A cognitive vulnerability–stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context

Abstract

Why is adolescence an "age of risk" for onset of bipolar spectrum disorders? We discuss three clinical phenomena of bipolar disorder associated with adolescence (adolescent age of onset, gender differences, and specific symptom presentation) that provide the point of departure for this article. We present the cognitive vulnerability-transactional stress model of unipolar depression, evidence for this model, and its extension to bipolar spectrum disorders. Next, we review evidence that life events, cognitive vulnerability, the cognitive vulnerability-stress combination, and certain developmental experiences (poor parenting and maltreatment) featured in the cognitive vulnerability-stress model play a role in the onset and course of bipolar disorders. We then discuss how an application of the cognitive vulnerability-stress model can explain the adolescent age of onset, gender differences, and adolescent phenomenology of bipolar disorder. Finally, we further elaborate the cognitive vulnerability-stress model by embedding it in the contexts of normative adolescent cognitive (executive functioning) and brain development, normative adolescent development of the stress-emotion system, and genetic vulnerability. We suggest that increased brain maturation and accompanying increases in executive functioning along with augmented neural and behavioral stress-sensitivity during adolescence combine with the cognitive vulnerability-stress model to explain the high-risk period for onset of bipolar disorder, gender differences, and unique features of symptom presentation during adolescence.

Disaggregating the Distal, Proximal, and Time-Varying Effects of Parent Alcoholism on Children’s Internalizing Symptoms

“…The risk resulting from the distal effects of parent alcoholism does not require that children be directly exposed to their parents' alcoholism, but merely to a more stressful environment or more intense genetic diathesis at some point prior to the study period. Consistent with this notion is evidence that children and adolescents experience physiological changes and develop patterns of biased information processing as a result of major stress events that may in turn place them at long-term risk for negative outcomes, including internalizing symptoms (Alloy et al 2006).…”

Empirical evidence of cognitive vulnerability for depression among children and adolescents: A cognitive science and developmental perspective

“…Following theory, which places dysfunctional attitudes at the center of the etiology of depression (Beck 1967(Beck , 1983, prospective studies with adults support the role of dysfunctional attitudes in the development of depression (Alloy et al, 1999;Joiner, Metalsky, Lew, & Klocek, 1999;Kwon & Oei, 1994). Results from the Temple-Wisconsin Cognitive Vulnerability to Depression project (CVD; Alloy et al, 2006) indicate that first onset of a depressive disorder is significantly more likely among individuals with high levels of dysfunctional attitudes and a negative attributional style than among individuals with low levels of these cognitions. In another example, increases in depression symptoms result from the interaction of dysfunctional attitudes and a negative university admissions life stressor among high school seniors .…”

Invited Commentary: Understanding Brain Mechanisms of Pain Processing in Adolescents’ Non-Suicidal Self-Injury

“…Adolescents display an exaggerated stress response due to an increased release of the steroid hormone cortisol from the hypothalamic-pituitaryadrenal (HPA) axis (Alloy et al 2006;Walker et al 2004). During stressful situations, the hypothalamus releases corticotropin-releasing hormone (CRH), which causes the pituitary to release adrenocorticotropic (ACTH), which triggers the adrenal glands to release cortisol.…”