5 questions with a child and adolescent psychiatrist about the factors that contribute to mental health conditions
It’s common to wonder how your child’s personality, behaviors and, sometimes, mental health challenges came to be. Are they genetic, or the result of factors in their environment? The answer could be either, or both! Dr. Kathryn Jones, child and adolescent psychiatrist at our Virginia Treatment Center for Children, offers some insight into the age-old question of nature versus nurture when it comes to mental health.
Are mental health conditions inherited from our parents?
Mental health disorders often run in families, which is why psychiatrists or therapists will ask about family history of these diagnoses during initial evaluations. Much like your child's height, eye color and whether their hair is curly or straight, development of a mental health diagnosis may be due to DNA they inherited from their parents. Mental health diagnoses are often more complicated than the genetics that underlie eye color and typically involve multiple genes (parts of DNA with a specific, distinct role). Many psychiatric disorders involve large networks of genes and sometimes the same genes are involved in different mental health disorders.
Another concept to consider is that, although we all have the same basic genetic code and are working with the same cellular elements, our genes may come in different “flavors.” These slightly, or sometimes highly, different ingredients make it more or less likely for us to develop a mental health disorder and impact how severe it may be. Different flavors of the same gene are called alleles. We get one allele from each of our biological parents. For some mental health diagnoses, you need the same flavor from both parents and for others, you just need that flavor from one parent.
Still another way genes can be involved in different disorders is through a process called epigenetics. This is where parts of genes are turned off or on, or are hidden or opened up by different elements inside your cells. These elements can be inherited, but can also occur in response to external events like physical illness, emotional stress and trauma.
Are there certain mental health conditions that tend to be genetic?
Neurodevelopmental disorders are strongly linked to genetic causes, but not exclusively. These are disorders that start prior to birth, are apparent in early childhood (sometimes in infancy) and last for the entire life, such as autism spectrum disorders, intellectual disability and tic disorders.
It's important to recognize that genes and DNA are not destiny; instead, it can be more helpful to think about it in terms of risk. If your child has alleles or flavors of a gene that will increase their risk of developing a particular mental health disorder, it doesn’t mean they will definitely have that disorder, but other factors outside genetics may be needed for the disorder to occur.
Psychotic disorders such as schizophrenia and compulsive disorders such as obsessive-compulsive disorder also often have genetic links.
Now that we’ve talked about ‘nature,’ are there also ‘nurture’ factors that contribute to mental health disorders?
Research done with children raised in Romanian orphanages and repeated in other countries' institutional settings – along with historical observations of children removed from their homes and primary caregivers and children growing up in other physically and emotionally neglectful settings – have indicated that there is a nurture component in the development of mental health disorders.
We know that having a secure primary caregiver between birth and age 2 is essential for a child to develop a healthy sense of self and learn how to build healthy relationships with other people. That caregiver must be:
- Attuned to the child (meet the physical and emotional needs of that specific child)
- Able to help the child be emotionally regulated (respond to distress/crying in a loving way without becoming overwhelmed with anxiety or anger)
- Consistent (behave towards the child in a predictable manner)
When these features are absent from the caregiver-child relationship, a child still has to get their physical and emotional needs met in some fashion. Kids who have to figure out how the world works on their own, and who haven’t seen healthy patterns of behavior from the people who are supposed to take care of them, may come up with ways of thinking about themselves and how people treat each other that are effective but not always safe or healthy.
A large study of adults showed that those who had what we call adverse childhood experiences, or ACES, were more likely to have mental and physical health disorders in adulthood than those who did not have ACES. The risk of illness increased with the number of ACES.
Does where a child lives impact mental health?
Where your child lives affects their access to healthy food, green spaces, safe spaces to play, good education and affordable, high quality health care. Without some or all of these social determinants of health, children are more likely to have adverse life experiences, putting them at greater risk of developing physical and mental health disorders.
Obesity is an example of a physical health diagnosis that is highly associated with social determinants of health, and with development of mental health disorders. If your child is at high genetic risk of developing obesity based on family history, if they live in a food desert and rarely are able to get fresh fruits and vegetables, if they live in an area prone to community violence where they have been victims or witnessed others who were victimized and if they’re bullied because of weight, they’re at high risk of also developing a mental health disorder.
Are there certain mental health conditions that tend to be linked to ‘nurture’ and environment?
Internalizing and externalizing disorders are often linked to nurture and environment, albeit often with some underlying genetic risk as well. These include mood/depressive disorders, anxiety and disruptive behavior disorders (conduct disorder, oppositional defiant disorder).
These conditions may not always be apparent. Think of a volcano. A child or teen (or adult) who tends to internalize their intense and overwhelming feelings is like a dormant volcano. There’s a lot of heat but the lava stays trapped, cools and, under pressure, compresses down into coal and then hardens like a diamond. These children may tend to fly under the radar and quietly suffer with depression and/or anxious distress. They may also keep thoughts about suicide to themselves.
If they tend to externalize their feelings, it's like an active volcano. In this case, the heat and pressure cause it to erupt and spew lava for miles around. These kids may have trouble controlling their tempers, act out towards others and even towards themselves (self-harm) and inanimate objects (destruction of property). In their teens and early adulthood, some will present with personality disorders like borderline personality disorder, narcissistic personality disorder, avoidant personality disorder (with social anxiety) or even antisocial personality disorder (evolves from conduct disorder once a person is over 18).
Whatever your child may be experiencing, they aren’t alone. One in five people will experience a mental illness. Care from a knowledgeable, compassionate team can help.