Understanding Psychopathology

THE ROLE OF VULNERABILITY

Rick E. Ingram and Joseph M. Price

We believe there is no more important goal in psychopathology research than understanding the causes of psychopathology. Although there may be multiple pathways to such an understanding, theory and research on vulnerability are indispensable to this quest for causality. In a broad sense, it is difficult to envision an effective effort to understand the causes of disorder that does not include an examination of the processes that give rise to the disorder. Even more broadly, a case can be made that efforts to understand vulnerability to psychopathology underlie virtually all efforts to understand psychopathology itself.

Theory and research related to a number of different psychopathological conditions are examined in the various chapters in this book. Each of these examinations focuses on the specific vulnerability theory and data that are relevant to particular disorders. We start here, however, with a broader examination of the idea of vulnerability that can serve as a foundation for understanding vulnerability in these more specific disorders. In this vein, we start by briefly examining what is arguably the single most important aspect of psychopathology, that is, the concept of causality in psychopathology. We follow with a discussion of the notion of vulnerability itself and then move to issues concerning the relationships among vulnerability, risk, and resilience, and then finally to issues concerning the distinction between childhood and adulthood.

WHAT IS CAUSALITY?

In the most obvious sense, "causality" refers to the processes that create or facilitate the transition from a normal state of psychological functioning into an abnormal psychological state. Although this concept of causality is accurate, it is incomplete; causality does not refer simply to this onset phase but also to other important processes in the course of psychopathology. As such, a more complete examination of causality necessitates some discussion of both onset and maintenance processes.

Onset Causality

Whether a first onset of a disorder or the occurrence of a subsequent episode of a disorder, understanding the processes involved in onset are critical to understanding the causes of psychopathology. From a vulnerability perspective, data on these processes inform researchers about the factors that place individuals at risk for experiencing a disorder. Similarly, data have also provided insights into how these risk processes in the nondisordered person are translated into a psychopathological state in that same person.

Onset can be further understood in the context of distal and proximal vulnerability. Although investigators differ to some extent in drawing the temporallines for these different risk processes, proximal factors are generally regarded as those that become apparent right before the onset of a disorder. Distal factors, however, occur before the disorder but more distant in time from its appearance. For example, a model of a psychopathological state that specified certain psychological or physiological responses to life events would be specifying a more proximal cause, whereas a model that focused on the creation of risk factors in childhood would be focusing on more distal variables.

Maintenance Causality

Some researchers have differentiated between the onset and the maintenance of a disorder and have tacitly suggested that the onset or appearance of psychopathology is synonymous with causality. Correspondingly, maintenance processes are not viewed as causal, and hence relatively little importance is ascribed to these factors (Ingram, Miranda, & Segal, 1998). We argue, however, that causality is not synonymous solely with onset and that the factors that maintain a disorder can be legitimately seen as causal.

We thus suggest that an exclusive focus on onset is too narrow a conception of the construct of causality. Consider the case of depression. A considerable amount of data shows that depression is a persistent disorder, with symptoms lasting months and in some cases years (e.g., dysthymia). Moreover, data also show that untreated depression...