P-factor in Children (Final) Flashcards
Comorbidity
It’s the rule, not the exception. What is the relationship between these disorders if they are so comorbid and highly related with each other?
Risk Factors are largely nonspecific
Multifinality: despite having similar early life experiences or risk factors, individuals can achieve diverse outcomes. A lot of the risk factors are very similar. Example: Childhood maltreatment is a risk factor for almost every form of mental disorder. Similarly, low SES is a risk factor for most disorder of childhood. SES is a proxy variable for other tings (e.g. lack of access to quality eduction and healthcare).
Data from Caspi et al., 24 - nonspecific risk X types of disorders
Each risk factor has basically equal association with externalizing, internalizing, and thought disorders.
Lack of specificity in predictors
Lots of risk for general psychopathology. Some factors increase risk for specific dimensions of psychopathology and general psychopathology.
Homotypic continuity vs heterotypic continuity
Homotypic continuity: Disorder predicts itself over time. It is logical.
Heterotypic continuity: Disorder predicts other things over time. Really plays out when you lookout things longitudinally. Having a disorder often predicts occurrence of different disorders across time and development.
Heredity of psychopathology and parental psychopathology as a risk factor.
E.g. Parents pass on risk for any anxiety disorder, not necessarily a specific anxiety disorder or the anxiety disorder they have. Parents pass on risk for a broader ASD phenotype. Certain disorders may run in families (e.g., bipolar), but psychopathology (i.e., having any psychological disorder) seems to run in families even more commonly.
Different construals of psychopathology: Correlated factors
A Correlated-Factors Model. Internalizing, Externalizing,, Thought process. Different domains are simply positively associated with each other. My level of internalizing psychopathology causes me to score at a certain level on, for example, MDD, PDD, and social anxiety. My level of externalizing causes me to score on a certain level of … some other disorders. Internalizing symptoms are probably positively related to externalizing symptoms. Nothing actually causal linking them together.
Different construals of psychopathology: Single Factor Model
P explains all disorders, no subtypes. One underlying cause that then explains my level across every single disorder. Everything is down to that general risk for psychopathology.
Different construals of psychopathology: Hierarchical model
Different domains of psychopathology cause specific disorders. Higher-order factor causes different domains. Higher order factor indirectly causes specific disorders (mediated through domains). Our underlying risk of psychopathology is causing us to be higher on either internalizing, externalizing, and/or thought disorders, and then our level of this domain causes whatever specific disorder we have at the time we’re assessed. At the very top is often called “p-factor”: the underlying factor that predicts our likelihood of being high in all disorders and specific domains.
Different construals of psychopathology: Bifactor model
Specific factors cause specific disorders, and general psychopathology also directly causes disorders. This is the model Caspi and Moffet’s research supports.
Which model of P is right?
Unclear, and research shows it doesn’t really matter. Scores of p correlated at .95+ regardless of how you model it. Achenbach et al., 2024 show this using datasets from 24 different societies across the world.
What is p?
Finding a p factor is empirically based - it comes out of the data (Is a result of statistical modelling, not directly observed).
Different Theories of P
Dispositional negative emotionality. Emotion regulation difficulties/impulsive responsively to emotion. Low cognitive functioning (Not just intelligence - attention & concentration, processing speed, higher level thinking). Though dysfunction/aberrant thought processes (thought dysfunction is actually present across a lot of different disorders). Underlying vulnerability to psychopathology: maybe a combination of everything?
Challenges to P-factor: Symptom Networks?
Symptoms across different disorders came each other. There is no underlying p or risk for general psychopathology that explains everything. Implication: intervening on central symptom leads to domino effect of symptom reduction in related symptom. Doesn’t apply any hierarchical status. Just have some symptoms that are more related to other symptoms.
Challenges to p-factor: Common result
Viewpoint: p might not be the cause of psychopathology, we might be assessing a common result of many forms of psychopathology.
Challenges to P - how do things like autism fit in? (Ronald, 2019)
Short editorial article on p-factor lightly challenging P-factor research. Highlights: P-factor theory does not mesh well with our understanding of ASD. ASD has: High homotypic continuity - it endures over time. High comorbidity, but ASD does not ‘morph’ to other disorders. Genetic risk for autism not associated with p (characterized by dysregulation) in 36-month olds.
Challenges to P-factor - ability to ‘explain’ each disorder changes a lot across studies (Watts et al., 2023)
Across studies, the correlation between any specific disorder an p can vary fairly widely. Shows that different studies find very different strengths of correlations between a disorder and p.
What are the implications of p if it is real?
We could gain a better understanding of psychopathology as a whole. How disorder relate to one another. Better understanding of comorbidity, how to make sense of the risk factor and genetic risk literature. Practically, why clinicians we see kids with different things over time and across development (underlying P expressing itself differently): P-factor is not incompatible with DSM, just says disorders have similar underlying cause.
Implications for Psychotherapy
If psychopathology has a common cause, can we have a common treatment? Transdiagnostic treatment: Treatment targeting underlying difficulties that occur across many disorders. Exposure-baed manuals. Target at emotional disorder broadly. Work well.
Transdiagnostic Treatments: UP-CA (Carlucci et al., 2021)
Meta-analysis 19 RCTs 13 uncontrolled pre-post trials. Moderate to large effects = effects across anxiety and depression. Did not lookout other outcomes. Most evidence of internalizing symptoms.
Modular Treatment
Match-ADTC - modular treatment for: Anxiety, depression, trauma, conduct problems. One manual that treats very different symptoms. Pick a starting point based on presenting problems then follow the flowchart. Based presenting problems, they will take you down a different decisions tree.
