The ‘L-factor’: Language as a transdiagnostic dimension in psychopathology

Abstract

Thoughts and moods constituting our mental life incessantly change. When the steady flow of this dynamics diverges in clinical directions, the possible pathways involved are captured through discrete diagnostic labels. Yet a single vulnerable neurocognitive system may be causally involved in psychopathological deviations transdiagnostically. We argue that language viewed as integrating cortical functions is the best current candidate, whose forms of breakdown along its different dimensions are then manifest as symptoms - from prosodic abnormalities and rumination in depression to distortions of speech perception in verbal hallucinations, distortions of meaning and content in delusions, or disorganized speech in formal thought disorder. Spontaneous connected speech provides continuous objective readouts generating a highly accessible bio-behavioral marker with the potential of revolutionizing neuropsychological measurement. This argument turns language into a transdiagnostic 'L-factor' providing an analytical and mechanistic substrate for previously proposed latent general factors of psychopathology ('p-factor') and cognitive functioning ('c-factor'). Together with immense practical opportunities afforded by rapidly advancing natural language processing (NLP) technologies and abundantly available data, this suggests a new era of translational clinical psychiatry, in which both psychopathology and language may be rethought together.

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