The Stress-Vulnerability Model of Co-occurring Disorders

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What Are the Elements of the Stress-Vulnerability Model?

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Treatment Implications of the Stress-Vulnerability Model

Empirical support for the applicability of the diathesis-stress model is robust and has warranted preventive interventions targeting those at highest risk of developing negative health outcomes. For example, psychological interventions address the way a person with high vulnerability appraises and responds to stressful life events. Researchers seek to refine measures of vulnerability, provide suggestions for preventive strategies, and gather empirical evidence for the effectiveness of preventive interventions. Overall, the diathesis-stress model has provided researchers and clinicians with a framework in which knowledge about biological, environmental, and psychological processes can be used to decrease the likelihood that an illness will develop or reoccur.

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5. Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull. 1991 Nov;110(3):406-25.

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Regions of significance RoS on X for a diathesis stress pages PSY C test

The premise underlying the "diathesis-stress" model is that a person is more likely to suffer an illness if he or she has a particular diathesis (i.e., vulnerability or susceptibility) and is under a high level of stress. Diathesis factors that have been studied include family history of substance abuse or mental illness; individual psychological characteristics such as hostility or impulsivity; biological characteristics (e.g., cardiovascular reactivity, hypothalamic-pituitary-adrenal responsivity); and environmental characteristics such as childhood maltreatment or low socioeconomic status. Diathesis factors are generally assumed to be relatively stable but not necessarily permanent.

The term stress refers to events and experiences that may cause psychological distress. Stress can influence mechanisms that help to maintain the stability of an individual’s cognition, physiology, and emotion. Although the notion that stress can influence the development of illness has been held since the mid-nineteenth century, it was not until theories of schizophrenia proposed during the 1960s that the concepts of stress and diathesis were combined. In studies of depression that found empirical support for the model, stress has most commonly been operationalized as having experienced major negative events within the past year.

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An implication of the diathesis-stress model is that the greater the vulnerability an individual has, the less stress is required for that individual to become ill. It is necessary to consider both the presence of a diathesis and a person’s level of stress in order to determine the degree of risk for the onset or reoccurrence of an illness. For example, a study of depression showed that among subjects with a diathesis in the form of genetic risk, 10 percent developed depression at low stress levels but 33 percent developed depression at high levels. For those without the diathesis, the figures were 10 percent and 17 percent, respectively.

Other health problems to which the diathesis-stress model has been widely applied include substance use, schizophrenia, and heart disease. Studies have investigated a broad range of both environmental and psychological vulnerabilities, as well as biological vulnerabilities, some of which involve genetic expression. Interest in the role of genetics in disease onset has also led to studies on gene-environment interaction, which suggest that elevation of disease risk by an environmental factor occurs primarily for individuals with a susceptible genotype.

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In other words, as an individual with a temperament that acts as a diathesis to RAD ages beyond childhood, the temperament remains consistent, although it is analyzed and diagnosed differently. To further illustrate this concept, it may be helpful to consider the similarities between the primary subtypes of RAD and Cluster A and B personality disorders.

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Marino
Rochester Institute of Technology "Reactive Attachment Disorder: A Disorder of Attachment or of Temperament?" provided an interesting view of RAD summarized by its analogy to the diathesis-stress model.

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The associations between levels of stress and maladaptive behaviors are stored in the survival brain states of 4 and 5. As the brain tends to generalize, when that level of stress is encountered, the allostatic circuit for brain state 4 or 5 is triggered and the associated maladaptive response is induced. The process is potentially repeated thousands of times over the course of a lifetime. This interpretation of maladaptive behavioral responses suggests an explanation for low adherence to behavioral recommendations seen in the current model for health care. In stress, it does not matter what the neocortex knows because the limbic and reptilian brains are dominant, set in a persistent allostatic brain state.

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Not everyone will react in the same way to a given situation. I would compare the etiology of reactive attachment disorder to the diathesis-stress model we discussed in class.

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These independently reported emotions and events were used to come up with the conclusion (Ge & Conger, 2003). The results found that early depressive symptoms carry forward to mid- and late adolescence and that the interaction between gender-linked vulnerabilities (diathesis) and the new biological and social challenges of early adolescence (stress) creates greater risk for depression for adolescent girls than boys (Ge & Conger, 2003).

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