Prevention of Psychological Disorders
Senior 6 · Psychology
Prevention of Psychological Disorders
Lesson 2 of 4
25 min
In the 2018 Rwanda Mental Health Survey, any mental disorder was found in 23.2% of the women interviewed and 16.6% of the men. Among the survivors of the 1994 Genocide against the Tutsi, the figures were 53.3% for women and 48.8% for men. Behind such numbers lie risk factors: experiences and characteristics that make disorders more likely. Prevention depends on knowing them, because you cannot reduce a risk you have not identified. This lesson surveys the risk factors for each main group of disorders from Unit 7, and for the childhood disorders that often come first.
Definition
Transdiagnostic risk factor: one that raises the risk of many different disorders, such as childhood abuse or poverty.
Specific risk factor: one linked mainly to a particular disorder, such as cannabis use for psychosis.
Childhood (neurodevelopmental) disorders: disorders that begin in the developmental period and affect learning, behaviour or social communication, such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, intellectual disability and specific learning disorders. Conduct disorder and separation anxiety disorder also usually begin in childhood.
Heritability: the proportion of the differences between people in a trait or disorder, within a population, that is linked to genetic differences. It is not the chance that a given person inherits a disorder.
Risk factors act at every age (Figure 1), and many are transdiagnostic. Childhood abuse, for example, raises the risk of depression, anxiety, PTSD, substance use, personality disorders and psychosis. That is good news for prevention: protecting children from violence prevents many disorders at once.
Figure 1. Examples of risk factors at each stage of life. Many of them raise the risk of several disorders at once.
| Disorder group | Main risk factors |
|---|---|
| Somatoform (somatic symptom) disorders | Serious illness in childhood or in the family; a family focus on bodily symptoms; childhood abuse; a tendency to notice and worry about bodily sensations; cultures in which distress is expressed through the body; stress |
| Dissociative disorders | Severe, repeated, early trauma, especially by caregivers; high suggestibility and fantasy-proneness; poor sleep (emphasised by the sociocognitive view) |
| Depression | Family history (heritability about 37%); female sex; childhood adversity; stressful life events; having no one to confide in; a negative thinking style; chronic physical illness; poverty; substance use; the period after childbirth |
| Bipolar disorder | Strong genetic influence (heritability roughly 60 to 85%); disrupted sleep and major stress can trigger episodes; some antidepressants taken alone can trigger mania in vulnerable people |
| Schizophrenia | Family history; complications of pregnancy and birth; infection or severe malnutrition during pregnancy (children conceived during the Dutch famine of 1944–45 had about twice the risk: Susser and others, 1996); childhood adversity; growing up in a city; migration and discrimination; frequent, high-potency cannabis use in adolescence |
| Disorder group | Main risk factors |
|---|---|
| Personality disorders | Childhood abuse and neglect; insecure attachment; an "invalidating environment" in which a child's emotions are dismissed or punished, combined with high emotional sensitivity (Marsha Linehan's biosocial theory of borderline personality disorder); moderate genetic influence |
| ADHD and autism | Mostly genetic (heritability of ADHD about 74%: Faraone and Larsson, 2019); preterm birth; exposure to alcohol or tobacco before birth. Vaccines do not cause autism: the 1998 paper that claimed so was retracted in 2010, and a study of 657,461 Danish children found no link (Hviid and others, 2019) |
| Intellectual disability | Genetic conditions; alcohol in pregnancy (fetal alcohol spectrum disorders, which are completely preventable); lack of oxygen at birth; severe malnutrition; iodine deficiency; lead poisoning; brain infections such as meningitis |
| Conduct disorder | Harsh or inconsistent discipline, abuse, little parental supervision, family conflict, deviant peers, school failure, and a fearless, impulsive temperament |
| Psychosexual disorders | Sexual dysfunctions: physical illness (diabetes, heart disease), some medicines, alcohol, anxiety, relationship conflict and past sexual abuse. Paraphilic disorders: causes poorly understood; most people diagnosed are men |
| Psychosocial deviances (substance misuse, gambling, delinquency) | Starting alcohol or drug use early; peers and family members who use; easy availability; low parental monitoring; family conflict; school failure; unemployment; trauma; impulsivity |
Three cautions apply. First, risk factors are probabilities, not destinies: most children who face adversity do not develop a disorder, because of protective factors (Unit 6's "ordinary magic" of resilience). Second, a risk factor is not always a cause: poverty and depression feed each other in both directions. Third, the factors that can be changed (violence, alcohol in pregnancy, bullying, social support) are the ones prevention targets; genes and sex cannot be changed, but they can help identify who needs selective prevention.
Important
Where to get help in Rwanda. If you, or someone you know, is struggling, talk to a trusted adult (a parent, teacher or school counsellor) and visit your local health centre. The Rwanda Biomedical Centre asks people to call its toll-free number 114 with questions about its services or in an emergency. Asking for help is a sign of strength, not weakness.
Warning
"Bad parents cause mental illness" is false. Parenting matters, but most disorders have many causes, including genes and events outside a family's control. Blaming parents, as some psychiatrists once did for schizophrenia and autism, caused great harm and stopped families from seeking help.
Tip
Sort risk factors into Bio, Psycho and Social for every disorder: it guarantees a balanced exam answer. Then add one protective factor and say which risk factors can be changed.
Practice
Sources and credits
Written by Ganzaa: the text, the diagram (Figure 1), the tables and the exercises.
