Development of Psychopathology

A Vulnerability-Stress Perspective

Benjamin L. Hankin, John R.Z. Abela, Benjamin L. Hankin, John R. Z. Abela

• Publisher: SAGE Publications, Inc
• Year: 2005
• Print ISBN: 9781412904902
• eBook ISBN: 9781452236575
• Edition: 1
• Topic: Psychology
• Subtopic: Psychopathology
• Index: Psychology

"..a blending of two important approaches to understanding psychopathology- the developmental approach and the vulnerability approach. I think a book like this is timely, is needed, and would be of interest to professors who teach courses in psychopathology at the advanced undergraduate and graduate levels."
— Robin Lewis, Old Dominion University

"Bringing together developmental psychopathology frameworks and the vulnerability-stress models of psychological disorders is an excellent idea. I am aware of no other book that incorporates these two approaches. Having taught Psychopathology courses for both master?s and doctoral students, I reviewed many books to recommend and use in the courses. It is my belief that a book of this type is needed particularly for graduate students."

—Linda Guthrie, Tennessee State University  

Edited by Benjamin L. Hankin and John R. Z. Abela, Development of Psychopathology: A Vulnerability-Stress Perspective brings together the foremost experts conducting groundbreaking research into the major factors shaping psychopathological disorders across the lifespan in order to review and integrate the theoretical and empirical literature in this field. The volume editors build upon two important and established research and clinical traditions: developmental psychopathology frameworks and vulnerability-stress models of psychological disorders. In the past two decades, each of these separate approaches has blossomed. However, despite the scientific progress each has achieved individually, no forum previously brought these traditions together in the unified way accomplished in this book.   

Key Features:

• Consists of three-part text that systematically integrates vulnerability-stress models of psychopathology with a developmental psychopathological approach.
• Brings together leading experts in the field of vulnerability, stress, specific vulnerabilities to psychological disorders, psychopathological disorders, and clinical interventions.
• Takes a cross-theoretical, integrative approach presenting cutting-edge theory and research at a sophisticated level.  

Development of Psychopathology will be a valuable resource for upper-division undergraduate and graduate students in clinical psychology, as well as for researchers, doctoral students, clinicians, and instructors in the areas of developmental psychopathology, clinical psychology, experimental psychopathology, psychiatry, counseling psychology, and school psychology.             

Part I

OVERVIEW AND FOUNDATIONS

CHAPTER 1

Conceptualizing the Role of Stressors in the Development of Psychopathology

KATHRYN E. GRANT AND SUSAN D. MCMAHON

Stressors occupy a central role in the field of developmental psychopathology. At the theoretical level, most prevailing models of psychopathology recognize the potential importance of environmental stressors in the etiology and maintenance of psychological disorder (e.g., Cicchetti & Toth, 1997; Haggerty, Roghmann, & Pless, 1993; Rutter, 1989). Stressors represent the environmental contribution of risk, which interacts with multiple forms of vulnerability (e.g., genetic, biological, cognitive, interpersonal, and personality) to lead to psychopathology (Mash & Barkley, 2003; Monroe & Hadjiyannakis, 2002).

In spite of the potential significance of stressors, recent reviews (Grant et al., 2003; Grant, Compas, Thurm, McMahon, & Gipson, 2004; McMahon, Grant, Compas, Thurm, & Ey, 2003) acknowledge that the past decades have yielded only limited and incremental progress in the field. What makes this conclusion particularly notable is that a vast number of studies have been conducted in this area—more than 1,500 in the past 15 years on child and adolescent stress alone. Two related problems have been identified as reasons for this lack of progress: (a) conceptualization problems, and (b) measurement problems (Grant et al., 2003).

DEFINING STRESS

Few constructs in mental health have been as important, yet at the same time as difficult to define, as the concept of stress (S. Cohen, Kessler, & Gordon, 1995). Prevailing definitions all focus on environmental circumstances or conditions that threaten, challenge, exceed, or harm the psychological or biological capacities of the individual (S. Cohen et al., 1995). These demands may occur in the form of change in the social environment or in persistent environmental conditions that present ongoing threats and challenges. In this sense, all definitions of stress include an environmental component. Definitions of stress differ, however, in the degree to which they emphasize psychological processes that occur in response to the environment.

The most widely accepted definition of stress has been the one offered by Lazarus and Folkman (1984): “Psychological stress involves a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well being” (p. 19). This definition has been cited frequently as the conceptual basis for research on stress in young people and adults.

Although the transactional theory that Lazarus and Folkman (1984) proposed helped to advance the field of psychology and the understanding of stress processes, there are some inherent problems with including appraisal in the definition of stress. First, a definition of stress that relies on cognitive appraisal processes is problematic for research on children and adolescents (Grant et al., 2003). Results of research on stress during infancy indicate there are clear negative effects of maternal separation, abuse, and neglect on infants (e.g., Field, 1995; Perry, Pollard, Blakley, Baker, & Vigilante, 1995). These negative effects occur, presumably, without the cognitive appraisal component that is central to the transactional definition.¹ In addition, preliminary research indicates that cognitive appraisal processes that play a significant role later in development do not play the same role for young children exposed to stressors (Nolen-Hoeksema, Girgus, & Seligman, 1992; J. E. Turner & Cole, 1994).

Further, in recent years, theoretical models of the etiology of developmental psychopathology have become more sophisticated, and there is greater emphasis on moderating and mediating processes that influence or explain the relation between stressors and psychopathology across development (Cicchetti & D. J. Cohen, 1995; Pearlin, 1999). Reliance on a definition of stress that “lumps” together potential mediating or moderating processes, such as cognitive appraisal processes, with stressors is conceptually unclear and empirically problematic (Reiss & Oliveri, 1991). To understand fully how stressful experiences, moderating factors, and mediating processes relate to one another in the prediction of psychopathology, it is important to discretely define and measure each of these variables (Aneshensel, 1999). This is particularly true in child and adolescent research, because the role of specific mediating and moderating processes is likely to shift across development.

A final reason for moving beyond a transactional definition of stress is that the individually based focus of such an approach may accentuate confounding of multiple vulnerabilities in stress research. From a transactional perspective, whether an experience is defined as a stressor is based on whether the individual appraises it as such. Appraisal processes, however, may reflect genetic or other vulnerability contributions to risk, thereby exacerbating potential confounding of vulnerabilities and environmental contributions to symptomatology (Brown, 1990; B. P. Dohrenwend & Shrout, 1986; Skodol, B. P. Dohrenwend, Link, & Shrout, 1990). Although any self-report method is susceptible to some degree of such confounding, methods that emphasize objective definitions of stressors are better equipped to assess the unique contribution of environmental risk to the development of psychopathology.

The single essential element of stress research—distinct from moderators and mediators, psychological symptoms, and other sources of risk or vulnerability—is external, an environmental threat to the individual (S. Cohen et al., 1995). For this reason, Grant and colleagues (2003) propose that stress be defined as “environmental events or chronic conditions that objectively threaten the physical and/or psychological health or well-being of individuals of a particular age in a particular society” (p. 449). Such a definition is consistent with traditional “stimulus-based” definitions of stress (Holmes & Rahe, 1967) and more recent definitions of stressors (McCubbin & Patterson, 1983) and objective stress (Brown & Harris, 1989; B. P. Dohrenwend & Shrout, 1985; Hammen, 1997).²

Development of a clear working definition of stressors, distinct from moderating and mediating variables, is an important first step toward fully defining the construct. Nonetheless, it remains a first step. Much additional research is needed to determine which specific environmental changes, events, and situations are “objectively threatening” to individuals. In this way, conceptualization of stressors is integrally linked with measurement and with the broader notion of a stressor classification system or taxonomy.

MEASURING STRESSORS

Stressor Checklists

The most widely used method for assessing stressors is the self-report checklist. Checklists are relatively easy to administer and allow investigators to collect data on large samples, thus increasing statistical power to detect relations among stressors, mediating and moderating variables, and psychological outcomes. Checklists vary in the extent to which they focus on breadth or depth. General checklists assess a broad range of stressful experiences, whereas specialized checklists assess specific types or domains of stressful events.

General Checklists of Stressful Events

Advances have been made in the development and refinement of general stressor checklists for adolescents and adults, but less progress has been made in the development of checklists for children. General checklists are all similar in that they present respondents with a sample of negative and, in some cases, positive events that are representative of the types of events that researchers deem relevant. None of the inventories is designed to be exhaustive; rather, they are intended to offer a sufficiently broad sampling to be representative of stressful events and experiences. Test-retest reliability and concurrent validity of several general life events checklists for adolescents and adults have been established (e.g., Burnett & Fanshawe, 1997; Cheng, 1997; L. H. Cohen & Park, 1992; Compas, Davis, Forsythe, & Wagner, 1987; B. S. Dohrenwend, Krasnoff, Askenasy, & B. P. Dohrenwend, 1978; Vagg & Spielberger, 1998; Williams & Cooper, 1998).

In contrast to self-report measures for adolescents and adults, checklists for the assessment of children's life events are often designed for parents to complete, on the assumption that preadolescents may not be reliable informants (e.g., Coddington, 1972). Little attention has been paid to the reliability and validity of child measures, however, and the implications of relying on external reports of parents as opposed to self-reports have not been examined (Grant et al., 2004). Much research is also needed on the developmental progression of children's ability to accurately report on stressful experiences (Stone & Lemanek, 1990).

Specialized Checklists

Specialized stressor checklists have generally been developed with two related issues in mind—the need for specific measures for specific populations, and the need for measures of specific types of events.

With some notable exceptions (e.g., Allison et al., 2004; Cheng, 1997; Gil, Vega, & Dimas, 1994; Loo et al., 2001; Nyborg & Curry, 2003; Richters & Martinez, 1993), measures of cumulative life stressors have been developed on European American middle-class samples. These measures have been criticized for lacking items pertinent to individuals of color, particularly those living in disadvantaged urban communities (Miller, Webster, & MacIntosh, 2002). A small number of measures have been developed to address this issue. For example, Hastings and Kelley (1997) developed a scale to assess exposure to violence in a sample of low-income urban adolescents (Hastings & Kelley). In the adult literature, measures have been developed to assess issues such as race-related stressors for Asian American Vietnam veterans (Loo et al.), race-related stressors encountered by African Americans (Utsey, 1999), and acculturative stressors for international students (Sandhu & Asrabadi, 1994).

A small number of measures have been developed on predominantly white middle-class samples exposed to specific stressors, including measures of events related to parental divorce (Roosa, Beals, Sandler, & Pillow, 1990) and parental alcoholism (Roosa, Sandler, Gehring, & Beals, 1988) affecting children and adolescents, and occupational stressors affecting adults (Greiner, Ragland, Krause, Syme, & Fisher, 1997; Vagg & Spielberger, 1998; Williams & Cooper, 1998). These measures contain events and chronic stressors that characterize these broader stressful experiences. Measures developed for specific populations offer the advantage of being more comprehensive and sensitive in measuring the types of stressors experienced by these groups. On the other hand, the limited range of events included on these measures prohibits their use in comparative studies across samples exposed to various types of stressful events and circumstances (Grant et al., 2004).

Critiques of the Checklist Approach

Although most stressor checklists are consistent with an objective conceptualization of environmental stress, the degree to which stressor checklists actually assess objective threat is unclear. The items included on stressor checklists have typically been selected by researchers based on their personal opinion, general consensus about the nature of threatening experiences, or information generated in small focus groups. Thus, the items themselves have not been empirically generated relative to objective threat. In addition, because cumulative stressor checklists include a list of brief items (e.g., death of a parent), it is unclear to what degree each item assesses the same experience for different individuals. For example, the death of a grandparent who has had little contact with a child represents less threat and disruption than the death of a grandparent who has served as that child's primary caregiver (Duggal et al., 2000)

Another critique of stressor checklists is that they do not require respondents to provide information about the date of occur-rence or timing of the events (Duggal et al., 2000). Most checklists focus on a particular period of time (e.g., events that have occurred in the previous 6 months) without specifying at what point during that period the event took place. This limits the usefulness of checklists in determining the role of the occurrence of stressors in relation to the onset and remission of psychiatric disorders, as well as physical and psychological symptoms.

Finally, most stressor checklists have been criticized for failing to distinguish between stressors that are independent of the individual's behavior (e.g., fateful events, such as death of a partner or parent) and those that are not independent of behavior (e.g., job loss or school failure) (Hammen, 1997). Independent events are generally considered less confounded with psychopathology and are therefore seen as representing “cleaner” markers of environmental effects. On the other hand, there is increasing evidence of a reciprocal relation between stressors and psychological symptoms (discussed further below), indicating the importance of also examining stressors that may be dependent on an individual's behavior.

Stressor Interviews

Stressor interviews were developed in part to address the methodological shortcomings of stressor checklists. The most extensive structured interview work on adult samples has been conducted by Brown, B. P. Dohrenwend, and Monroe and their colleagues (e.g., Brown & Harris, 1989; B. P. Dohrenwend, Raphael, Schwartz, Stueve, & Skodol, 1993; McQuaid, Monroe, Roberts, Kupfer, & Frank, 2000; Monroe, Kupfer, & Frank, 1992; Wethington, Brown, & Kessler, 1997). Child and adolescent researchers, such as Garber, Goodyer, Frank, and Hammen and their colleagues, have modified and built upon adult work with these methodologies for use with children and adolescents (e.g., Adrian & Hammen, 1993;...

Table of contents

• Cover Page
• Dedication
• Titlepage
• Copyright
• Contents
• Preface
• Acknowledgments
• Part I. Overview and Foundations
• Part II. Vulnerabilities
• Part III. Disorders
• Author Index
• Subject Index
• About the Editors
• About the Contributors