The p Factor
An under-studied hypothesis about mental disorders
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In 2014, Avshalom Caspi and others published a paper arguing that the correlations among psychological disorders suggest the existence of a common factor. They proposed calling this the p factor. It is analogous to the g factor, known as general intelligence, popularly known as IQ.
I am surprised to find very little in the way of follow-up literature. When a striking and controversial theory appears in economics (take the Efficient Market Hypothesis, for example), the follow-on literature, pro and con, is voluminous.
I have not taken so much as one course in personality psychology. But the p-factor theory strikes me as interesting, in the same way that the EMH is interesting.
For one thing, the p-factor theory puts a focus on innate factors in determining mental health. But it suggests that parents with one disorder might have children with very different disorders.
Someone with a high p factor is likely to have parents with high p factors and/or experienced brain development that resulted in a high p factor. See Kevin Mitchell’s Innate.
For example, when I see an essay that refers to an old paper on mothers of boys with gender identity disorder showing that the mothers have dramatically higher incidence of borderline personality, I do not presume that the mothers’ behavior toward their sons caused their sexual identity issues. Instead, I think of the mothers as having a high p factor, which they pass along to their sons, and this happens to manifest itself in such issues.
When Jonathan Haidt wants to blame an increase in teen depression on an environmental factor (smart phones and social media), how does this relate to the p factor? One possibility is that the p factor predicts a propensity for mental disorders, but the environment heavily influences which mental disorders become manifest. Smart phones and social media do not affect the p factor, but they trigger an epidemic of teen depression, because that is how a high p factor manifests itself in the current environment. Before smart phones, the same people would have been susceptible to mental illness, but it might have manifested differently or not at all.
On a somewhat related note, Scott Alexander wrote,
Watters suggests, there probably is some base-level objectively-real mental illness. If you have to think of it as something, you can think of it as formless extreme stress, looking for an outlet. But the particular way the stress finds an outlet is based on the patient's cultural preconceptions.
He refers to Ethan Watters’ Crazy Like Us,
The p-factor theory can account for what I see as the difficulty in distinguishing among mental disorders. I have heard of the same child being diagnosed by one psychiatrist as autistic, by another as having defiance disorder, by another as having anxiety, and by another as having ADHD. This seems to me consistent with the idea that there is a general propensity for mental disorders that is manifested in different ways under different circumstances.
I should note that all of this is complicated by the fact that the term “disorder” is loaded. It has a connotation that there is something is wrong with the person. Making that judgment often feels uncomfortable. But I don’t think that we should completely avoid making such judgments.
Another possibility that occurs to me is that instead of (or in addition to) thinking in terms of a p factor that causes mental illness we might think of a factor that protects against mental illness making someone dysfunctional. This might be termed a “coping factor,” which we could call c. That is, if you have two people with a propensity for a given disorder, the one with higher c will be able to overcome the disorder, and the one with lower c will be unable to do so. So we have the high-functioning autistic compared to the low-functioning autistic. We have the creative and original thinker compared to the schizophrenic.
I wonder if some drugs that tend to work on mental disorders do so by raising c in some people. Note that the mechanisms by which anti-depression medications work have recently been called into question. The role of serotonin, in particular, has been cast into doubt. I wonder if perhaps the medications do not fight depression per se, but they give some people a higher level of c, which changes the way that people experience depressive episodes.
The p factor theory says that a single patient might well be subject to a variety of disorders. The c factor theory speaks to the mildness or severity of the disorder that will be manifest in the patient.
These sorts of speculation on my part are not well grounded. But if I were a student in the psych field, I would expect to find considerable research into the p factor theory (or even the c factor theory). Relative to what I would expect to find, the literature seems quite sparse.
This essay is part of a series on human interdependence.
I think you are onto something. With respect to the c factor, I have met and know a number of people with their inner demons, yet they are aware of these and cope. Often these folks experienced quite wild times in their younger years, but evolved. My own airchair opinion (I am not any sort of mental health professional) is that our "consciousness," our "self" is not a single essense, but it is as though we are several people in one (e.g. watch the Disney animated movie "Inside Out"). For some people, the various selves are more capable of coordinating and integrating their parts into a functioning whole (i.e., your "c"). Some other souls struggle with this, for whatever reason(s)
Re: "Comorbidity rates are very high in psychiatry and conform roughly to the rule of 50%: Half of individuals who meet diagnostic criteria for one disorder meet diagnostic criteria for a second disorder at the same time, half of individuals with two disorders meet criteria for a third disorder, and so forth [... .] [...] retrospective and prospective-longitudinal research has shown that comorbidity is also sequential. For example, longitudinal research has shown that GAD [generalized anxiety disorder] and MDE [major depression] are linked to each other sequentially such that each disorder increases the likelihood of developing the other disorder in the future among individuals who presented with only one condition at one point in time. These results underscore the need to take into account both concurrent and sequential comorbidity when evaluating the structure of psychopathology." -- Caspi & others, "The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders?" (embedded link in Arnold's essay)
Might social mechanisms explain part of these concurrent and sequential 'comorbidities'?
For example, if a person is anxious, she might avoid social interaction, including opportunities for personal and educational growth (say, participation in a debate team at school). Anxious avoidance of opportunities for personal growth might diminish her performance in school. Low performance might diminish her self-esteem -- further lowering her academic performance. Household tensions might increase at home because school is the only gateway to adulthood. Depression might follow. Perhaps this youth would flourish if the initial social problem (anxiety about interaction) were addressed in a timely, constructive manner -- or if there were various sound pathways to adulthood, other than school-as-we-know-it.
Similarly, consider a boy who, by personality, lacks Arnold's capacity to daydream when bored. The boy might have a strong desire to be outside playing, feel trapped during class in school, and act out. A diagnosis of ADHD follows. Instead of addressing the mismatch of child and institution (education) in a timely, constructive way, clinicians administer pharmacological 'treatment'. Unintended psychological side-effects ('comorbidites') might then occur.
Humans evolved as hunters-gathers in small bands. The pace, scope, and depth of institutional and cultural change in human history are mind-boggling. Is it any wonder that many youths struggle to find their sea legs, and lose their way?