Predictive coding in psychopathology: mechanistic model or metaphorical re-description?

TL;DR

This paper reviews how predictive coding, a brain model, applies to mental disorders like schizophrenia and autism, highlighting both its potential and limitations.

Contribution

The paper provides a critical comparative analysis of predictive coding's clinical applicability across multiple psychiatric domains.

Findings

PC offers testable insights into hallucinations and sensory issues in schizophrenia and autism.

Theoretical tensions persist regarding prior precision and neural-behavior mapping.

Inconsistent terminology limits predictive coding's explanatory power in different disorders.

Abstract

Predictive coding (PC) has become a central framework in contemporary cognitive neuroscience, proposing that the brain operates as a hierarchical inference system that continuously minimizes the mismatch between predicted and actual sensory input. Its extension into clinical neuroscience has been accompanied by considerable enthusiasm, yet attempts to translate its computational principles into explanations of psychiatric and neurological disorders have yielded uneven results. The present review critically examines the clinical applicability of PC across three diagnostic domains: schizophrenia, autism spectrum disorder (ASD), and mood and anxiety disorders. Drawing on findings from neuroimaging, electrophysiology, and computational modeling, the discussion evaluates how disturbances in prediction error signaling, the precision weighting of sensory evidence relative to prior beliefs, and hierarchical inference have been proposed to relate to core clinical phenomena such as hallucinations, sensory hypersensitivity, and affective dysregulation. Particular attention is given to persistent theoretical tensions, including debates surrounding prior precision, the mapping between neural proxies and behavior, and the inconsistent use of PC terminology across diagnostic contexts. By adopting a structured and comparative approach, this review aims to clarify where predictive coding offers testable mechanistic insight into psychopathology, and where its explanatory scope remains limited or provisional.