A synthesis of evidence on inhibitory control and auditory hallucinations based on the Research Domain Criteria (RDoC) framework

Abstract

The National Institute of Mental Health initiative called the Research Domain Criteria (RDoC) project aims to provide a new approach to understanding mental illness grounded in the fundamental domains of human behavior and psychological functioning. To this end the RDoC framework encourages researchers and clinicians to think outside the [diagnostic] box, by studying symptoms, behaviors or biomarkers that cut across traditional mental illness categories. In this article we examine and discuss how the RDoC framework can improve our understanding of psychopathology by zeroing in on hallucinations- now widely recognized as a symptom that occurs in a range of clinical and non-clinical groups. We focus on a single domain of functioning-namely cognitive [inhibitory] control-and assimilate key findings structured around the basic RDoC "units of analysis," which span the range from observable behavior to molecular genetics. Our synthesis and critique of the literature provides a deeper understanding of the mechanisms involved in the emergence of auditory hallucinations, linked to the individual dynamics of inhibitory development before and after puberty; favors separate developmental trajectories for clinical and non-clinical hallucinations; yields new insights into co-occurring emotional and behavioral problems; and suggests some novel avenues for treatment.

Keywords: Research Domain Criteria project; cognition; hallucinations; hearing voices; inhibitory control.

Figure 1

Schematic representation of possible functional relationships between inhibitory control and hallucination frequency. Solid black line () depicts a roughly linear association between inhibition difficulty and AH frequency. Solid gray line () indicates a potentially non-linear relationship between inhibition and AH frequency, characterized by a critical “tipping point” (dashed line) in inhibitory dysfunction, beyond which the frequency of hallucinations rises markedly. Right vertical axis illustrates the link with the degree of OFC activation, which influences the emotional valence of participants' response (details in text).

Figure 2

Schematic illustration of potentially separate pathways to clinical and non-clinical hallucinations linked to the dynamics of inhibitory development.