Vulnerability-Stress model on Schizophrenia

This essay discusses the Vulnerability-Stress model of schizophrenia, co-morbid disorders, interventions, and recovery. The model involves two factors, vulnerability and stress, and helps demonstrate the mechanism of schizophrenia for therapy and clinical management.

Running head: VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
Vulnerability-Stress model on Schizophrenia
Name of the Student
Name of the University
Author Note:

1VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
In general, psychiatric maladies have a fundamental basis of biology. However,
environmental factors play an influencing role on their course with time. There are few
models which helps us to comprehend the basis of psychiatric disorders. The Vulnerability-
Stress model is one of those models. This model involves with two basic factors which are
vulnerability and stress. Vulnerability refers to the proneness of mental illness which is
determined by genetic disposition and early life involvement. On the other hand, stress refers
to the challenging issues faced in everyday life. Stress can be affected by the coping
mechanism, social support and stress handling capability. Vulnerability to develop a
psychiatric disorder varies from person to person as well as its severity (Burns & Machin,
2013). Due to genetic disposition and early life exposure, some people are susceptible to
psychiatric disorder like schizophrenia. Schizophrenia can be triggered by the combination of
complicated birth, genetic predisposition, viral infections (CNS), biological stressors and
stress (Cheng, Walsh & Schepp, 2016). The vulnerability-stress model helps demonstrate the
mechanism of schizophrenia for therapy and clinical management. Therefore, in this essay
vulnerability-stress model of schizophrenia will be discussed. Co-morbid disorders,
interventions and recovery of schizophrenia will also be discussed alongside.
Stress is a subjective phenomenon. The effect of same stressors varies from one
person to another depending on their cognitive appraisal. Moreover, an individual can behave
differently to the same stressors over longer period of time, depending on the person’s
adaptability to the stressors. The Vulnerability-Stress model of schizophrenia suggests that
stress have to cross a certain threshold for positive symptoms to occur. From above
discussion it can be said that stress is subjective, so in turn, threshold of stress also become a
subjective parameter. Thus, the threshold become different for each individual and makes it
extremely difficult to determine the threshold value of stress for the occurrence of positive
symptoms for each individual in advance. This problem of subjectivity of stress might nullify

2VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
the whole model as it does not have any predictive power. Vulnerability or diathesis is the
increased chance of developing a particular disease or disorders compared to general
population. Schizophrenia’s vulnerability is commonly considered as genetic. Recent
research suggests that it follows polygenic model. Findings of recent research suggest that
this vulnerability may not be particular to schizophrenia rather a widespread vulnerability
towards many of neuropsychiatric disorders. This implies that an individual with history of
schizophrenia not only susceptible to schizophrenia but to bipolar disorder as well. Some
recent researches suggest that vulnerability can be psychological. Evidence suggests that
childhood trauma act as a factor for emergence of schizophrenia in teenage and adulthood.
The vulnerability-stress model of schizophrenia suggests that the occurrence of vulnerability
or/and stress has to be specific to schizophrenia, otherwise positive symptoms would not
reveal. However, there are positive symptoms of schizophrenia which are also present in
other disorders. To tackle this problem, there is a need to identify the difference between non
specific and specific factors of schizophrenia. A particular gene that plays a vital role in
schizophrenia could be a specific factor whereas other genes that play general role can be
considered as non specific factors. In addition with it, symptoms or outcomes that are
commonly associated with schizophrenia can be conceptualized as predisposing factors. The
stress in vulnerability-stress model of schizophrenia might not be unrelated of vulnerability.
It is vital for this model to understand the relation between stress and vulnerability in case of
schizophrenia mainly conceptual and empirical dependence. The requirement for empirical
dependence needs factual association among constructs whereas the requirement for
conceptual dependence needs overlap of definition among the constructs. Evidence from
previous research suggests that in vulnerability-stress model of schizophrenia, stress might be
reliant on vulnerability but this reliance is empirical one rather than conceptual. As a result,
in theory, it can be said that stress can be evaluated independently of vulnerability. Therefore,

3VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
this does not pose a conceptual challenge in case of vulnerability-stress model of
schizophrenia (Pruessner et al., 2017).
Symptoms and outcomes are very diverse in schizophrenia. Practically, no two
patients have the same symptoms. Along with this, symptoms can change drastically and
involve into new secondary or co-morbid disorders. Some of the co-morbidities that are
common with schizophrenia are anxiety, substance abuse and depression. Moreover, these
symptoms can lead to secondary negative symptoms. For instance, marijuana abuse can lead
to worsen the disorganization and positive symptoms and paranoia can be derived from panic
attacks. Anxiety is much more common in schizophrenia patients in comparison with general
populace. They are obsessive compulsive disorder, panic disorder, post traumatic stress
disorder, social and generalized anxiety disorder (Buckley & Hwang, 2015). Challenging
issues with schizophrenia is that the symptoms can originate spontaneously without any
warning, as a side effect of drug abuse, response to a direct psychotic symptoms or
intermittently. Two survey studies have found that 28% - 63% and 45% occurrence of panic
attacks in schizophrenia patients (Baldwin et al., 2014). Many more studies have examined
the occurrence of panic attack in schizophrenia patients. All of them have a maximum
occurrence percentage of above 30. In contrast, occurrence of panic disorder amongst the
United States general populace varies from 2% - 5.1% (Baldwin et al., 2014). Similar like
anxiety, trauma is also very common amongst schizophrenia patients. Schizophrenia patients
are much more susceptible to suffer trauma. A study crudely established that the occurrence
percentage of post traumatic stress disorder among schizophrenia patients is 29. Just like the
previous two, obsessive compulsive disorder and obsessive compulsive symptoms are very
much common amongst schizophrenia patients. A research has shown that people with
schizophrenia have 12.5 times more chance of having obsessive compulsive disorder.

4VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
Recent research regarding schizophrenia shows that psychological interventions are
much more useful to lessen psychotic symptoms in addition with psychiatric care or
medications. According to the studies, for schizophrenia, there are five major strategies for
psychosocial interventions which are psycho education programs, social skills training
programs, cognitive therapy, assertive community treatment and family intervention. Psycho
education programs generally use educational approach for intervention with schizophrenic
patients. This program generally performed medical professionals and in medium duration
ranging from nine months to two year. On the other hand, social skill training helps patient
with schizophrenia to perform their daily social skills competently as lack of social skill is
major deficit amongst schizophrenia patients. Social skill training is the oldest intervention
technique for the patients with schizophrenia. Recent study suggests that social skill training
intervention method is much more effective while used together with other intervention
methods (Chien et al., 2013). Cognitive therapy is one of the oldest and well established
methods for handling patients with schizophrenia. It is very highly standardized and
organised method to aid schizophrenic patients to cope with their symptoms (Williams,
2017). Assertive community treatment has been designed to help those patients who have
history of frequent relapsing or social collapse like loss of control or withdrawal. This
method use very small employees to patient ratio which is 1 is to 10 and higher contact per
visits. In case of schizophrenia, family of the schizophrenic patient are also the sufferer along
with the patient. Also, family of the patient is the main care giver to the patient. Sometimes
this can be burdensome to the family of the patients (Chien et al., 2013). Hence, intervention
targeting the family of the patient can be very vital. Lots of interventions methods for
schizophrenia have been applied over the year. Unfortunately, still there is a lack of one
adequate and effective method due to inconsistent application and availability.

5VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
Regrettably, schizophrenia has no cure as of now. Patient with schizophrenia and their
family have defined that recovery from schizophrenia should include two types of remission
which are functional and symptomatic. Functional remission should include returning to
education or employment, fulfilment responsibilities and duties, social and independent
functioning whereas symptomatic remission includes self care, activity, symptom control,
reduced side effects, cognitive ability and management of schizophrenia without medication.
Sadly, patient with schizophrenia seldom achieve full recovery (Warner, 2013). To cite one
example, only 15.7 percent of first episode schizophrenia patient have fully recovered on five
year follow up (Firth et al., 2015). Schizophrenia characterized as episodic disorder and there
is always a chance of relapse of symptoms if patients stop taking antipsychotic medicine
thinking they are cured. This relapse can happen in a year or two or as early as within weeks.
Antipsychotic medicine and social aid is absolutely essential for the treatment of
schizophrenia. One of the effects of schizophrenia is lack of insight which makes it very
difficult convince schizophrenic people to stay on their medicines (Asmal et al., 2013). This
in turn leads to high attrition rates rendering the treatments useless. To summarize, it can be
concluded that patients with schizophrenia may improve their functioning and cognitive
ability after each relapse with the help of antipsychotic medicine or social support, but they
can never go back to the level of their pre-relapse functioning and cognitive ability.

6VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
References
Asmal, L., Flegar, S. J., Wang, J., Rummel‐Kluge, C., Komossa, K., & Leucht, S. (2013).
Quetiapine versus other atypical antipsychotics for schizophrenia. Cochrane database
of systematic reviews, (11).
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J.
A., ... & Malizia, A. (2014). Evidence-based pharmacological treatment of anxiety
disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a
revision of the 2005 guidelines from the British Association for
Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439.
Buckley, P. F., & Hwang, M. Y. (2015). Comorbid psychiatric disorders in schizophrenia:
more than just a chance co-occurrence. In Obsessive-Compulsive Symptoms in
Schizophrenia (pp. 3-10). Springer, Cham.
Burns, R. A., & Machin, M. A. (2013). Psychological wellbeing and the diathesis-stress
hypothesis model: The role of psychological functioning and quality of relations in
promoting subjective well-being in a life events study. Personality and Individual
Differences, 54(3), 321-326.
Cheng, S. C., Walsh, E., & Schepp, K. G. (2016). Vulnerability, stress, and support in the
disease trajectory from prodrome to diagnosed schizophrenia: diathesis–stress–
support model. Archives of psychiatric nursing, 30(6), 810-817.
Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to
treatments for schizophrenia spectrum disorders, part II: psychosocial interventions
and patient-focused perspectives in psychiatric care. Neuropsychiatric disease and
treatment, 9, 1463.

7VULNERABILITY-STRESS MODEL ON SCHIZOPHRENIA
Firth, J., Cotter, J., Elliott, R., French, P., & Yung, A. R. (2015). A systematic review and
meta-analysis of exercise interventions in schizophrenia patients. Psychological
medicine, 45(7), 1343-1361.
Pruessner, M., Cullen, A. E., Aas, M., & Walker, E. F. (2017). The neural diathesis-stress
model of schizophrenia revisited: an update on recent findings considering illness
stage and neurobiological and methodological complexities. Neuroscience &
Biobehavioral Reviews, 73, 191-218.
Warner, R. (2013). Recovery from schizophrenia: Psychiatry and political economy.
Routledge.
Williams, E. (2017). A CBT Approach to Mental Health Problems in Psychosis. Routledge.