vulnerability to psychopathology etiological...

Vulnerability to psychopathologyVulnerability to psychopathologyEtiological modelsEtiological models

Cornelia Pinnell, Ph.D.Cornelia Pinnell, Ph.D.Argosy University/PhoenixArgosy University/Phoenix

Lecture Outline Lecture Outline

•• History of etiological explanatory modelsHistory of etiological explanatory models•• PsychopathologyPsychopathology•• Contemporary models:Contemporary models:•• Contemporary models:Contemporary models:

–– StressStress--DiathesisDiathesis/Vulnerability/Risk Factors /Vulnerability/Risk Factors (personality=mediating factor)(personality=mediating factor)•• Vulnerability Vulnerability –– biological, psychological, social biological, psychological, social (developmental model)(developmental model)

•• Stress Stress –– distal and proximaldistal and proximal

–– Resilience/Strength Resilience/Strength –– Protective FactorsProtective Factors

Etiological modelsEtiological models

•• Causality/etiologyCausality/etiology in psychopathology refers in psychopathology refers to the factors that elicit the emergence from a to the factors that elicit the emergence from a relatively ‘normal’ state into an abnormal or relatively ‘normal’ state into an abnormal or disordered state of psychological functioning disordered state of psychological functioning disordered state of psychological functioning disordered state of psychological functioning ((onsetonset))

•• Causality/etiology Causality/etiology in psychopathology also in psychopathology also refers the factors that refers the factors that maintainmaintain and contribute and contribute to the to the continuationcontinuation of the problem(s)of the problem(s)

Clinical RealityClinical Reality

•• Clinical reality Clinical reality = The cognitive = The cognitive construction of reality construction of reality –– by the clinician by the clinician and the client within a clinical context/ and the client within a clinical context/ setting and is influenced by their learned setting and is influenced by their learned setting and is influenced by their learned setting and is influenced by their learned cultural schemascultural schemas

Castillo (1996)Castillo (1996)

Clinical RealityClinical Reality

Five ways culture affects clinical realityFive ways culture affects clinical reality1.1. CultureCulture--based subjective experiencebased subjective experience2.2. CultureCulture--based idioms of distressbased idioms of distress2.2. CultureCulture--based idioms of distressbased idioms of distress3.3. CultureCulture--based diagnosesbased diagnoses4.4. CultureCulture--based treatmentsbased treatments5.5. CultureCulture--based outcomesbased outcomes

Castillo (1996)Castillo (1996)

Evolution of the clinical realityEvolution of the clinical reality

•• Supernatural causesSupernatural causes: : demonic possession, demonic possession, evil spirits; evil spirits; treatmenttreatment involved exorcism or other involved exorcism or other techniques to dispossess a spirit from a human techniques to dispossess a spirit from a human body body body body

•• Natural causesNatural causes: : organismicorganismic or environmental; or environmental; treatmenttreatment involved rest, diet, exercise, restoring involved rest, diet, exercise, restoring balance, etc.balance, etc.


AntiquityAntiquity -- Hippocrates (460Hippocrates (460--375/351 B.C.) 375/351 B.C.) ––•• EtiologyEtiology -- natural causes: 4 bodily fluids natural causes: 4 bodily fluids (humors (humors –– blood, phlegm, black and yellow bile), blood, phlegm, black and yellow bile), each associated with a body type and each associated with a body type and each associated with a body type and each associated with a body type and temperament temperament –– if there is an imbalance, there is if there is an imbalance, there is a vulnerability to specific type of illness a vulnerability to specific type of illness ((wholisticwholistic view) view)

•• TreatmentTreatment –– diet, exercise, blood letting, diet, exercise, blood letting, vomitingvomiting


•• European medievalEuropean medieval: demonic possession & : demonic possession & witchcraft witchcraft –– exorcism; exorcism; MalleusMalleus MalleficarumMalleficarum

•• Modern Modern psychiatrypsychiatry: medical/biological paradigm: medical/biological paradigm•• Modern psychologyModern psychology: behaviorism, : behaviorism, •• Modern psychologyModern psychology: behaviorism, : behaviorism, psychoanalysis, humanismpsychoanalysis, humanism

•• PostPost--modernmodern psychiatrypsychiatry: cultural paradigm: cultural paradigm•• PostPost--modern psychologymodern psychology: developmental, : developmental, multifactorialmultifactorial, bio, bio--psychopsycho--socialsocial--spiritualspiritual

Holistic perspective Holistic perspective

•• Physical diseasePhysical disease is one of several is one of several manifestations of a basic imbalance of the manifestations of a basic imbalance of the organismorganism

•• Mental illnessMental illness results from a failure to results from a failure to evaluate and integrate experienceevaluate and integrate experience

Little consensus on Little consensus on the definition of psychopathologythe definition of psychopathology

•• The DSM does not provide a clear The DSM does not provide a clear indication of what differentiates indication of what differentiates abnormal functioningabnormal functioning

•• WakefieldWakefield (1992, 1999) discusses (1992, 1999) discusses •• WakefieldWakefield (1992, 1999) discusses (1992, 1999) discusses ‘‘harmful dysfunctionharmful dysfunction’’1.1. Harm = condition that creates distress or Harm = condition that creates distress or

problems for an individualproblems for an individual2.2. Dysfunction = failure to perform at a Dysfunction = failure to perform at a

particular developmental stageparticular developmental stage

Little consensus on Little consensus on the definition of psychopathologythe definition of psychopathology

•• BergnerBergner (1997): “significant restriction in the (1997): “significant restriction in the ability of an individual to engage in deliberate ability of an individual to engage in deliberate action and to aprticiapte in available social action and to aprticiapte in available social practices”practices”practices”practices”

•• Lilienfeld & Marino Lilienfeld & Marino (1995): “it is (1995): “it is not possible not possible to clearly distinguish between normal to clearly distinguish between normal and abnormal functioning, as the and abnormal functioning, as the boundaries are fuzzyboundaries are fuzzy””

Comprehensive & ecologically valid Comprehensive & ecologically valid models of psychopathologymodels of psychopathology

Psychopathology is viewed as resulting Psychopathology is viewed as resulting from a from a complex and dynamic series of complex and dynamic series of interactionsinteractions between the characteristics between the characteristics of the individual (i.e., genotype; acquired of the individual (i.e., genotype; acquired of the individual (i.e., genotype; acquired of the individual (i.e., genotype; acquired cognitive, affective & behavioral schemas cognitive, affective & behavioral schemas and patterns) with personal life and patterns) with personal life experiences and life stressors.experiences and life stressors.

StressStress--Diathesis modelDiathesis model

Major tenetMajor tenet: : All forms of psychopathology can be All forms of psychopathology can be All forms of psychopathology can be All forms of psychopathology can be best explained within the framework of best explained within the framework of a stressa stress--diathesis modeldiathesis model

StressStress--diathesis modeldiathesis model

•• DiathesisDiathesis = = Constitutional disposition or Constitutional disposition or predisposition to some anomalous or predisposition to some anomalous or morbid condition (Meehl, 1962)morbid condition (Meehl, 1962)

•••• PersonalityPersonality = = mediating factormediating factor•• VulnerabilityVulnerability

a)a) Narrow useNarrow use: Biological predisposition/ vulnerability : Biological predisposition/ vulnerability (due to genetic & biological factors)(due to genetic & biological factors)

b)b) Broad useBroad use: Biological, cognitive affective and social: Biological, cognitive affective and social

Vulnerability to psychopathologyVulnerability to psychopathology

•• Stable & enduring traitStable & enduring trait (Zubin & Spring, 1977) (Zubin & Spring, 1977) --there is there is functional variability/fluctuationfunctional variability/fluctuation; vulnerability ; vulnerability can can increase increase (e.g., “(e.g., “kindling effectkindling effect” described by Post, 1992)” described by Post, 1992)or or decreasedecrease throughout lifetime throughout lifetime

•• Locus of vulnerabilityLocus of vulnerability is is in the individualin the individual: hereditary : hereditary •• Locus of vulnerabilityLocus of vulnerability is is in the individualin the individual: hereditary : hereditary ((inborninborn) or environmental () or environmental (acquiredacquired) through ) through trauma/injury or socializationtrauma/injury or socialization

•• Vulnerability domainsVulnerability domains may interact (biological, may interact (biological, cognitive, affective, social/behavioral)cognitive, affective, social/behavioral)

•• Latent processesLatent processes (not readily observable)(not readily observable)

Biological modelBiological model

•• Biological traditionBiological tradition of the 19of the 19thth and 20and 20thth

centuries centuries –– belief that psychological belief that psychological disorders are caused by a biological disorders are caused by a biological vulnerability/diathesis and can be treated vulnerability/diathesis and can be treated vulnerability/diathesis and can be treated vulnerability/diathesis and can be treated through biological means:through biological means:–– Insulin shock therapyInsulin shock therapy–– ECT (Electroconvulsive therapy)ECT (Electroconvulsive therapy)–– Psychotropic drugsPsychotropic drugs

Biological vulnerabilityBiological vulnerability

•• Genetics (heritability)Genetics (heritability)–– Multiple genes Multiple genes

•• Neuroscience (neurological/biochemical)Neuroscience (neurological/biochemical)–– Brain morphology & physiologyBrain morphology & physiology–– NeurotransmittersNeurotransmitters–– Endocrine systemEndocrine system–– Central & peripheral nervous systemCentral & peripheral nervous system

•• Dysregulation/dysfunctionDysregulation/dysfunction

Cognitive & affective vulnerabilityCognitive & affective vulnerability

•• CognitiveCognitive –– early maladaptive schemas; early maladaptive schemas; core (dysfunctional) beliefs; irrational core (dysfunctional) beliefs; irrational thinking; thinking errors, etc.thinking; thinking errors, etc.

•••• AffectiveAffective –– high intensity or low intensity high intensity or low intensity (blunted affect); affect dysregulation & (blunted affect); affect dysregulation & labilitylability

Social/behavioral vulnerabilitySocial/behavioral vulnerability

•• Insecure attachmentsInsecure attachments•• Limited/absent social skills (skill deficits)Limited/absent social skills (skill deficits)

Psychological modelsPsychological models

•• PsychoanalysisPsychoanalysis –– focus on unconscious intrapsychic focus on unconscious intrapsychic conflicts & defense mechanismsconflicts & defense mechanisms–– Recent developments: Ego psychology, Object relations theory, Recent developments: Ego psychology, Object relations theory,

Self psychologySelf psychology

•• HumanismHumanism ––•• HumanismHumanism –– focus on human potential & emotions, focus on human potential & emotions, incongruenceincongruence

•• BehaviorismBehaviorism –– focus on the environment, and focus on the environment, and environmental stimulienvironmental stimuli–– Classical & operant conditioning, social learning theoryClassical & operant conditioning, social learning theory–– CognitiveCognitive--behavioral theories behavioral theories –– role of cognitive processesrole of cognitive processes

SocialSocial--cultural modelscultural models

•• Social effects on behavior & healthSocial effects on behavior & health ––focus focus on culture and social factorson culture and social factors–– CultureCulture--bound syndromesbound syndromes

“Human beings cannot“Human beings cannot develop into functioning develop into functioning individuals without internalizing cultural schemas in the individuals without internalizing cultural schemas in the neural networks of the brain” (Castillo, 1997)neural networks of the brain” (Castillo, 1997)

AAssssoocccciiaatteeddFigure 5.5Figure 5.5 An integrative model of generalized anxiety disorderAn integrative model of generalized anxiety disorder

Risk FactorsRisk Factors

•• Risk factorsRisk factors predict the likelihood of predict the likelihood of dysfunction, expressed in probabilities. dysfunction, expressed in probabilities. They are empirically related to They are empirically related to vulnerability (Rutter, 1987).vulnerability (Rutter, 1987).vulnerability (Rutter, 1987).vulnerability (Rutter, 1987).–– A person ‘at risk’ may develop a disorder due A person ‘at risk’ may develop a disorder due to increased (or activated latent) vulnerability to increased (or activated latent) vulnerability when living under stressful conditions. when living under stressful conditions.

Child and adult vulnerabilityChild and adult vulnerability

•• The distinction between vulnerability in The distinction between vulnerability in childhood/adolescence and adulthood is childhood/adolescence and adulthood is arbitrary. arbitrary.

•••• Most researchers agree that most likely Most researchers agree that most likely precursors are rooted in experiences precursors are rooted in experiences encountered early in life. encountered early in life.

Adult vulnerabilityAdult vulnerability

•• Some of the adult learning, new life Some of the adult learning, new life experiences and cognitive/emotion schemes. experiences and cognitive/emotion schemes. “Wear & tear” of the system “Wear & tear” of the system –– through illness, through illness, difficult life circumstances. difficult life circumstances. difficult life circumstances. difficult life circumstances.

•• Activation of latent vulnerability factors, which Activation of latent vulnerability factors, which leads to the actualization and realization of leads to the actualization and realization of psychopathology.psychopathology.

•• Functional vulnerability factors can change Functional vulnerability factors can change


StressStress1.1. In physicsIn physics, it , it refers to an ‘applied force that refers to an ‘applied force that

tends to strain or deform a body’tends to strain or deform a body’

2.2. In psychologyIn psychology, it denotes both an , it denotes both an external external factorfactor (a stressor) and an (a stressor) and an internal responseinternal response to to the stressorthe stressor


StressorsStressors::

1.1. Distal stressorsDistal stressors (early stress, whether biological or (early stress, whether biological or 1.1. Distal stressorsDistal stressors (early stress, whether biological or (early stress, whether biological or social in nature may make a child more vulnerable to social in nature may make a child more vulnerable to later stress)later stress)

2.2. Proximal stressorsProximal stressors (immediate stressors that may (immediate stressors that may trigger the disorder trigger the disorder -- e.g., divorce, illness, loss of job)e.g., divorce, illness, loss of job)


•• Diathesis with a Diathesis with a single dominant genesingle dominant gene•• Diathesis with Diathesis with polygenic originpolygenic origin (Meehls’ model (Meehls’ model

for schizophrenia has the acronym SHAITU for schizophrenia has the acronym SHAITU –– SHAI SHAI stands forstands for personality traitspersonality traits of polygenic origins: of polygenic origins: stands forstands for personality traitspersonality traits of polygenic origins: of polygenic origins: submissive, hypohedonic, anxious, & introvertedsubmissive, hypohedonic, anxious, & introverted); TU ); TU stands for stands for environmental risk factorsenvironmental risk factors: T for : T for major major and frequent minor traumas during developmentand frequent minor traumas during development & U for & U for unlucky events in adult life)unlucky events in adult life)

•• Additive modelAdditive model of stressof stress--diathesis diathesis interactioninteraction

Developmental view of Developmental view of psychopathologypsychopathology

•• The manner in which an individual negotiates a The manner in which an individual negotiates a variety of developmental tasks contributes to variety of developmental tasks contributes to increased increased vulnerabilityvulnerability or to or to resilienceresilience

•• There is a There is a dynamic interactiondynamic interaction between a between a •• There is a There is a dynamic interactiondynamic interaction between a between a person’s “person’s “givensgivens” and ” and environmental demandsenvironmental demandsthroughout the lifespanthroughout the lifespan

•• There are There are many different possible pathwaysmany different possible pathwaystowards the same disordertowards the same disorder

Developmental view of Developmental view of psychopathologypsychopathology

•• EPIFINALITY = A specific disorder may be EPIFINALITY = A specific disorder may be reached from a variety of different initial reached from a variety of different initial conditions and through a variety of different conditions and through a variety of different processesprocessesprocessesprocesses

•• MULTIFINALITY = The same vulnerability MULTIFINALITY = The same vulnerability processes may lead to different types of processes may lead to different types of disordersdisorders

Contemporary etiological models of Contemporary etiological models of psychopathologypsychopathology

We are moving beyond models that assert that disorders We are moving beyond models that assert that disorders arise from singular endogenous pathogens. There is a arise from singular endogenous pathogens. There is a need to examine the need to examine the complex interactionscomplex interactions among various among various need to examine the need to examine the complex interactionscomplex interactions among various among various vulnerability factors and the vulnerability factors and the dynamic transactionsdynamic transactionsbetween the vulnerability factors, normal maturational between the vulnerability factors, normal maturational processes, and the environment; the search for processes, and the environment; the search for multidimensional causalitymultidimensional causality or or multiple multiple determinants of psychopathologydeterminants of psychopathology is the rule rather is the rule rather than the exception Rutter (1996). than the exception Rutter (1996).

ResiliencyResiliency

•• Resiliency is the term applied to children Resiliency is the term applied to children exposed to severe risk factors, such as exposed to severe risk factors, such as poverty, who nevertheless thrive and poverty, who nevertheless thrive and excel. It is the ability to spring back from excel. It is the ability to spring back from excel. It is the ability to spring back from excel. It is the ability to spring back from and successfully adapt to adversity. and successfully adapt to adversity.

ResilienceResilience

•• 7 crucial qualities (Steven Wolin)7 crucial qualities (Steven Wolin)–– InsightInsight–– IndependenceIndependence–– InitiativeInitiative–– InitiativeInitiative–– Ability to form relationshipsAbility to form relationships–– CreativityCreativity–– HumorHumor–– MoralityMorality

Protective factors & resilienceProtective factors & resilience

•• Multiple Multiple vulnerability vulnerability and protective and protective factors can be examined in relationship to factors can be examined in relationship to multiple forms of psychopathology to multiple forms of psychopathology to determine the degree to which a particular determine the degree to which a particular determine the degree to which a particular determine the degree to which a particular vulnerability factor or set of factors are vulnerability factor or set of factors are specific to a particular disorder or increase specific to a particular disorder or increase the likelihood of disorders in general. the likelihood of disorders in general.

ReferencesReferences

•• Ingram, R. E., & Price, J. M. (Eds.) (2002). Ingram, R. E., & Price, J. M. (Eds.) (2002). Vulnerability to psychopathology. Risk Vulnerability to psychopathology. Risk across the lifespanacross the lifespan. New York: The . New York: The Guilford Press.Guilford Press.Guilford Press.Guilford Press.

•• Zuckerman, M. (1999). Zuckerman, M. (1999). Vulnerability to Vulnerability to psychopathologypsychopathology. A . A biosocial modelbiosocial model. . Washington, DC: American Psychological Washington, DC: American Psychological Association. Association.

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