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8 - Emotions and Psychopathology in Childhood

(EN: No chapter introduction)

Emotions in Child Psychopathology

Psychopathology attempts to define the causes of mental states, particularly those that are dysfunctional, with the implicit assumption that there is an identifiable reason for a person's present mental state that can be discovered and addressed.

Given that our personality develops over time, it is generally believed that a present mental state is the result of an emotional and cognitive framework that was developed in the past, and is applied and tested to the present. Per the previous chapter, this framework is developed in early childhood, and many psychopathologists investigate the events of childhood as a basis of tracing subjects' personalities back to their origins.

Psychopathology is also primarily concerned with disorders - so the authors reiterate that disorder is based on dysfunction. There is a difference between being very sad and being depressed, in that the latter has long-term functional consequences.

Classifying Childhood Disorders

Patterns of dysfunctional behavior are most often observed outside the home (at school). When there arises a pattern of behavior, cases are referred to mental health professionals (school counselors, social workers, or other professionals) who typically interview the subject and their parents to determine whether there is a significant psychological issue.

(EN: The authors suggest that these patterns occur more often in boys than in girls, but I think it's more along the lines of they are more concerning in boys than in girls because, in western culture, males are encouraged to demonstrate outwardly whereas girls are encouraged to be less aggressive - such that the dysfunctional behavior in girls is not disruptive to the classroom environment, and is therefore less often noticed. So ultimately, it is not the incidence that is more prevalence, but the degree to which the incidence is given attention.)

The diagnosis of a psychological condition is based on the same disease model as are physical conditions. Unusual or abnormal behavior is generally tolerated up to a certain level, and only when these parameters are exceeded that the behavior may be considered dysfunctional.

(EN: This also brings to mind that there are periods in which psychological dysfunction is said to be rising or falling in the general population - and from what has just been said, it may have nothing to do with the behavior itself, but with the way in which criteria are chosen and tolerances are adjusted over time.)

The authors concede that "there are no sharp distinctions between having and not having a disorder. Instead there is a continuum." Checklists and questionnaires are used in an attempt to arrive at more consistent diagnoses, but the nature of the questions is often subjective.

It's suggested that there is potential for a disorder to be recognized when behavior falls to the extremes - an individual's behavior is abnormal with it is in the most extreme 5% or 10% of the population (two standard deviations from the norm).

(EN: Another problem here is that the "norm" is variable and culturally derived. A child whose behavior seems normal in one group may be abnormal in another.)

Finally, it's noted that child psychologists tend to be concerned principally with two emotions: anger and fear.

How Childhood Psychopathology Involves Emotions

The two main disorders of childhood are oppositional defiant disorder and conduct disorder - both of which are characterized by behavior patterns that are too independent, and insufficiently compliant to adults who desire for children to be obedient to their own will.

Oppositional defiant disorder is characterized by behaviors such as temper tantrums, arguing with adults, refusing to obey rules, deliberately acting to annoy others, refusal to accept personal responsibility, being quick to take annoyance with others, vindictiveness, and verbal aggression. Conduct is considered disorderly when four or more of these behaviors are displayed over a size month period and this leads to an impairment of their social or academic life.

Conduct disorders include more serious behavior such as stealing, fire setting, cruelty to other people or animals, use of weapons, and the like. Again, it is based on six months of consistent behavior, but the focus is more on the harm caused to others rather than to the individual's own success.

There are also disorders of anxiety and depression, which are evidenced by withdrawal and lack of effort in social and academic affairs, feelings of incompetence, excessive shyness, and self-consciousness, which are evident over at least six months.

(EN: It's interesting that the authors choose to omit disorders, given that attention deficit disorder is the darling of the profession in recent years. Perhaps this is considered a cognitive rather than emotional disorder?)

One hypothesis about emotion and psychopathology is that emotions become imbalanced, such that one emotion becomes prominent in the demeanor of an individual, to the exclusion of others, even when it is believed that circumstances merit a different emotional reaction. A child who is sad when they ought to be happy, or happy when they ought to be anxious, draws the attention of observers.

There is also a hypothesis of misplaced reactions, that occur because an association has been drawn between an incidental detail of an incident (repetitive or traumatic) and an emotional reaction: a child who noticed that policemen were present when a parent was injured may associate their anxiety to policemen rather than to the injured parent. In effect, the emotions are short-circuited.

A final hypothesis considers an absence of emotional regulation - that the emotional reaction that a child has is entirely valid given the situation, but is not controlled to a degree that is deemed sufficient. For example, a ten-year-old child that cries when his mother leaves the room is showing a natural reaction, but it is expected that by that age he would demonstrate greater control. A gender difference is noted, in that boys feel that it is more acceptable to act on their emotions whereas girls feel it is more acceptable to control them.

Appraisal biases have also been noted - which pertains to the way in which children assess the behavior of others. For example, shown a film in which someone bumps into another person an knocks them over, there may be an inclination to interpret the action as having been intentional, and motivated by meanness. Children who make such appraisals often react vindictively, or take this behavior as a model of what is acceptable, either of which results in overly aggressive reactions to the behavior of others. It is also possible for this interpretation to be internalized, in that a child becomes depressive in response to behavior he assumes to have been intentionally inappropriate toward themselves.

Similarly, children who externalize the causes of behavior are often prone to emotional disorders - the notion that someone "made them" behave in a certain way, when in reality they chose to act in that manner, fails to identify with, understand, and control their own emotions - which likewise can amplify aggression or depression.

The authors acknowledge that psychology itself is an instrument of culture - it considers children to be deviant when their behavior is different to that of others and seeks to change behavior to conform to cultural standards. Even when behavior is assess by its negative consequences, this is based on the assumption that consequences should be different, and would be better if behavior was more conventional.

This is necessarily so. There can be little argument that stealing from others, doing physical harm to others, intimidating others, doing injury to oneself, and other such behaviors are harmful to the social order as well as to the success and well-being of the individual. Particularly in the nurturing of children, adults feel that they are responsible for guiding their behavior in a way that will lead to greater personal success and social harmony.

But ultimately, considerations of normal behavior are highly subjective and based on assumptions about what behavior will lead to the greatest success, often without consideration of the actual consequences.

(EN: I find this to be much more disturbing than do the authors, particularly in a political perspective. It is not uncommon for totalitarian governments to declare citizens who rebel against the establishment to be mentally dysfunctional, to subject them to imprisonment, torture, and execution for their objection to the agenda of those in power. I also consider this to be a problem in more liberal societies, albeit to a lesser degree, such that psychology as an instrument of the state is itself dysfunctional and counterproductive.)

Prevalence of Psychopathology in Childhood

Observation, interviewing, and experimentation are the main methods of exploring the development of emotions in childhood. This yields an evaluation of behaviors and reactions, for which psychopathology seeks to define causation, principally in the epidemiology of disorders with particular attention to their prevalence in the population and their incidence in a given subject.

Rough estimates of psychiatric disorder among children in western societies range form 15% to 22%, primarily differing by the way in which "disorder" is defined - the degree to which a given proclivity handicaps a subject. Externalizing disorders and anxiety disorders are the most common in children and adolescents.

One study (Kishani 1989) provided a more specific accounting:

The authors refer to the Isle of Wight Study (1970) that undertook significant effort to make a comprehensive study of all children in this location over a ten-year period. That is to say that such studies do not merely consider the incidence of disorder in patients who are referred to a clinic, because there are many disorders that may go unnoticed, whose symptoms are often ignored because they are not disruptive - such that it is estimated that as few as 10% of children with psychological disorders receive any help (Esser 1990). It's also noted that care is taken to avoid subjectivity by having children interviewed by multiple practitioners and including only cases in which two or more "agree closely" in their assessment.

In terms of clinical statistics, they seem to indicate that there is a difference between reporting of children and parents. Children are more likely to report their own fears and anxieties, of which parents may be dismissive or entirely unaware, whereas parents and other adults tend to recognize only conditions that are problematic to their own agenda - the child is resistant or uncooperative to their will, therefore there must be a problem with the child. It's suggested that teachers can be just as biased, if not more biased, than parents because their interest is in maintaining order in the classroom rather than the welfare of the children in their keeping.

Eternalizing Disorders

Externalizing behavior attributions to external causes against which the child takes action - destroying property, fighting with others, cruelty to animals, and other behaviors that seek to exact revenge on an external object that is believed to be the cause of emotional distress. It's suggested that sadness and anxiety may also be attributed to external causes, but the subject's primary focus is on his own behavior as the root cause and any external antagonist as reacting, such that these subjects direct their frustration inward.

It is theorized that externalizing behaviors begin in a subtle manner, and if left unchecked will escalate to delinquent or criminal behavior in later life. This may merely be a matter of sophistication - the nature of the emotional response is the same, but as children age they gain they physical abilities, resources, and knowledge to do greater harm.

Angry outbursts are quite common in infants, but there is a sharp decline between the ages of one and two as children learn to modulate their emotions or express them in different ways - the decrease is more significant in girls than in boys, but this may be a matter of the way in which children are nurtured rather than biological, though as in all things it is assumed to be some combination of the two.

Anxiety Disorders

Anxiety disorders also increase during childhood, with research demonstrating a "ninefold increase" in worrying between ages three and eight and continuing to develop with age afterward. However, the expression of anxiety changes, with separation anxiety being most common among younger children and withdrawal among older ones, and this translates into depression in adolescence and adulthood.

Girls are more likely than boys to have anxiety disorders, which is also reckoned to be a combination of nature and nature as it is common among a number of cultures to coach girls to become withdrawn and discourage them from being aggressive to a higher degree than with boys.

Depressive Disorders

Children are naturally curious an exploratory, so it is considered unusual for a child to be withdrawn or show little interest or activity. However, this changes over time - depression among young children is very rare, but 11% of eight-year-olds were observed as depressive, which rose to 30% by age thirteen.

In childhood, the rate of depression is roughly equal in boys and girls, but the rate increases more dramatically in girls than in boys. It's suggested that the incidence in boys remains relatively stable whereas the incidence in girls is a "tenfold" increase. (EN: I checked a couple of the studies cited - it's a ten times increase, not a tenfold increase, which is still dramatic.)

Given the late development of depressive disorders, the case for socialization rather than genetics is well supported in terms of this disorder, though biological factors during maturity are also likely to have an effect as female passivity and male aggression are common to many species.

Continuity of Disorders

In the course of development children show "some continuity" of emotional response over time (EN: and I here echo my concern about the low coefficient of correlation those studies demonstrated), but continuation of disorders over time are much more pronounced. It is estimated (Richaman 1982) that 60% of children with a disorder at age three also had a disorder at age eight, 75% of children with disorders at age 10 had disorders at age 14.

Another study (Huesmann 1984) found that stability of aggression is almost as reliable as stability of IQ between the ages of eight and thirty. Further, 50% of children with an externalizing disorder in childhood grew into adults with personality disorders, and were five times more likely than other children to become criminals or substance abusers.

While there is high correlation in the incidence of disorders, there are marked changes in the way that disorders are expressed over time. In general, people who attribute their emotional distress to external causes remains stable, but those who react externally rather than internally decrease - some percentage of aggressive children become self-destructive or depressive, though their externalization of causes remains unchanged. Children wit anxiety or depressive disorders do not tend to change the way in which they express emotion (i.e., a violent child may become a depressed adult but a depressed child does not tend to become a violent adult.)

(EN: It occurs to me that this is not a hard-and-fast rule, especially given some of the more dramatic examples in the media in recent years of individuals who internalize emotional distress going on shooing sprees. It's said that they "snapped" but it is likely more accurate to say that they simply switched tactics.)

Viewed from another perspective, the recovery rates from psychological disorders between youth and adulthood is exceedingly low - a 75% correlation in disorder means that only 25% are "cured" whereas the remainder retain their disorder even if the manner in which it is expressed changes.

Some consideration has been made of environmental factors, in that the recovery rate from psychological disorders is higher when there is an environmental change (the family is removed from the community or the child is removed from the family) - but it is also noted that a stable and healthy child may also develop disorders when his environment is changed. However, there is insufficient data to conclude that this is an effective solution.

It's also noted that the environment of the home and the influence of parents are factors: a child raised by a depressed mother is more likely to learn to express depressive symptoms, and in that sense there is continuity in the family: a mother who is depressed when her child is age three is 50% likely to remain depressed at age eight, and couples in a "conflictual marriage" are 60% likely to remain in conflict during those same years. Likewise, if relationships within the family were positive at the beginning, they were likely (EN: no percentage given) to still be positive at the end of this period.

Risks and Causes of Childhood Psychiatric Disorders

Disorders in children are rarely caused by a single factor or incident. Instead, many things "go wrong" in their lives: they may have a difficult temperament, a neglectful caregiver, parents who model negative behaviors, hostility with siblings, and so on. Studies such as the Isle or Wight often find multiple factors that contribute to the psychiatric conditions of children.

Conflict Between Parents

Children who are exposed to prolonged conflict between parents are at increased risk of developing externalizing disorders. This is pronounced in boys who express aggression and anger to parents and other children, which reflects the expressions of anger and aggression between the parents.

One study (Smith 1991) notes three common features of poor marital relationships: frequent and severe arguing, disagreement and inconsistency in child rearing, and periods of silent tension. The first is most commonly associated to child psychology.

It was previously considered that divorce was harmful to children's development, but it is now theorized that it is not the divorce itself, but the hostility between parents that occurs before and after the event that causes the damage - not the event or its functional consequences.

Experiments (Cimmings 1987) arranged for pairs of children to play and interact together in an environment in which two adults were present but not interacting with the children. In instances in which the adults conversed with one another in a casual manner, there was negligible effect on the children; but if the two adults modeled an angry verbal argument, children increased their aggressive behavior toward one another afterward. This was taken as evidence that the interactions among adults, not merely among parents, influenced the behavior of children.

Parental Psychiatric Disturbance

Epidemiological studies have repeatedly demonstrated that children of parents with psychiatric disorders are more likely to have disorders themselves - and on this basis it is often assumed that disorders are genetic rather than developmental. Such a facile interpretation fails to account for the influence of the parent's behavior on the behavior of children.

The Cummings study (just above) demonstrates that children model the behavior of adults - even adults who are not their parents. It should therefore be apparent that it is behavior, not merely DNA, that transmits behavior from one generation to the next.

(EN: I don't disagree, but would find the assertion more convincing if the authors could present a study that shows correlation between disorders in children who have been adopted - such that the correlation exists in the absence of genetics. A cursory search did not turn up any such study.)

Children with a depressed parent are exposed to the expressions of sadness and withdrawal, and are therefore more likely to mimic and adopt these patterns of emotion. Studies (Cohn 1990) established a baseline that typical children spend 0.2% of their time showing sadness and 0.8% showing anger - whereas those with a depressed mother spent 6.7% and 7.6% respectively. It is reckoned that the sadness is based on modeling the behavior of the parent, and the anger results from frustration because the parent is unresponsive to them.

The second assumption is of particular interest because a child's schemas for behavior are developed through atrial-and-error process of taking action and observing consequences, such that when a parent is in a depressive state there is no response to the action of a child, and their schema is not reinforced by feedback. In particular, such children do not expect adults to be responsive, and tend to avoid contact with them, which influences their development of attachment in general to be in line with the avoidant style.

A secondary effect is observation of the interactions among family members - a spouse who routinely becomes frustrated by the unresponsiveness of a depressed spouse expresses annoyance or anger - to which the spouse does not respond. Another finding from the same study is that parents who suppressed their anger with their spouses tended to express it more frequently toward their children.

Another effect is that a depressed parent is more likely to express negative views in general, and negative views of their children in specific. There is much parental criticism and little parental praise, which undermines the self-confidence of children - or creates a sort of egotism in which the child maintains self-confidence while disregarding the negative feedback of others.

The Parent-Child Relationship

The relationship between parent and child is considered to be fundamental because it is the only relationship a child has during infancy and the most significant for the first few years of life, so it is reckoned that this forms the starting point of the child's mental framework for all relationships.

Attachment failures (resulting in ambivalent or avoidant attachment styles) are highly significant, as there is far lower incidence of mental disorders among adults who formed secure attachment as children.

Studies of orphans or children in protective custody (such as Hodges 1984) generally observe that the staff of such institutions provide good physical care and some degree of stimulation, but given that the ratio of staff to children is low and that children are often attended by a changing cast of caretakers (as many as 50 different adults over the course of two years), it is reckoned that attachment does not form.

Adopting parents are often eager to have the children, place greater effort into cultivating a relationship, and are sensitive to the psychological conditions of the children - and as such are more likely to conform to ideal standards of parenthood than genetic parents.

However, by that point the damage is done. In spite of the effort and attention of adoptive parents, children between eight and sixteen who were adopted are more likely to show signs of disorders than children who had experienced continuous care of a less meticulous parent. Observations and interviews of teachers indicate the ex-institutional children show more signs of attention seeking, restlessness, unpopularity, quarrelsomeness, and aggression than non-institutional peers.

Even within the home, adoptive parents observe more conflict and difficult family relationships, which also affects other children in the family. However, there is a marked difference between adopted children and children removed and restored, in that the latter were more likely to be dysfunctional.

It is conceded that part of this difference may be in the way that adopted children are treated by others: because they lack attachment at first, others tend to regard them as unusual or abnormal and avoid them, which exacerbates the issues.

Following them into adulthood, it is found that ex-institutional children have a higher incidence of "handicapping" psychiatric disorders: 33% as compared to 5% of non-institutional ones. It is suggested that these dysfunctions spread, in the nature of a disease, to others with whom these individuals have contact - their own spouses and children, primarily.

Another set of studies have been done to children who lose a parent through death. This is likewise damaging, particularly when the loss occurs during early childhood. Such children are more sullen and socially withdrawn, and even show disorders related to appetite and sleep. These are natural consequences of the grieving process, but even after a year there are lingering traces of grieving behaviors that become part of the child's temperament.

Childhood attachment styles seem so basic that many researchers consider that these styles - secure, ambivalent, and avoidant - can along be predictors of psychopathology. However, in spite of many studies into the matter, it has been found that the correlation between attachment style and psychopathology is "inconsistent and weak."

It's further noted that children do not have one consistent attachment style, but give evidence of differing styles in the context of different relationships. So it is likely more accurate to state that the style of material attachment forms a method for developing relationship schemas in the context of other relationships rather than developing a single schema that is maintained or transferred to other relationships.

It has also been observed that the way in which children choose to relate to others is interactive, and reflects the way in which others relate to them. This is the reason that a child may have a loving relationship with one parent or sibling but a distant relationship to another, which is also plainly evident in the differences in relationship styles throughout life: a person does not have one style of attachment to all people, but develops a relationship specific to each individual.

A few studies are cited into the relationships have with abusive parents. Naturally, the child forms an avoidant or ambivalent relationship to the abusive parent and can at the same time form a secure relationship with the other, provided they are not abusive as well. Patterns of favoritism, child for parent and parent for child, are quite common though less pronounced in households in which there is not a pronounced or ongoing incidence of abuse. It's also noted that a "highly critical" relationship with a parent, even in the absence of physical abuse, can also have a negative impact on development.

This is not to entirely dismiss the notion that parental attachment is significant in developing the temperament of the individual, mere that it is not as significant as was previously assumed, and that the effects are not indelible. A child who has a negative relationship with a parent is entirely capable of forming positive relationships with other members of the family and outside the home - though it does tend to affect their approach to forming relationships with others.

Poverty

A brief mention (one paragraph) of the effects of poverty, as the notion that poor children are emotionally disadvantaged has been exploited for political reasons. There have indeed been correlations that demonstrate that children whose household income is over $50K per year show less than half as much incidence of psychiatric disorders than those whose parents earn less than $10K (Costello 1989).

However, there is little indication of how the conditions of poverty contribute to risk of disorder. It is reckoned that a parent who is struggling to meet financial demands experiences stress, which creates a stressful environment of the child, and worse if the stress is expressed to the children.

But it is also reasonable to consider covariance to a common cause: a parent who has poor relationship skills may fail to achieve financial success as a result, and the psychopathology of the child is also attributable to the poor relationship skills of the parent.

(EN: All of this is extremely speculative, and overlooks the fact that most psychological experimentation is done in an academic environment, such that research is subject to political agendas and cannot be regarded as unbiased.)

Other Risks

Two additional factors have been suggested: family size and parental criminality.

The authors suggest that family size may operate similar to poverty, in that even if the total amount of income is significant, the resources are spread thinly given the number of people who must be supported, resulting in the same levels of material deprivation and parental stress.

(EN: My sense is that fiscal responsibility can also be an issue - even families with few children and significant income may be economically distressed. So all in all, I don't think researchers have done adequate work to identify a causal relationship or identify the root cause. The notion it has "something to do with money" is too vague.)

Parentally criminality is also largely assumptive, suggesting that people who act in ways society considers to be unacceptable may have "poor parenting practices" in the sense that they coach and model unacceptable behavior.

There is also correlation between population density and psychological dysfunction, given that the level of incidence in children is twice as high in urban environments as in rural ones.

When all these risks are considered (parents who fight, a parent with a disorder, ambivalent or avoidant attachment, poverty, a large family, criminal parent, urban environment), children who have one such factor show negligible difference from those who have none. Incidences of disorder are four times as high in children with two or three factors (with little difference between two and three) and children with four or more are twenty times as likely to have a disorder.

(EN: However, I take that with a grain of salt without a more detailed examination of the methodology. It could be that researchers are more likely to take a closer look at the factors for children who have disturbances than those who do not, and find evidence or interpret evidence for more factors, to a higher degree. Even if it was a blind study, it seems likely that when one factor is identified, or perhaps when the second factor is noticed, the researchers take a closer look for others.)

Bidirectional and Reinforcing Environmental Effects

While most of the research into childhood disorders regards children as the victims of circumstance, there is growing evidence that it is bidirectional - that the behavior of children causes other to interact with them in different ways.

In plain terms, the behavior of the parents may cause the child to misbehave, but the misbehavior of the child causes parents to react differently toward the child, such that it becomes a vicious circle: the child behaves inappropriately, as a result the parents discipline the child, as a result of the discipline the child escalates misbehavior, increasing misbehavior results in increasing discipline, and so on.

The same can be seen in adult relationships, in the way that an innocuous comment provokes a hostile response, that response causes the other party to become hostile, and they cycle of escalation continues. Though much depends on the tactics of the individuals involved - whether a person responds to hostility with additional hostility or avoidance.

Also, given that observation of aggression in others provokes aggression in the observer, the tension in one relationship in a household may cause other relationships to become stressed, such that the environment itself becomes toxic.

Constitutional Factors Related to Psychopathology

In the previous chapter, temperament was identified as an element that contributes to emotional biases, but to a low degree: the correlation between emotional expression in infancy and that of early childhood was a mere 4% in boys and 9% in girls, and childhood and infancy together correlated to 8% of behavior in boys and 17% in girls.

The authors must that "perhaps it is only when adverse temperament interacts with a negative environment that psychopathology develops." That is to say that a difficult child in the context of a dysfunctional family is in situation where the two factors will amplify one another. When there is only one factor (negative temperament in a functional family or positive temperament in a dysfunctional one) the negative factor is mitigated by the positive.

The authors mention that there has been "a great deal of interest in genetic influence" but they do not discuss it in detail because the research is presently scattered and has thus far failed to establish a consistent correlation between genetics and emotion. Moreover, it is quite common for hypotheses to be rejected for lack of statistically significant proof in studies of adequate scale.

There has been good progress in identifying genetic factors that predispose a person to a medial condition that is in turn associated to cognitive dysfunction (such as autism), but no direct link between genetics and cognition in otherwise healthy subjects.

It is likewise considered that some conditions that are related to genetics - such as having a high IQ, good language skills, and the like - also impact a person's ability to interact and form relationships with other people, which in turn contribute to their psychological well-being.

Protective Factors

Just as certain factors have been shown to increase the risk of disorders, others factors have been found to mitigate it. This explains the reason that children who are exposed to the same risks show different outcomes: not all children who live in poverty or in stressful homes develop disorders, and even siblings in the same family develop different personalities.

A few mitigating factors are listed:

It is reckoned that each of these factors can help a child to function well in spite of stress and avoid developing a disorder.

The authors are impressed by the work done by Comer (1988) with children of minority families. Comer theorized such children failed to perform academically because they were alienated from school and their parents did not value academic achievement. His work involved providing a more supportive environment in the school as well as counseling parents of children with discipline problems. Over the course of ten years, his results were a significant improvement in the academic performance (as measured by standardized testing) of such students and a significant reduction in disciplinary incidents.

(EN: No detail is provided on exactly what was done, or the level of improvement that was witnessed - so it's likely this was tossed in as an interesting case, in the absence of research to prove the value of mitigating factors. As such, my sense is it remains a theory and an observation into which research is needed.)

Diathesis-Stress Model of Disturbance

The authors mention the diathesis-stress model as one that demonstrates the ideas discussed in this chapter. This model considers a number of psychological and environmental factors analyzing and predicting psychological disorders in children.

One of the concepts is that, due to various factors, some individuals have an increased tendency (diathesis) to develop a disorder: genetic vulnerability, cognitive defects, and temperamental factors. The second concept is that od stress in the environment, which influences behavior: parents who fight, poverty, poor relationships with peers, etc. The combination of these two factors results in a high likelihood of developing a disorder.

This meshes well with the authors' perspective of emotional development as a dynamic system: schemas are internalized and adjusted over time as a matter of adaptation to experience. In essence, human emotions are developed rather than being hardwired and can change dramatically over time, given the experiences in which they are engaged and modified.

It also underscores that there is great variety and change in human emotions, such that a simplistic model has not been conceived, nor is it likely that there will be a stunning discovery of a small number of factors that are flawlessly predictive. Human experience is far too varied to yield to facile examination.

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