Why is adolescence an “age of risk” for onset of bipolar
spectrum disorders? We discuss three clinical phenomena of bipolar
disorder associated with adolescence (adolescent age of onset, gender
differences, and specific symptom presentation) that provide the point of
departure for this article. We present the cognitive
vulnerability–transactional stress model of unipolar depression,
evidence for this model, and its extension to bipolar spectrum disorders.
Next, we review evidence that life events, cognitive vulnerability, the
cognitive vulnerability–stress combination, and certain
developmental experiences (poor parenting and maltreatment) featured in
the cognitive vulnerability–stress model play a role in the onset
and course of bipolar disorders. We then discuss how an application of the
cognitive vulnerability–stress model can explain the adolescent age
of onset, gender differences, and adolescent phenomenology of bipolar
disorder. Finally, we further elaborate the cognitive
vulnerability–stress model by embedding it in the contexts of
normative adolescent cognitive (executive functioning) and brain
development, normative adolescent development of the stress–emotion
system, and genetic vulnerability. We suggest that increased brain
maturation and accompanying increases in executive functioning along with
augmented neural and behavioral stress–sensitivity during
adolescence combine with the cognitive vulnerability–stress model to
explain the high-risk period for onset of bipolar disorder, gender
differences, and unique features of symptom presentation during
adolescence.Preparation of this article was
supported by National Institute of Mental Health Grants MH 52617 (to
L.B.A.) and 52662 (to L.Y.A.).