Developmental psychopathology

Student Number: 01051571 Word Count: 2,706 Date: 04/04/2005

Developmental psychopathology is an integrative approach combining a number of theoretical perspectives and thus tapping the empirically validated contributions of different schools of thought in order to understand the emergence of psychopathology across the life-span (Norcross, 1997). Developmental psychopathology integrates behaviour, cognition, unconscious processes and family processes in order to establish a comprehensive understanding of the development of psychopathology (Cicchetti, 1984; Wenar & Kerig, 2000). This essay will focus on the contribution of the behaviourist, psychoanalytic, family systems and cognitive models to the understanding of developmental processes (with a focus on attachment, initiative, and control) which are involved in the emergence of psychopathology as discussed in regard to major depression and anorexia nervosa. The models discussed will also be evaluated in terms of their contribution to integrative explanations of psychopathology.

The Behaviourist Model

From a behavioural perspective psychopathology is evident when the behaviour displayed exceeds or occurs at a lower frequency or intensity than is considered age-appropriate (Wenar et al., 2000). Psychopathology is also characterised in terms of learning principles. For instance, the attachment bond between caregiver and child was first understood as a generalised conditional response to the satisfying of the child’s biological needs by the caregiver (Novak & Harlow, 1975). However, it was subsequently demonstrated that psychological needs such as comfort were more important than biological needs in the formation of attachment (Novak et al., 1975). This demonstrates that whilst learning theory is often parsimonious, its reduction of complex behaviour to simple contingencies can sometimes be erroneous.

The behavioural perspective does propose that the abnormal reinforcement and punishment of behaviour related to developmental processes will result in psychopathology (Davison & Neale, 2001). For instance, in the development of anorexia nervosa self-control behaviour (e.g. diet restriction) is frequently positively reinforced by parents and others and reflecting the cultural value placed on thinness (Strober, 2004). However, this behavioural mechanism whilst explaining the maintenance of restricting behaviour does not explain the cause. A simple behavioural explanation for major depression proposes that a failure in the production of the social behaviour which elicits positive reinforcement from others results in depression through the process of extinction (Cole & Milstead, 1989). Again this explanation fails to identify the cause of this behavioural deficit, but does explain the maintenance of depression by the loss of social support which results from this deficiency.

Behaviourist explanations of psychopathology have been described as oversimplistical and circular (Davison et al., 2001). In particular behaviourist models are most applicable to the explanation of environmental events which maintain current psychopathology but do not provide causative mechanisms or developmental explanations and are therefore of limited use in the understanding of the mechanisms which produce psychopathology.

The Psychoanalytic Model

In the traditional psychoanalytic model psychopathology is typically conceptualised in terms of problems in timing such as the persistence of behaviour beyond a point considered age-appropriate, or a return to behaviours which are no longer considered appropriate (Wenar et al., 2000). Whilst these concepts are broadly useful and have been incorporated into developmental theory, the associated Freudian psychoanalytic model of development is less useful in its traditional form (e.g. it denies the possibility of early childhood depression) and more progressive developments in psychoanalytic theory will be discussed here.

A recent development in the psychoanalytic model is object relations theory which focuses on the development of affectionate attachments throughout life (Biringen, 1994; Masterson, 1977). Disturbed attachment patterns are proposed to result in a failure to form an integrated self early in life which is predictive of a subsequent pathological interpersonal style associated with the development of major depression (Bartholomew & Horowitz, 1991; Hazan & Shaver, 1994). Similarly, in anorexia a lack of coherent sense of self is proposed to result from abnormal caregiving characterised by parental overcontrol and is associated with subsequent psychopathology (Carr, 1999). Objects relations theory proposes that the child is perceived by the parents as a self-object and expression of need for separation-individuation is seen as a personal betrayal (Diamond, 2004; Masterson, 1977). This need thus becomes associated with abandonment anxiety and results in a failure of the child to develop self-sufficiency. The restriction of appetite contributes to feeling of autonomy and coherence. However, in both major depression and anorexia the processes whereby patterns of caregiving lead to the proposed unintegrated self and to subsequent disorder are not explicated (Hazan et al., 1994).

Recent psychoanalytic perspectives also focus on the abnormal development of initiative (Bateman & Fonagy, 2001). Initiative is described as “surrendered” or “arrested” as a result of cumulative trauma during infancy (Bateman et al., 2001). Subsequently disorders of “Acting Out” are observed whereby the traumatic experiences are unconsciously acted out in an aggressive manner in therapy (Lapkin, 1985; Stein, 1973). The incorporation of parental neglect into the self-system during attachment results in the subsequent loss of initiative is proposed to result in the coupling of aggression with self-assertion and need-expression (Bateman et al., 2001). In the case of anorexia nervosa ...

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This psychoanalytic explanation whilst making developmental sense in indicating the progression of psychopathology from disordered attachment to initiative loss to subsequent psychopathology, again does not sufficiently explain the processes which link the steps in this series and includes vague, poorly designed and unoperationalised terms (e.g. surrendered initiative). As in Freudian psychoanalysis the post-Freudian accounts described rely on invoking a causal nature in regard to unconscious processes to bridge the gaps between concepts and between developmental processes (e.g, initiative development) and the emergence of psychopathology (e.g. hostility-anorexia) (Grunbaum, 2001). The model also does not sufficiently explicate motives or causes which initiate these unconscious mechanisms (Grunbaum, 2001). The focus of psychoanalytic models are often, as in the above example of “acting out”, therapeutically derived (Fonagy et al., 1997). This method is limited in validity in that it retrospectively infers antecedent processes from clinically presenting phenomena rather than vice-versa (Grunbaum, 2001).

The psychoanalytic model is useful in that it provides developmental accounts of the progression from maladaptive developmental processes to psychopathology. However, the tendency towards retrospective explanation, and the pervasive problem of the unconscious and the resultant reluctance on the part of psychoanalytic theorisers to explain and operationalise dynamic processes limits the usefulness of even the recent formulations of psychoanalytic model in the explanation of psychopathology.

The Family Systems Model

The family systemic model locates psychopathology in the relationships between family members and sees problem behaviour as serving a function in the family system (Rothbaum, Rosen, Ujie, & Uchida, 2002). For instance, the family systems model proposes that the overcontrolling or overprotective parent and the influence of the associated parenting style on the child’s sense of control is central to the development of psychopathology. This is demonstrated in anorexia where the parent-child relationship is characterised by a coercive parental overprotection response and a deficient understanding of the child’s age-appropriate need for individuation and independence (Stern, 1986). Self-starvation serves the function in the family of both maintaining the dependence of the child on the parent and also acts as a form of rebellion (Wenar et al., 2000).

Through an emphasis on the function of behaviour associated with psychopathology in relation to the maintenance of familial relations the systemic model moves closer towards explaining the relationship between psychopathology and caregiving. However, this explanation of anorexia whilst coherent with clinical manifestation does not explain causative mechanisms or developmental processes which lead to either disturbed familial relations or psychopathology.

The family systems model attempts to explain the developmental process of attachment as resulting from the social interaction of the caregiver and child (Byng-Hall, 1995). Abnormal attachment patterns are proposed to arise when caregiver-child relationships are characterised by overinvolvement, or when marital conflict produces an inconsistent pattern of preoccupied then distant care giving (Rothbaum et al., 2002). The family systems model also relates relationship characteristics associated with deviance in the developmental process of attachment formation to disorder. For instance, parent-child overinvolvement and marital conflict are also central features in the families of children with major depression, a disorder associated with abnormal patterns of attachment (Lopez, 1986). Parental conflict and overinvolvement are also found in anorexia nervosa, as are patterns of insecure attachment (Dallos, 2004).

The family systems model proposes that a transgenerational transmission of insecure attachment occurs in anorexia (Rothbaum et al., 2002). The insecure attachment of the mother has also been proposed to result in a reluctance on her part to express feelings or emotion (Armstrong & Roth, 1989). This contributes to the maintenance of insecure attachment in her child and also the emergence and continuance of the disorder (Dallos, 2004). The family systems model is useful in that it explains the source and maintenance of insecure attachment. The model does not, however, explain how exposure to abnormal patterns of caregiving results in either abnormal attachment or disorder.

The link between family relationships, developmental processes and psychopathology is largely associative in family systems theory. Cluster analytic findings indicate that a range of parent-child relationships can be associated with a specific disorder. It is important that the family systems model further investigate family processes such as conflict resolution, emotional expression and value expression and the functional relevance of these processes (Carr, 1999). This would help to identify commonalities between families as different family relationships lead to the same disorder, and to explain the differentiation in developmental paths of children with similar familial relationships who progress to a specific disorder from those who do not (Wenar et al., 2000).

The family systems model currently offers a significant contribution to the understanding of the emergence of psychopathology in that it specifies interpersonal relationships and a number of relationship characteristics (e.g. function and effect on child) related to abnormal developmental processes and psychopathology. Whilst limited in their explanatory power in isolation these relational processes are useful when added to unspecified components of other models. For instance, in the case of the negative stimuli referred to in the cognitive model of learned helplessness discussed below the family systems model can be invoked to explain these stimuli as characteristics of relationships within the family system such as interparental conflict, controlling parenting, child maltreatment, or parental loss (Messer & Gross, 1995).

The Cognitive Model

In the cognitive model, psychopathology is evident in maladaptive thoughts and interpretations of experiences (Craighead, Craighead, Kazdin, & Mahoney, 1994). The cognitive model typically explains psychopathology through reference to models, schemas and cognitive processes. For instance, the cognitive model of attachment elucidates the intrapersonal processes of attachment as involving the development of an internal working model (IWM) of the caregiver’s behaviour within the child (Miller, 1993). The cognitive model also explains processes which occur within this model. The IWM is proposed to focus on the synchrony between mother and child in terms of cues and expectations, and the child is proposed to develop an internal model of expectation of caregiver responsiveness. The concept of the IWM thus extends to include the perception of self and others.

Importantly, the working model of the mother-child relationship also generalises over time to incorporate new people and new experiences (Miller, 1993). The cognitive model therefore generates the expectation that deviation in regard to attachment due to inadequate parenting (e.g. inconsistency and insensitivity) will be associated with negative relational schemas regarding the self and others which are observable through deviant patterns of social behaviour (Belsky & Cassidy, 1994; Feeley, DeRubeis, & Gelfand, 1999). The IWM associated with insecure attachment has also been shown to be related as predicted to interpersonal difficulties and also subsequently anorexia nervosa (Broberg, Hjalmers, Nevonen, 2001). Controlling, rejecting and inconsistent parenting can similarly lead to an abnormal IWM, associated insecure attachment, and major depression (Hammen, 1992; Wenar, 1982).

The cognitive model thus proposes an intrapersonal input-process-output based account which explains the connection between caregiver behaviour, abnormality in a developmental process, the associated maladaptive cognitive processes and also resultant maladaptive behaviour. However, in cognitive explanations of developmental processes the causal nature of the invoked models as in the case of the IWM are questionable as the abnormal model may be a correlationary phenomenon which arises is parallel with in this case the developmental process of abnormal attachment, or may be caused by this process rather than vice-versa (Davidson & Neale, 2001).

The cognitive model also contributes to the understanding of the process of initiative development through the concept of learned helplessness which proposes that if children’s initiative based attempts to explore their environment as active-agents are significantly impeded and the individual is regularly exposed to negative, uncontrollable stimuli that the individual becomes a passive recipient to the unpleasant events s/he encounters (Seligman & Peterson, 1986). The cognitive exhaustion model accounts for the process by which the child becomes such a passive recipient. The model proposes that in situations which are perceived as controllable individuals engage in generative thinking (Kofta & Sedek, 1989). However, when the environment is perceived as uncontrollable cognitive exhaustion occurs due to the lack of association between cognitive effort and cognitive gain (Sedek & Kofta, 1990). In the cognitive model the loss of initiative associated with learned helplessness has been proposed to also underlie the central helplessness aspect which characterises major depression. Similarly, a sense of childhood helplessness has been identified to exist amongst those with anorexia, a disorder highly comorbid with major depression (Toro, Nicolau, & Cervera, 1995).

The initiative models discussed provide examples of process based cognitive accounts of abnormal process development where inserted models account for various processes within an overarching framework of explanation (Eysenck & Keane, 2005). The cognitive model is useful in that the construction of its models often leaves space for the “fleshing out” of dynamic processes (e.g. cognitive exhaustion(→)) between and within other components of the model (e.g. initiative impeded→ passive recipient) (Eysenck et al., 2005). However, a problem with cognitive process accounts of psychopathology is their lack of developmental progression: in the case described the model is deemed to hold true throughout development. The cognitive model has produced comprehensive accounts of cognitive development demonstrating qualitatively different processes as occurring at different stages throughout the lifecourse, but it has not as yet developmentally tailored the majority of its accounts of psychopathology (Wenar et al., 2000; Davison et al., 2001).

The perception of the uncontrollability of aversive events in major depression is compounded by the presence of attributional schemata that allow these events to be perceived as because of the individual, stable and globally applicable to all aspects of the individual’s life (Davidson & Neale, 2001; Weisz, Southam-Gerow, McCarthy, 2001). This proposal reflects a significant flaw applicable to a number of proposals from the cognitive model in that the schemata proposed are likely to be characterised by qualitative differences at different points in development (Herbert, 2003). The proposed attributions and schemata may also be correlates of major depression rather than predictors or causes of it (Bennett & Bates, 1995).

However, despite its limitations the cognitive model of psychopathology is perhaps the most useful in understanding of developmental processes involved in the emergence of psychopathology. The cognitive model’s focus on operational definition, causative dynamic processes, and the construction of conditional model frameworks make it ideal for the generation of testable hypotheses, the findings from which can allow the evolution of the model.

The Integrated Contribution of the Models

In this essay, the discussion of the developmental processes under review showed that the four models of psychopathology can explain different aspects of a developmental process or can offer different perspectives on the same aspect. For instance, the cognitive model explains the intrapersonal processes which lead to abnormal attachment and the family systems model explains the interpersonal events associated with abnormal attachment. The psychodynamic model proposes overcontrolling parenting leads to excessive self-control as in anorexia, whereas the behaviourist approach points to reinforcement of self-control by parents and relevant others. It is therefore clear that each model makes a valid contribution to the understanding of developmental processes. The models also act to compliment each other with each model focusing on a specific aspect of the developmental process in question and pointing to a certain aspect of emergent psychopathology. Intrapersonal processes are central to both the psychodynamic approach and the cognitive model, whereas the family systems approach focuses on interpersonal relationships and the behaviourist model on the influence of the environment. There is a place for all models in the developmental psychopathology approach and the integration of diverse findings into models of psychopathology will be the greatest challenge for the future of the approach and of the greatest benefit to the understanding of both psychopathology and its emergence.

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