The theoretical relationship between stress and negative symptoms in first-onset psychosis
Type of content
First-onset psychosis offers a unique window in which to observe the longitudinal interaction of the many semi-independent factors associated with the evolution of severe psychopathology. Research into these factors has been stimulated by the emergence of several vulnerability-stress models of psychosis. These models highlight interactions between biological and psychosocial precipitants, acute illness, and long-term outcome, and suggests that even if a biological vulnerability is present, this may not inevitably result in a functional 'disease'. It also has the potential to account for the significant heterogeneity and non specificity of symptomology in severe mental disorder. However, a comprehensive theory of the many co-occurring and multiplicative factors that mediate dysfunction has so far eluded the literature, with segregated theories that lacking in detailed observable and subjective factors typically being presented. In this study, an integrative approach is taken to research associated to stress and psychosis, and it is argued that models of trauma and posttraumatic stress disorder may provide a valuable framework for explaining a range of psychotic phenomena. Specifically, the theoretical overlap between the phenomenology of stress and the negative symptoms of psychosis is developed as a contribution to better understanding deficit psychopathologies. Case studies from clients in a first-onset psychosis intervention programme will be presented to illustrate a number of associations between adverse life events and negative symptoms. Implications are discussed for integrating multiple factors related to mental illness, the subjective experience, and the socio-cultural context, into theories of psychosis. The clinical implications of regarding components of negative symptomology as potentially modifiable are also discussed.