Vulnerability to Psychopathology.

Abstract

Zuckerman, Marvin. Vulnerability to Psychopathology. Washington, DC: American Psychological Association, 1999. xv + 535 pp., $49.95. In the preface to Vulnerability to Psychopathology, Zuckerman notes that this book's intended audience is researchers, teachers of psychopathology, graduate students, and physicians in psychiatry residency training programs. The book serves as a valuable contribution to the field in that it includes cogent reviews of highly significant research articles typically discussed in psychopathology courses, with the added advantage of integration and synthesis that is often lacking in psychopathology textbooks. The text intentionally emphasizes the more recent literature but gives appropriate attention to major historical contributions in each area as well. Throughout, the text emphasizes a diathesis-stress model (Meehl, 1962) as an explanatory framework for understanding psychopathology, including the premise that preexisting personality traits play a role in pathological response to stress, which is conceptualized in terms of both distal and proximal sources. Although not without limitation and controversy, this biosocial approach is based on a widely accepted theory that serves to organize the book, is likely to stimulate thought and provoke discussion, and thereby prevents it from becoming an uninspiring review of the literature. It can be expected to retain the interest of students and thereby promote learning and synthesis of complex material. Although some might quibble with the pronounced emphasis on personality factors and stress, the book achieves balance through its empirical approach in presenting recent findings from genetics, neuropsychology, and psychopharmacology, as well as its reviews of more behavioral and cognitive-behavioral research. Zuckerman deliberately omits discussion of psychodynamic theory because of its inferential nature, but when research exists to support doing so, he reviews the role of early environmental experiences in the pathogenesis of various disorders. In Chapter 1, Zuckerman provides a thorough review of the diathesis-stress model, including clear definitions of terms and concepts that will be essential to understanding the remainder of the volume (e.g., gene-environment interactions, personality traits, stress, and the complex relationships among these variables). Chapter 2 provides a more colorful, intriguing review of diagnostic issues than is typically found in textbooks of this ilk. In addition, the discussion includes relevant information on the historical progression of diagnoses up to the current DSM-IV conceptualizations of various disorders, giving appropriate attention to, but without belaboring, the contributions of the early thinkers. The chapter also includes a valuable summary of cultural, class, and gender considerations in psychodiagnostics. Chapters 3 through 7 review the anxiety disorders, mood disorders, antisocial personality disorder, substance use and gambling disorders, and schizophrenia, respectively. Each chapter includes a description of the disorder and associated symptoms, followed by a review of recent literature regarding related epidemiological, genetic, neuropsychological, and psychopharmacological factors (including brain imaging research, neurotransmitter functional relationships, and hormonal influences, when known), as well as some consideration of other theoretical approaches, e.g., behavioral and cognitive theories. A strength of these chapters is their attention to issues of psychiatric comorbidity, including discussion of associations with personality disorders and traits, and the meaning thereof within the context of the overarching biosocial theory around which the text is organized. The text is limited to review of the literature regarding one personality disorder, that being antisocial personality disorder, which is admittedly the personality disorder that is supported by the most research data. However, the book would be enhanced by additional attention to borderline personality disorder because it is also a relatively well-researched personality disorder that has interesting relationships to other disorders and very profound clinical implications. A final chapter, entitled "Prognosis for the Science of Psychopathology," reviews some persistent and thorny diagnostic problems, including issues related to dimensional versus categorical approaches, and unresolved issues pertaining to the degree of continuity between normal personality dimensions and various disorders. Zuckerman returns to the thesis of this volume, that "all forms of psychopathology can be best explained within the framework of a diathesis-personality-stress model" (p. 417). He reviews distinctions between necessary, sufficient, and contributing causal factors to psychopathology, and follows this with a discussion of personality dimensions as likely to be the underlying heritable component of many psychopathological conditions. This is followed by a compelling discussion of the treatment implications that flow from this premise. In particular, Zuckerman predicts increased refinement of combined pharmacological and psychotherapeutic approaches and greater emphasis within the latter on interpersonal determinants of psychopathology. In summary, this is a superbly well written, clearly organized, and informative textbook, based on the scientific literature yet unabashedly tied to a diathesis-personality-stress theoretical orientation. In general, this volume presumes some basic knowledge of psychopathology that the intended audience could certainly be expected to possess but that a wider audience would be likely to lack. Overall, it lives up to Zuckerman's stated aim, to provide a thorough compendium of the vast body of relatively recent empirical research on psychopathology within the context of an overarching biosocial theoretical framework. Karen K. Downey, Ph.D. Associate Professor and Clinic Director; Department of Psychology; Eastern Michigan University