Comorbidities and continuities as ontogenic processes: Toward a developmental spectrum model of externalizing psychopathology
Comorbidities and continuities as ontogenic processes: Toward a developmental spectrum model of externalizing psychopathology
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DOI：
10.1017/s0954579413000746
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发表时间：
2013-11-01
影响因子：
3.3
通讯作者：
McNulty, Tiffany
中科院分区：
文献类型：
--
作者：
Beauchaine, Theodore P.;McNulty, Tiffany
自 1989 年《发展与精神病理学》创刊号出版以来，关于儿童和青少年心理健康问题的研究蓬勃发展。在此后的四分之一个世纪里，按照编辑但丁·西凯蒂 (Dante Cicchetti) 和该学科的其他支持者设定的议程，精神病理学的静态模型被抛弃，转而采用交互模型。交易方法已应用于自闭症、抑郁症、自残和犯罪，(a) 明确了从基因到文化的多个分析层面的脆弱性和风险因素，(b) 确定了精神病理学的多重最终和平等途径，(c) 超越了传统的学科界限。然而，正如 Rutter 和 Sroufe (2000) 所指出的，如果我们希望充分理解病因学，就必须确定精神病理学的连续性、不连续性和共病的具体机制。在本文中，我们提出了一个早发性外化行为模型，其中合并症和连续性被视为本体过程：相互依赖的个体层面的脆弱性（例如，遗传、表观遗传、变态）和同样相互依赖的背景风险因素（例如，强制养育、异常的同伴群体关系、邻里犯罪）之间复杂的纵向交易的产物。通过跨层次分析的互动，一些人沿着外化谱进行遍历，从学龄前的遗传性冲动开始，到成年后的反社会性结束。在描述我们的模型时，我们注意到（a）DSM中概述的外化障碍亚型方法继续模糊了反社会性的发展途径，（b）分子遗传学研究可能无法识别外化障碍的有意义的亚型，以及（c）精神病理学的本体特征方法更有可能在未来几年推动该学科的发展。
Research on child and adolescent mental health problems has burgeoned since the inaugural issue of Development and Psychopathology was published in 1989. In the quarter century since, static models of psychopathology have been abandoned in favor of transactional models, following the agenda set by editor Dante Cicchetti and other proponents of the discipline. The transactional approach, which has been applied to autism, depression, self-injury, and delinquency, (a) specifies vulnerabilities and risk factors across multiple levels of analysis spanning genes to cultures, (b) identifies multifinal and equifinal pathways to psychopathology, and (c) transcends traditional disciplinary boundaries. However, as noted by Rutter and Sroufe (2000), specific mechanisms of continuity, discontinuity, and comorbidity of psychopathology must be identified if we wish to understand etiology fully. In this article, we present a model of early-onset externalizing behavior in which comorbidities and continuities are viewed as ontogenic processes: products of complex longitudinal transactions between interdependent individual-level vulnerabilities (e.g., genetic, epigenetic, allostatic) and equally interdependent contextual risk factors (e.g., coercive parenting, deviant peer group affiliations, neighborhood criminality). Through interactions across levels of analysis, some individuals traverse along the externalizing spectrum, beginning with heritable trait impulsivity in preschool and ending in antisociality in adulthood. In describing our model, we note that (a) the approach outlined in the DSM to subtyping externalizing disorders continues to obscure developmental pathways to antisociality, (b) molecular genetics studies will likely not identify meaningful subtypes of externalizing disorder, and (c) ontogenic trait approaches to psychopathology are much more likely to advance the discipline in upcoming years.