Precision psychiatry is currently described as an approach that would bring significant advance to psychiatric clinical practice. Theaim of this article is to investigate Precision Psychiatry’s promise for the future; should we substantially invest in this new approach? Thearticle is based on a review of the literature and reports a conceptual analysis. A critical examination of Precision Psychiatry’s foundationsshows us that its fundaments are obsolete and flawed: we cannot reduce mental suffering to essences in biology. It is problematic to statethat biological processes hold and capture qualia and meaning, and in themselves and without context would hold and capture somethinglike abnormality. Despite its good efforts, precision psychiatry does not represent a sufficiently promising alternative to the phenotyping thatcomes with the current classification systems.

The comorbidity of personality disorders and mental disorders is commonly understood through three types of theoretical models: either a) personality disorders precede mental disorders, b) mental disorders precede personality disorders, c) mental disorders and personality disorders share common etiological grounds. Although these hypotheses differ with respect to their idea of causal direction, they all imply a latent variable perspective, in which it is assumed that either personality and mental disorders are latent variables that have certain causal relations [models a) and b)]; or that, as in model c), the common etiology is in fact a latent variable that causes symptomatology of both personality and mental disorders. We aim to provide another perspective on the comorbidity between personality and mental disorders, namely a network perspective. To this end, we investigated Major Depression (MD) and Borderline Personality Disorder (BPD) and hypothesized that symptoms of BPD and MD could interact with one another rather than being caused by a latent variable (e.g., identity diffusion → unstable relationships → depressed mood). To illustrate this theoretical network conceptualization of the comorbidity of BPD and MD we analyzed a cross-sectional clinical dataset of 376 patients who were asked to complete the Structured Clinical Interview for DSM-IV Axis II Disorders and the Beck Depression Inventory II. The results identify direct associations between symptoms of MD and BPD. If we take the links in this empirical network to be ‘substantive', this suggests a radical shift of our current conceptualization of the comorbidity of mental disorders and personality disorders.

It is not enough to sing its praises: the very foundations of precision psychiatry may be scientifically unsound and require examination. Psychological Medicine 1-3.