Evaluation of the unique and specific contributions of dimensions of the triple vulnerability model to the prediction of DSM-IV anxiety and mood disorder constructs

The triple vulnerability model (Barlow, 2000, 2002) posits that three vulnerabilities contribute to the etiology of emotional disorders: (1) general biological vulnerability (i.e., dimensions of temperament such as neuroticism and extraversion); (2) general psychological vulnerability (i.e., perceived control over life stress and emotional states); (3) disorder-specific psychological vulnerability (e.g., thought-action fusion for OCD). Despite the prominence of this model, a comprehensive empirical evaluation has not yet been undertaken. The current study used structural equation modeling to test the triple vulnerability model in a large clinical sample (N=700), focusing on vulnerabilities for depression, social phobia, generalized anxiety disorder (GAD), and OCD. Specifically, we examined the incremental prediction of each level of the triple vulnerability model for each disorder, with the following putative disorder-specific psychological vulnerabilities: thought-action fusion (TAF) for OCD, the dysfunctional attitudes (DAS) for depression, and intolerance of uncertainty (IoU) for GAD. In the final model that included all three levels of vulnerabilities, neuroticism had significant direct effects on all four disorder constructs, and extraversion was inversely associated with depression and social phobia. However, perceived control was significantly associated with GAD and OCD only. Of the disorder-specific psychological vulnerabilities, TAF was significantly and specifically related to OCD. In contrast, DAS and IoU were not significant predictors of depression and GAD respectively, instead contributing to other disorders. The results are discussed in regard to structural models of the emotional disorders and the various roles of general and specific vulnerability dimensions in the onset, severity, and temporal course of psychopathology.