Stress Response in Individuals and Families Predicts Psychosis


Researchers from King’s College, London, reviewed all studies examining psychological and biological markers of the stress response in both individuals at high risk of psychosis and in the relatives of patients diagnosed with psychosis.  They found increased sensitivity to stress in relatives as well as people who experienced attenuated psychotic symptoms. Moreover, they say, these markers are even greater among those who go on to develop “frank psychosis,” suggesting “the presence of an additive factor, possibly environmental,” during the transition to first-episode psychosis. Results appeared online June 2 in Psychoneuroendocrinology.

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Aiello, G. Horowitz, M, et. al; “Stress abnormalities in individuals at risk for psychosis: A review of studies in subjects with familial risk or with “at risk” mental statePsychoneuroendocrinology, online June 2, 2012


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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. Are we getting closer to uncovering the hidden biology of 1950’s concepts of a “generational” transmission of emotionality, for the “identified patient,” in the genesis of affective disorders?

    “Family projection process:

    Descriptively the family projection process is a triangular emotional process through which two powerful people in the triangle reduce their own anxiety and insecurity by picking a defect in the third person, diagnosing and confirming the defect as pitiful and in need of benevolent attention, and then ministering to the pitiful helpless one, which results in the weak becoming weaker and the strong becoming stronger.

    It is present in all people to some degree, and by over compassion in poorly integrated, over emotional people, powered by benevolent over helpfulness that benefit’s the stronger one more than the recipient, and is justified in the name of goodness and self sacrificing righteousness.

    The prevalence of the process in society would suggest that more hurtfulness to others is done in the service of pious helpfulness than in the name of malevolent intent.” _Murray Bowen.

    “PTSD models are shifting from the later developing hippocampus to the early developing amygdala, from “cool” to “hot” memory systems, from the explicit memory of places to the implicit memory faces. Research demonstrates that chronic stress induces contrasting patterns of dendritic remodeling in hippocampus and amygdaloidal neurons, leading to a loss of hippocampus inhibitory control as well as a gain of excitatory control by the amygdala, and thereby an imbalance in HPA axis function. (p, 258)

    Cumulative relational instead of “single-hit” trauma emphasizes that the traumatic event of the PTSD patient originated as a personal and social process, thereby suggesting that the “affectively charged traumatic memory” is not of a specific overwhelming experience with the physical environment as much as a re-evocation of a prototypical disorganized attachment transaction with the mis-attuning social environment that triggers an intense arousal dysregulation. The right brain, at non-conscious levels, both appraises trauma-related conditioned social stimuli and re-organizes the traumatic “conditioned emotional response.” (p, 259)

    The stress responses exhibited by infants are the product of an immature brain processing threat stimuli and producing appropriate responses, while the adult who exhibits infantile responses has a mature brain that barring stress-related abnormalities in brain development, is capable of exhibiting adult response patterns. However, there is evidence that the adult brain may regress to an infantile state when it is confronted with severe stress. This “infantile state“ is a disorganized-disoriented state of insecure attachment. As in infancy, children, adolescents, and adults with post traumativ stress disorders can not generate an active coherent behavioral coping strategy to confront subjectively perceived overwhelming, deregulating events, and thus they quickly access the passive survival strategy of disengagement and dissociation. (p, 259)

    The concept of “decompensation” describes a condition in which a system is rapidly disorganizing over a period of time. This construct derives from Jackson’s classic principle that pathology involves a “dissolution,” a loss of inhibitory capacities of the most recently evolved layers of the nervous system that support higher functions (negative symptoms), as well as the release of lower, more automatic functions (positive symptoms). This principle applies to the dissolution or disorganization of the brain’s complex circuit of emotion regulation of orbito-frontal cortex, anterior cingulated, and amygdala. _Allan N Schore, “Affect Dysregulation & Disorders of the Self.”

    Ultimately “stress” is about how we cope with the emotional anxiety of the lived moment. Unconscious coping styles are generationally transmitted within the nuclear family, as learned behavioral responses?

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