W4L2 Comorbidity, Equifinality, and Multifinality PDF

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Co-Morbidity, Multifinality, and Equifinality Co-morbidity -

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Co-morbidity refers to the co-occurrence of two separate conditions in the same individual (Rutter, 1997). If we have high levels of co-morbidity in psychiatry, this may be problematic. As, according to some arguments, these separable conditions shouldn’t co-occur all that often Caspi et al. (2014): the rule of halves. 50% of patients (i.e., people who meet criteria for one disorder) meet criteria for a second disorder. 50% of patients who meet criteria for two disorders meet the criteria for a third disorder. 50% of patients who meet criteria for three disorders meet the criteria for a fourth disorder. And so on Something like 1% of people meet criteria for psychosis. o So, if mental health problems are separate diseases, about 1% of people with a particular mental health problem should also have schizophrenia. o Slotema et al. (2018): 38% of people with borderline PD patients meet criteria for a psychotic disorder o Level of co-morbidity is very elevated to what we should expect Rutter (1997): multiple reasons why there may be co-morbidity. o Is it because of diagnostic overlap? o That is, the presence of hallucinations are part of the criteria for BPD and for psychotic disorders. o This increases the likelihood that there will be co-morbidity between BPD and psychotic disorders Rutter (1997): multiple reasons why there may be co-morbidity. o Is it because of diagnostic overlap? o One problem causes the other? o Shared risk factors?  Low self-esteem is associated with Depression (Sowislo & Orth, 2013). Anxiety (Sowislo & Orth, 2013). Psychosis (Kesting & Lincoln, 2013). Borderline PD (Rusch et al., 2007)  Cutajar et al. (2010): childhood sexual abuse is associated with psychotic disorders, anxiety disorders, substance abuse…  Selzam et al. (2018) showed that their genetic data indicated the presence of a set of genes that predisposed a person to risk for any mental health problem.  Not ‘genes for psychosis’ or ‘genes for depression’ or ‘genes for borderline PD’.  Genes for ‘risk of psychopathology’

Pa invol NMDA Enc

Equifinality -

We end up at the same problem from multiple different pathways Pathway involving Childhood Sexual Abuse

Multifinality

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From the same starting point, we end up at different mental health problems It’s that (with very few exceptions) there is multi-factorial causation. o Rutter (2007, p. 378): “When considering either psychopathology or psychological traits… multifactorial causation is the rule.” o There are always multiple factors acting together to cause a mental health problem. These ideas should make us think differently about causes. Think of things we normally think of as causes (e.g., CSA, cannabis use, genetic factors) aren’t causes. They are components of causes...