Emotional Reactivity to Daily Life Stress in Psychosis

Abstract

THE VULNERABILITY-stress model^1-3 has been widely accepted as a heuristically useful framework for the study of the cause and clinical course of schizophrenia and other psychotic disorders. According to this model, psychiatric symptoms emerge whenever a threshold of stressors exceeds the individual's vulnerability level, with the latter being a stable characteristic.⁴ The stress-vulnerability concept is essentially interactional, and as such, it remains difficult to investigate. To date, most research using this model has focussed on either the indicator of vulnerability or the stressor; whereas their interplay has rarely been examined.⁵ For example, cognitive deficits,⁶ abnormalities in smooth-pursuit eye movements,⁷ alterations of event-related potentials,⁸ and cerebral structural abnormalities⁹ are more prevalent in the first-degree relatives of patients with schizophrenia, which suggests that they are indicators of vulnerability. Similarly, onset and relapse of schizophrenia and other psychotic disorders are associated with minor daily hassles,¹⁰ life events,^11,12 exposure to the stresses of urban life,¹³ or a hostile family environment.¹² However, these have mostly been examined without acknowledgment of their specific effects on vulnerable persons, and without acknowledging that reaction to stress is a continuous process with important intraindividual variation over time.