Reimagining the biopsychosocial model: hierarchical mechanisms from transdiagnostic to precision psychiatry

Bio-psycho-social models of psychopathology have been long proposed. Despite this, few details have been identified in part due to the poor match between clinical phenomenology and diagnostic categories (e.g., overlapping symptoms and comorbidity). In the present paper, the author reviews the evidence for three factors thought to affect vulnerability across diagnoses: mesocorticolimbic function, early life adversity, and early propensities to high emotional and behavioral reactivity. All three factors now have compelling support but their effects on clinical outcomes are small to moderate in isolation. In comparison, our preliminary studies suggest that combining these factors yields a powerful model that predicts liability to all common psychiatric disorders. Narrower mental health problems are identified when the model incorporates high brain reactivity to disorder-specific stimuli. Since the combination of these factors accounts for more variance than the sum of their parts, this novel, hierarchical model might explain how the structure of psychopathology arises.