Continuity and discontinuity in psychopathology: the converging role of risk factors and resilience for the pathways toward schizophrenia

The role of clinical psychiatry today is to contribute to a “dynamic view” of biological, psychopathological and social factors. Indeed, in the light of recent contributions of gene-environment interaction 1, a growing body of interest is emerging from concepts as risk factors, traumas, protective factors and resilience 2. In particular, studies on early adversities have lead to an increasing interest in the concept of resilience in psychology, i.e. the positive capacity of people to cope with stress and catastrophe. Furthermore, it can be used to indicate having an adaptive system that uses exposure to stress to provide resistance to future negative events 3. In this sense “resilience” corresponds to cumulative “protective factors” and is used in opposition to cumulative “risk factors”. Great attention should be given to create a new open field of research for the study of risk factors, protective factors, clinical pathways and the connections between childhood psychopathology and adult psychopathology. This kind of approach has historically challenged the relationship between the manifestations of psychiatric disturbances in childhood and in adult age; in particular, the traditional point of view of a chronicity of clinical course of psychiatric disorders has been replaced by a more dynamic psychopathological pathway; in fact, more recent studies highlighted a longitudinal pathway, and attempted to investigate the possible presence of clinical antecedents of adult psychiatric disorders. Therefore, such kind of research led to the development of the concepts of continuities and discontinuities in psychopathology between childhood and adult life. The first studies of continuity/discontinuity in psychopathology originate from psychoanalysis (R.A. Spitz, J. Bowlby, S. Freiberg, M.D.S. Ainsworth), from Daniel Stern’s “Infant Research”, from “Developmental Psychology and Psychopathology” (A.J. Sameroff, R.N. Emde, A.Sroufe) and from Piaget’s early studies. These authors analyzed the mechanisms of normal and pathological development, focusing their attention on the ability to adapt and to maladjustment of children in various developmental steps; in particular, great attention has been given to the mother-child relationship and to the various attachment styles. In the last years, developmental psychopathology studies focused mostly on the early manifestations of adult disturbances and on the pathways throughout the course of the illness. In particular, converging evidence indicates that most patients who present for treatment are cases with long-standing histories of psychiatric problems in childhood and adolescence, either of the same (homotypic continuity) or a different type (heterotypic continuity) 4. So, the main purpose of this approach is to recognize the deviations from the psychopathological pathways in order to prevent consequences. Such growing awareness of a developmental perspective on mental disorders led to the performance of several longitudinal studies.