Explaining delusional beliefs: a hybrid model

Introduction: In this paper we present and defend a hybrid theory of the development of delusions that incorporates the central ideas of two influential (yet sometimes bitterly opposing) theoretical approaches to delusions-the two-factor theory and the prediction error theory. Method: After introducing the central ideas of the two-factor theory and the prediction error theory, we describe the motivations for our conciliatory project, explain the theoretical details of the hybrid theory we propose, and answer potential objections to our proposal. Results: According to the hybrid theory we advance, the first factor of a delusion is physically grounded in an abnormal prediction error, and the second factor is physically grounded in the overestimation of the precision of the abnormal prediction error. Against anticipated objections, we argue that the hybrid theory is internally coherent, and that it constitutes a genuine hybrid between the two-factor theory and the prediction error theory. Conclusion: A rapprochement between the two-factor theory and the prediction error theory is both possible and desirable. In particular, our hybrid theory provides a parsimonious and unified account of delusions, whether monothematic or polythematic, across a wide variety of medical conditions.