here is a list of words that do not appear anywhere in the eating disorders FOA:

peer (when not followed by “review” referring to the funding processes)
body image
self (when not followed by “-report” in a rote recital of the RDoC units of anlaysis)

And maybe I shouldn’t get too hung up on a choice of a definite vs. indefinite article, but what’s up with stating that neural circuits should be “ultimately, the target of assessment and treatment”?

Eating disorders isn’t my area. So I might have missed something. Perhaps NIMH is planning to issue another RDoC-based eating disorders FOA that invites research on sociocultural factors. Or maybe I’m missing some other important way that they will be incorporated into NIMH’s priorities for studying eating disorders. But if not — if NIMH thinks that basic research on media, on family environments, on peer influence, on self-concept, on cultural norms are not terribly important for understanding and treating eating disorders — well, that’s really hard to defend. And not a good sign of where things are headed more broadly.