Attachment and externalizing disorders: a developmental psychopathology perspective

OBJECTIVE: Attachment theory offers an intriguing formulation of protection and risk that ties together key aspects of behavior, emotion, and cognition. The authors present links among attachment status, other developmental domains, and the development and maintenance of externalizing disorders to illustrate an approach to integrating attachment theory and relationship research with the study of externalizing symptoms. METHOD: The authors review the literature on the attachment system's theoretical and empirical associations with domains of emotion regulation, social attributions, socialization and moral development, and intergenerational transmission of behavior, as well as with externalizing behaviors. RESULTS: There are a number of risk and protective connections between attachment security and other developmental processes that are associated with externalizing disorders. CONCLUSIONS: Knowledge of relational processes, in this case, attachment relationships, can contribute to an understanding of etiology, maintenance, and treatment of externalizing disorders.     

Resilience and developmental psychopathology

Humans vary to a great extent in their ability to adapt to adverse experiences. Resilience reflects the positive end of this spectrum of adaptation and maladaptation in response to risk exposure. Some individuals, despite being faced with the most pernicious of adversities, manage to avoid psychologic collapse and to maintain healthy adjustment. For decades, researchers and clinicians have searched for the correlates and causes of resilience, and several comprehensive reviews of these efforts are available. This article provides an overview of resilience research and selectively summarizes recent advances in the field, with a particular focus on a developmental psychopathology perspective. This article highlights some of the challenges to resilience research and uses the example of maltreatment to illustrate some of these issues.     

Epidemiological approaches to developmental psychopathology

Developmental psychopathology as a research approach draws on both developmental and psychopathologic perspectives to tackle questions about causal mechanisms. Developmental perspectives are discussed in terms of the implications that flow from age differences in prevalence, age trends in remission of disorders, developmental appropriateness of psychiatric conditions, continuities and discontinuities in psychopathology between childhood and adult life, and age differences in the effects of psychiatric risk factors. Psychopathologic perspectives are considered in terms of continuities and discontinuities between normality and pathology and the contrasts between pervasive and situation-specific disorders, and by the differences between single variables and behavioral composites. The use of epidemiological data to examine causal processes is discussed, with attention to the need to consider development in its social context and to examine indirect, as well as direct, causal chains of connection.     

Temperament and its role in developmental psychopathology

Temperament refers to early-appearing variation in emotional reactivity. The core dimensions of temperament and optimal method for assessment continue to be sources of considerable discussion. Nevertheless, the moderate stability of most temperamental traits and the strong influence of genetic and unique environmental factors have been well established, along with temperament's association with childhood psychiatric disorders. Both temperamental predisposition toward experiencing negative emotions and low inhibitory control are linked to many psychiatric conditions, while other dimensions, such as levels of extraversion, vary by, and likely even within, disorders. Accumulating research directed at understanding the mechanism of these links between temperament and psychopathology indicate that, at least for most disorders, the two constructs cannot be viewed as simply different points along a shared continuum. The effect of temperament upon psychopathology has been found to be mediated and moderated by a number of both internal and external factors. Additional research is needed to help further define the core dimensions of temperament and the complex mechanisms through which temperamental traits interact with other influences in affecting developmental trajectories.     

A dimensional approach to developmental psychopathology

The expression psychopathology in general and child psychopathology in particular, is affected by multiple sources of variance. Some of these sources include gender differences, informant differences, and age-related differences. In this paper, we discuss how these sources of variance complicate both research and clinical management. We argue that the current diagnostic system would be aided by the inclusion of a quantitative axis that can take these sources of variance into account. We reason that the fields of genomics and neuroscience are prepared to move the field of developmental psychopathology forward, but need a diagnostic system that allows for these sources of variance to be controlled. We demonstrate how in Conduct Disorder, inclusion of dimensional information would allow the clinician or researcher to demonstrate not only the presence or absence of pathology, but also the degree to which the disorder is manifested in a particular individual. Because dimensional approaches are already used widely as an alternative measure of psychopathology, we argue that there is reason to consider dimensionalizing some aspects of the DSM.     

Adolescents with developmental psychopathology in adulthood

Abstract We conducted a comparative study of the outcomes at 7 years and at 17 years after initial diagnosis of 77 cases of adolescent developmental psychopathology. The results suggest that the prognosis of adolescent developmental psychopathology could be derived at 5–6 years after commencement of medical treatment. The parent-child relationships during infancy to adolescence, considered to affect the long-term prognosis of adolescent developmental psychopathology, was studied. It is believed that the emotional bond between parents and children in early to middle childhood are vital which seems to affect their relationships during pre-adolescence to early adolescence and to the development of adolescent turmoil. It can be considered vital that the development of the infantile provocative state during preadolescence to early adolescence should progress to a more mature ability to negotiate and which forms the core of adolescent turmoil. The function of the latter will bring better results to adolescent developmental psychopathologies.     

Interoception and psychopathology: A developmental neuroscience perspective

Interoception refers to the perception of the physiological condition of the body, including hunger, temperature, and heart rate. There is a growing appreciation that interoception is integral to higher-order cognition. Indeed, existing research indicates an association between low interoceptive sensitivity and alexithymia (a difficulty identifying one’s own emotion), underscoring the link between bodily and emotional awareness. Despite this appreciation, the developmental trajectory of interoception across the lifespan remains under-researched, with clear gaps in our understanding. This qualitative review and opinion paper provides a brief overview of interoception, discussing its relevance for developmental psychopathology, and highlighting measurement issues, before surveying the available work on interoception across four stages of development: infancy, childhood, adolescence and late adulthood. Where gaps in the literature addressing the development of interoception exist, we draw upon the association between alexithymia and interoception, using alexithymia as a possible marker of atypical interoception. Evidence indicates that interoceptive ability varies across development, and that this variance correlates with established age-related changes in cognition and with risk periods for the development of psychopathology. We suggest a theory within which atypical interoception underlies the onset of psychopathology and risky behaviour in adolescence, and the decreased socio-emotional competence observed in late adulthood.     

Representation and structure from a developmental psychopathology perspective

An attempt to define "psychic structure" leads to the conclusion, that "structure" provides adaptive behavioral strategies for the interaction of the person with a physical and social world by representing experiences of earlier interactions in memory processes. Compatibility of different definitions of "structure" in psychopathology and psychoanalysis is being discussed. Developmental aspects of a "theory of mind" in children and of different modes of representation have to be addressed. A "multiple code theory" of W. Bucci is introduced. Conclusions for diagnosis and therapy in psychodynamic approaches will be drawn. It has to be faced, that children represent optimal structures in each level of psychic development, noting the importance of age-relevant normative measures.     

The developmental psychopathology of motivation in adolescence

Adolescence is a key period for the emergence of psychopathology, with many psychiatric disorders having their modal age-of-onset during this period. Relative to other periods of the lifespan, susceptibility to a number of psychiatric disorders is greatest during adolescence, particularly in females. In addition, disorders which emerge during adolescence appear to be more enduring and serious than those with a later onset. Although these psychiatric conditions may appear different from each other in terms of their associated behavioral signs or symptoms, this review will argue that they involve common alterations in motivational processes or disturbances in reward processing, although the direction of such changes (hypersensitivity vs. hyposensitivity to reward) and the stage of processing affected (reward anticipation vs. receipt) may differ across broader groupings of disorder. Recent behavioral, neuropsychological and neuroimaging research on reward processing in children, adolescents, and adults with these conditions will be described and evaluated. In addition, this article will consider what these studies tell us about their etiology and highlight gaps in our knowledge base. The review will also attempt to explain why adolescence is a period of elevated risk for the development of psychopathology, by discussing normative changes in reward processing in humans and animals.     

Childhood parent loss: developmental impact and adult psychopathology

A large number of cases in analytically oriented psychotherapy and psychoanalysis were studied to determine the developmental consequences of parent loss by death or continuous separation in childhood. The cumulative evidence from this data is that the meaning, impact, and consequences of parent loss on emotional development are determined both by the phase-sensitive issues impacted, as well as the unique interpretation by the child of the fantasied cause and effect of the loss event. Specific issues arising in treatment as a derivative of earlier parent loss are presented as they relate to developmental diagnosis, therapeutic alliance, transference, countertransference, mourning, and termination.     

Role of affect dysregulation in the developmental psychopathology

In this article the issue of developmental psychopathology is presented in conjunction with the concept of Affect Regulation--the term which is understood as a proces in mother-child interactions that indicates the ability or disability of affective self-regulation in later life. The results of recent developmental research are presented to underline the specific features of these interactions that influence the process of affect regulation and affect dysregulation as well. In addition, neurophysiological data is explored, which makes it possible to create a bridge between psychopathology and dysregulation of emotions.     

The developmental psychopathology of social anxiety in adolescents

To evaluate a developmental psychopathology approach for understanding adolescent social anxiety, parent-reported predictors of social anxiety were examined in a nonclinical sample of adolescents. Structured diagnostic interviews were obtained from biological parents of 770 participants. Potential risk factors assessed included child characteristics: negative affect, shyness, separation anxiety disorder, and childhood chronic illness, as well as parent characteristics: major depression, panic disorder, and agoraphobia. Adolescent social anxiety was measured multiple times during high school. Findings indicate stability in social anxiety symptoms across time. Parent-reported, childhood negative affect, shyness, and chronic illness as well as parental panic disorder or agoraphobia were associated with adolescent social anxiety. Interactions were observed between parent-reported childhood shyness and gender and between parent-reported childhood shyness and parent-reported childhood chronic illness in the prediction of social anxiety. Parent-reported childhood shyness was a stronger predictor of adolescent social anxiety in females compared to males. The combined effect of subjects being positive for both parent-reported childhood shyness and parent-reported childhood chronic illness was greater than would be expected based on additive effects. This study provides support for a multifactorial and developmentally informed understanding of adolescent social anxiety.     

The developmental psychopathology of social anxiety disorder.

The role of developmental theory and developmental psychopathology in understanding the development, maintenance, and course of social anxiety disorder (SAD) is explored in this article. Following a brief examination of the phenomenology of SAD in youth, we provide an overview of the tenets of developmental psychology and developmental psychopathology, including the principles of equifinality (i.e., the same outcome can result from diverse developmental pathways) and multifinality (i.e., the same risk factor can lead to or result in different outcomes). We review various pathways for the acquisition and maintenance of SAD (e.g., genetic and temperamental influences, parental factors, conditioning or learning experiences, peer influences, and cognitive styles) and conclude, consistent with a developmental psychopathology perspective, that multiple pathways to SAD exist and that the various precursors to SAD do not invariably lead to SAD. We suggest that specificity in outcome is afforded by the combination, timing, and circumstances surrounding these various risk factors. Finally, we propose studies to test the viability of the developmental psychopathology model in understanding SAD.