Hacia un modelo Transdiagnóstico integrador de la Psicopatología externalizante [Towards an Integrative Transdiagnostic Model of the Externalizing Psychopathology]
DOI:
https://doi.org/10.5944/ap.17.1.25831Keywords:
Psicopatología, transdiagnóstico, agresión, rumiación, disregulación [Psychopathology, transdiagnostic, aggression, rumination, dysregulation]Agencies:
Universidad de AlmeríaAbstract
Resumen
La investigación de las psicopatologías del espectro externalizante ha tenido avances significativos desde modelos transdiagnósticos integradores. En el presente artículo se presenta un análisis de los avances y las direcciones de integración, haciendo un énfasis particular en las principales variables y modelos teóricos considerados relevantes. En primer lugar, se resalta la importancia de una perspectiva dimensional espectral de los diagnósticos, según sus mecanismos etiológicos y mantenedores comunes, no solamente a nivel sintomático sino procesal. Entre las variables con mayor evidencia se presentan la disregulación emocional y la rumiación ira, ambas asociadas a la aparición y modulación de la respuesta agresiva reactiva y proactiva. Al finalizar, se propone la integración de los aportes derivados de la teoría de la sensibilidad al refuerzo y los sistemas de dominancia conductual, en un modelo transdiagnóstico integrador. Esta propuesta involucra los avances teóricos a nivel motivacional como la inhibición y la activación conductual, cuya capacidad explicativa permite comprender las dificultades relativas a la impulsividad, la psicopatía, y la autorregulación emocional y conductual. Estos avances convergen en el marco de investigación de criterio dominante, un verdadero avance en los estudios de la salud mental actual.
Abstract
Research on externalizing spectrum psychopathologies has had significant advances from integrative transdiagnostic models. This article analyzes the progress and directions of integration, with particular emphasis on the main variables and theoretical models considered relevant. First, the importance of a spectral dimensional perspective of the diagnoses is highlighted based on their common etiological mechanisms and maintainers, not only at the symptomatic level but also at the procedural level. Emotional dysregulation and anger rumination are among the variables with the most evidence, both associated with the appearance and modulation of the reactive and proactive aggressive response. In the end, the integration of the contributions derived from the theory of reinforcement sensitivity, and behavioral dominance systems is proposed in an integrative transdiagnostic model. This proposal involves theoretical advances at the motivational level, such as inhibition and behavioral activation, whose explanatory capacity allows understanding the difficulties related to impulsivity, psychopathy, and emotional and behavioral self-regulation. These advances converge in the dominant criterion research framework, a real breakthrough in current mental health studies.
Downloads
References
Achenbach, T. M. y Edelbrock, C. S. (1983). Manual for the Child Behavior Checklist and Revised Child Profile. University of Vermont Department of Psychiatry.
Aldao, A. (2012). Emotion Regulation Strategies as Transdiagnostic Processes: A Closer Look at the Invariance of their Form and Function. Revista de Psicopatología y Psicología Clínica, 17(3), 261–277. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11843
Aldao, A., Nolen-Hoeksema, S. y Schweizer, S. (2010). Emotion Regulation Strategies across Psychopathology: A Meta-analysis. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
American Psychiatric Association. (2013). Diagnostic and Estatistical Manual of Mental Disorders (4ª ed.) Autor.
Beauchaine, T. P. (2015). Future Directions in Emotion Dysregulation and Youth Psychopathology. Journal of Clinical Child & Adolescent Psychology, 44(5), 875–896. https://doi.org/10.1080/15374416.2015.1038827
Beauchaine, T. P. y Gatzke-Kopp, L. M. (2012). Instantiating the Multiple Levels of Analysis Perspective in a Program of Study on Externalizing Behavior. Development and Psychopathology, 24, 1003–1018. https://doi.org/10.1017/S0954579412000508
Beauchaine, T. P., Klein, D. N., Crowell, S. E., Derbidge, C. y Gatzke-Kopp, L. (2009). Multifinality in the development of personality disorders: A Biology × Sex × Environment Interaction Model of Antisocial and Borderline Traits. Development and Psychopathology, 21, 735–770. https://doi.org/10.1017/S0954579409000418
Belloch, A. (2012). Propuestas para un enfoque transdiagnóstico de los trastornos mentales y del comportamiento: Evidencia, utilidad y limitaciones [Proposals for a Transdiagnostic Perspective of Mental and Behavioural Disorders: Evidence, Usefulness, and Limitations]. Revista de Psicopatología y Psicología Clínica, 17(3), 295–311. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11845
Cole, P. M., Hall, S. E. y Hajal, N. J. (2017). Emotion Dysregulation as a Vulnerability to Psychopathology. En T. P. Beauchaine y S. P. Hinshaw (Eds.), Child and Adolescent Psychopathology (3ª ed., pp. 346–386). Wiley.
Corr P. J. (2008). The Reinforcement Sensitivity Theory of Personality. Cambridge University Press. https://doi.org/10.1017/CBO9780511819384
Crick, N. R. y Dodge, K. A. (1994). A Review and Reformulation of Social Information-Processing Mechanisms in Children's Social Adjustment. Psychological Bulletin, 115(1), 74–101. https://doi.org/10.1037/0033-2909.115.1.74
Denson, T. F. (2012). The multiple systems model of angry rumination. Personality and Social Psychology Review, 17(2), 103–123. https://doi.org/10.1177/1088868312467086
Du Pont, A., Rhee, S. H., Corley, R. P., Hewitt, J. K. y Friedman, N. P. (2017). Rumination and Psychopathology: Are Anger and Depressive Rumination Differentially Associated with Internalizing and Externalizing Psychopathology? Clinical Psychological Science, 6(1), 18–31. https://doi.org/10.1177/2167702617720747
Du Pont, A., Rhee, S. H., Corley, R. P., Hewitt, J. K. y Friedman, N. P. (2019). Rumination and Executive Functions: Understanding Cognitive Vulnerability for Psychopathology. Journal of Affective Disorders, 256, 550–559. https://doi.org/10.1016/j.jad.2019.06.026
Fino, E., Melogno, S., Iliceto, P., D'Aliesio, S., Pinto, M. A., Candilera, G. y Sabatello, U. (2014). Executive Functions, Impulsivity, and Inhibitory Control in Adolescents: A Structural Equation Model. Advances in Cognitive Psychology, 10(2), 32–38. https://doi.org/10.2478/v10053-008-0154-5
Fowles, D. C. (1980), The three Arousal Model: Implications of Gray’s two Factor Learning Theory for Heart Rate, Electrodermal Activity, and Psychopathy. Psychophysiology, 17, 87–104.
Friedman, N. P. y Miyake, A. (2017). Unity and Diversity of Executive Functions: Individual Differences as a Window on Cognitive Structure. Cortex, 86, 186–204 https://doi.org/10.1016/j.cortex.2016.04.023
Garofalo, C. y Wright, A. G. C. (2017). Alcohol Abuse, Personality Disorders, and Aggression: The Quest for a Common Underlying Mechanism. Aggression and Violent Behavior, 34, 1–8. https://doi.org/10.1016/j.avb.2017.03.002
Gray, J. A. (1970). The Psychophysiological Basis of Introversion–Extraversion. Behaviour Research and Therapy, 8(3), 249–266. https://doi.org/10.1016/0005-7967(70)90069-0
Gray, J. A. y McNaughton, N. (2000). The Neuropsychology of Anxiety. Oxford University Press.
Gross, J. J. (2013). Conceptual and Empirical Foundations. En J. J. Gross, (Eds.), Handbook of Emotion Regulation (pp. 13-21). Guilford Press.
Guerra, R. C. y White, B. A. (2017). Psychopathy and Functions of Aggression in Emerging Adulthood: Moderation by Anger Rumination and Gender. Journal of Psychopathology and Behavioral Assessment, 39(1), 35–45. https://doi.org/10.1007/s10862-016-9563-9
Harmon, S. L., Stephens, H. F., Repper, K. K., Driscoll, K. A. y Kistner, J. A. (2017). Children’s Rumination to Sadness and Anger: Implications for the Development of Depression and Aggression. Journal of Clinical Child & Adolescent Psychology, 48(4), 622–632. https://doi.org/10.1080/15374416.2017.1359788
Harvey, A. G., Watkins, E., Mansell, W. y Shafran, R. (2004). Cognitive Behavioural Processes across Psychological Disorders. Oxford University Press.
Hayes, S. C., Strosahl, K. D. y Wilson, K. G. (1999). Acceptance and Commitment Therapy. An Experiential Approach to Behavior Change. Guilford.
Hundt, N. E., Brown, L. H., Kimbrel, N. A., Walsh, M. A., Nelson-Gray, R. y Kwapil, T. R. (2013). Reinforcement Sensitivity Theory Predicts Positive and Negative Affect in Daily Life. Personality and Individual Differences, 54(3), 350–354. https://doi.org/10.1016/j.paid.2012.09.021
Johnson, S. L., Leedom, L. J. y Muhtadie, L. (2012). The Dominance Behavioral System and Psychopathology: Evidence from Self-report, Observational, and Biological Studies. Psychological Bulletin, 138(4), 692–743. https://doi.org/10.1037/a0027503
Johnson, A. K., Sellbom, M. y Phillips, T. R. (2014). Elucidating the Associations between Psychopathy, Gray’s Reinforcement Sensitivity Theory constructs, and Externalizing Behavior. Personality and Individual Differences, 71, 1–8. https://doi.org/10.1016/j.paid.2014.06.026
Jones, J., Penner, F., Schramm, A. T. y Sharp, C. (2019). Experiential Avoidance in Adolescents with Borderline Personality Disorder: Comparison with a non-BPD Psychiatric Group and Healthy Controls. Cognitive Behaviour Therapy, 49(3) 1–13. https://doi.org/10.1080/16506073.2019.1623303
Krueger, R. F., Markon, K. E., Patrick, C. J. y Iacono, W. G. (2005). Externalizing Psychopathology in Adulthood: A Dimensional-Spectrum Conceptualization and its Implications for DSM-V. Journal of Abnormal Psychology, 114(4), 537–550. https://doi.org/10.1037/0021-843X.114.4.537
Lopez, M. F., Compton, W. M., Grant, B. F., & Breiling, J. P. (2007). Dimensional Approaches in Diagnostic Classification: A Critical Appraisal. International Journal of Methods in Psychiatric Research, 16(S1), S6–7. https://doi.org/10.1002/mpr.213
Lykken, D. T. (1995). The Antisocial Personalities. Lawrence Erlbaum Associates.
Mansell, W., Harvey, A., Watkins, E. R. y Shafran, R. (2008). Cognitive Behavioral Processes across Psychological Disorders: A Review of the Utility and Validity of the Transdiagnostic Approach. International Journal of Cognitive Therapy, 1(3), 181–191. https://doi.org/10.1521/ijct.2008.1.3.181
Masi, G., Muratori, P., Manfredi, A., Pisano, S., & Milone, A. (2015). Child Behavior Checklist Emotional Dysregulation Profiles in Youth with Disruptive Behavior Disorders: Clinical Correlates and Treatment Implications. Psychiatry Research, 225, 191–196. https://doi.org/10.1016/j.psychres.2014.11.019
National Institute of Mental Health. (2014). Research Domain Criteria Matrix. http://www.nimh.nih.gov/research-priorities/rdoc/research-domain-criteria-matrix.shtml
Pederson, C. A., Fite, P. J. y Bortolato, M. (2018). The Role of Functions of Aggression in Associations between Behavioral Inhibition and Activation and Mental Health Outcomes. Journal of Aggression, Maltreatment & Trauma, 27(8), 811–830. https://doi.org/10.1080/10926771.2017.1370053
Pickering, A.D. y Gray, J.A. (1999). The Neuroscience of Personality. En L. A. Pervin, L.A. y O. P. John, (Eds.), Handbook of Personality: Theory and Research (2ª ed., pp. 277–299). Guilford Press.
Pickering, A. D. y Smillie, L. D. (2008). The Behavioural Activation System: Challenges and Opportunities. En P. J. Corr (Ed.), The Reinforcement Sensitivity Theory of Personality (pp. 120–154). Cambridge University Press. https://doi.org/10.1017/CBO9780511819384.005
Quan, F., Yang, R., Zhu, W., Wang, Y., Gong, X., Chen, Y., Dong, Y. y Xia, L.-X. (2019). The Relationship between Hostile Attribution Bias and Aggression and the Mediating Effect of Anger Rumination. Personality and Individual Differences, 139, 228–234. https://doi.org/10.1016/j.paid.2018.11.029
Sandín, B., Chorot, P. y Valiente, R. M. (2012). Transdiagnóstico: nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185–203. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11839
Shea, S. E. y Coyne, L. W. (2017). Reliance on Experiential Avoidance in the Context of Relational Aggression: Links to Internalizing and Externalizing Problems and Dysphoric Mood Among Urban, Minority Adolescent Girls. Journal of Contextual Behavioral Science, 6(2), 195–201. https://doi.org/10.1016/j.jcbs.2017.03.001
Shankman, S. A. y Gorka, S. M. (2015). Psychopathology Research in the RDoC era: Unanswered Questions and the Importance of the Psychophysiological unit of Analysis. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 98(2), 330–337. https://doi.org/10.1016/j.ijpsycho.2015.01.001
Schramm, A. T., Venta, A. y Sharp, C. (2013). The Role of Experiential Avoidance in the Association between Borderline Features and Emotion Regulation in Adolescents. Personality Disorders: Theory, Research, and Treatment, 4(2), 138–144. https://doi.org/10.1037/a0031389
Sturman, E. D. (2011). Involuntary Subordination and its Relation to Personality, Mood, and Submissive Behavior. Personality Assessment, 23, 262–276. https://doi.org/10.1037/a0021499
Tang-Smith, E., Johnson, S. L. y Chen, S. (2014). The dominance behavioural system: A multidimensional transdiagnostic approach. Psychology and Psychotherapy: Theory, Research and Practice, 88(4), 394–411. https://doi.org/10.1111/papt.12050
Thompson, R. A. (2019). Emotion Dysregulation: A Theme in Search of Definition. Development and Psychopathology, 31, 805–815. https://doi.org/10.1017/s0954579419000282
van Vugt, M. K. y van der Velde, M. (2018). How does Rumination Impact Cognition? A First Mechanistic Model. Topics in Cognitive Science, 10(1), 175–191. https://doi.org/10.1111/tops.12318
Verona, E. y Bresin, K. (2015). Aggression Proneness: Transdiagnostic Processes Involving Negative valence and cognitive systems. International Journal of Psychophysiology, 98(2), 321–329. https://doi.org/10.1016/j.ijpsycho.2015.03.008
Wallace, J. F. y Newman, J. P. (2008). RST and Psychopathy: Associations between Psychopathy and the Behavioral Activation and Inhibition Systems. En P. Corr (Ed.), The Reinforcement Sensitivity Theory of Personality (pp. 378–414). Cambridge University Press. https://doi.org/10.1017/CBO9780511819384.014
Wang, X., Yang, L., Yang, J., Gao, L., Zhao, F., Xie, X. y Lei, L. (2018). Trait Anger and Aggression: A Moderated Mediation Model of Anger Rumination and Moral Disengagement. Personality and Individual Differences, 125, 44–49. https://doi.org/10.1016/j.paid.2017.12.029
White, B. A. y Turner, K. A. (2014). Anger Rumination and Effortful Control: Mediation Effects on Reactive but not Proactive Aggression. Personality and Individual Differences, 56, 186–189. https://doi.org/10.1016/j.paid.2013.08.012
Wills, T. A., Simons, J. S., Sussman, S. y Knight, R. (2016). Emotional Self-control and Dysregulation: A Dual-Process Analysis of Pathways to Externalizing/Internalizing Symptomatology and Positive Well-Being in Younger Adolescents. Drug and Alcohol Dependence, 163(Suppl 1), S37–S45. https://doi.org/10.1016/j.drugalcdep.2015.08.039
Wolgast, M., Lundh, L. y Viborg, G. (2013). Experiential Avoidance as an Emotion Regulatory Function: An Empirical Analysis of Experiential Avoidance in Relation to Behavioral Avoidance, Cognitive Reappraisal, and Response Suppression. Cognitive Behaviour Therapy, 42(3), 224–232. https://doi.org/10.1080/16506073.2013.773059
