Non-bivalent psychopathology: Rethinking mental disorders through metacontrol

Traditional approaches to psychopathology are based on a bivalent or binary view (healthy vs. ill), oftentimes obscuring an understanding of the heterogeneity of symptoms, fluctuations, comorbidities, and of relationships/boundaries between psychopathologies. The recent Research Domain Criteria (RDoC) approach recognizes these problems without providing mechanistic solutions. We propose a novel non-binary approach based on neurocognitive principles derived from the well-established, mechanistically transparent Metacontrol State Model of psychopathology (MSMp). We suggest (1) abandoning phenomenologically-derived classifications of psychopathologies altogether; (2) explaining functional and dysfunctional behavior by means of the same theory; and (3) reconstructing behavioral observations from basic mechanisms. In line with the ambitions of RDoC, our mechanistic account allows addressing, analyzing, and treating malfunctioning at its very core—the responsible mechanism, rather than focusing on observable symptoms that may not indicate a common problem. Our theory-guided, evidence-based approach has the potential to foster a novel mechanistic understanding of psychopathology, improve diagnostic criteria weighting, and make interventions more effective.