Precipitating factors

Precipitating factors
n., singular: precipitating factor
[pɹɪˈsɪpɪteɪtɪŋ ˈfæktəz]
Definition: a precipitate (cause) of the onset of a problem, especially unhealthy conditions, symptoms, disease, or disorder

Table of Contents

Precipitating Factor Definition

Precipitating factors are factors that initiate or promote the onset of any illness, disease, accident, or behavioral response. Apart from the precipitating factors, other factors that are considered to have potentially caused the onset of symptoms, disorder, or disease are predisposing factors, perpetuating factors, and protective factors.

4Ps and the Biopsychosocial Formulation

The biopsychosocial model is a strategy that is applied to understand a person’s medical condition. It takes into consideration the various aspects — biological, psychological, and social, thus, the name. George Engel was the person who conceptualized the biopsychosocial model in 1977. (Biopsychosocial Model, 2013)

biopsychosocial model of health diagram — Figure 1: The biopsychosocial model of health. The biological aspect looks into the physiology or pathology of the disease. The psychological aspect looks into the person’s thoughts, emotions, and behaviors. The social aspect looks into socio-economical, environmental, and cultural factors. Image Source: Maria Victoria Gonzaga of Biology Online.

This model is applied to Case Formulation. Together, they are referred to as the Biopsychosocial Formulation. It takes into consideration four factors, so-called the 4Ps:

1. Predisposing factors
2. Precipitating factors
3. Perpetuating factors
4. Protective factors

In psychology and psychiatry, Biopsychosocial Formulation is a way to comprehend the patient, more than for diagnostic purposes. For the intervention and for examining the prognosis of disease, the biopsychosocial model combines different psychological, social, and biological factors, which may further be classified into 4Ps.

Predisposing factors. Factors or areas of susceptibility that promote the risks of the presenting problem are termed as predisposing factors. For example, exposure to alcohol of the fetus in prenatal life and any genetic predisposition of mental illness
Precipitating factors. These are factors, events, or stressors that initiate or promote the onset of any illness, disease, accident, or behavioral response. For example, conflict about relationships, transitions, or identity
Perpetuating factors. These are factors that maintain the disabling symptoms. Any condition or factors, either in the family or community that exaggerate the problem rather than solve it are perpetuating factors. For example, lack of education, occupation, or financial stress
Protective factors. These are factors that take into account the person’s skill, competency, talent, or any supportive element that helps the patient in facing and overcoming the predisposing, precipitating, and perpetuating factors.

3P-disease model by Wright et al — Figure 2: The 3P-Disease Model (frontiers, 2019) Image Credit: Wright et al., 2019.

Precipitating factors, as already defined and described (above), are factors that “precipitate” the problem. It causes or sends the person suddenly into an undesirable state or condition. Biologically, they are factors that trigger the onset of a health problem or a behavioral response.

Precipitating factors are factors that cause or trigger the onset of disease, disorder, illness, accident, or behavioral response. It is one of the 4Ps of the Biopsychosocial Formulation used to understand the health condition of an individual. It helps to understand the origins and causes of symptoms by formulating hypotheses around the 4Ps. Using this formulation, the presence of a disease or disorder could then be explained by looking at the factors: predisposing factors, precipitating factors, perpetuating factors, and protective factors.

Precipitating Factors Example

Aggressive behavior
Insomnia

Aggressive behavior

Le’s take for example a patient showing aggressive behavior. The person would express aggression through:

Verbal aggressive behavior includes swearing, screaming.
Physical aggressive behavior includes kicking, biting, or throwing.
Hostile body language includes angry gestures or dirty looks.

The aggressive behavior could have been triggered by the following precipitating factors:

Fear, anxiety, or nervousness
Unmet emotional (love, recognition) or physical needs (silence, hunger)
Any physical or mental trauma
Pain
Behavior and arrogance of peers and family members
Uncomfortable environment (noise)
Impaired intellectual capability (dementia or any mental illness)
Impaired communication skill
Frustration
Lack of personal power
Lack of self-esteem

Insomnia

The various factors leading to insomnia are summarized in the table below.

Table 1: Predisposing, Precipitating, and Perpetuating Factors of an Insomniac Patient
Predisposing factors	Precipitating events	Perpetuating factors
Factors that promote insomnia	Factors that cause sleep disruption	The cognitive and behavioral factors that cause poor sleep over time
1. Any childhood or interpersonal trauma 2. Any chronic mental health conditions such as anxiety or depression 3. Chronic pain 4. The employment history of work in shifts and disturbed sleep pattern	1. Any accident that causes physical injury 2. Divorce from the spouse 3. Death of a close friend or family member 4. Change in the employment place 5. Loss of job or transition of a new job	1. Watching television before bedtime 2. Long naps during day time 3. Staying in bed for a long period during the day 4. Anxiety about sleep loss

(Source: Martin et al., 2018)

Watch this video for another example of precipitating factors.

Predisposing Factors of Diseases

How is precipitating factor different from a predisposing factor? Genetic predisposition is also known as genetic susceptibility. It is an increased chance of developing a specific disease or condition, which is based on the genetic makeup of the person. Genetic predisposition is the variation in the genetic makeup of the offspring, which is inherited from the parents. The alteration in the genetic makeup will cause the disease development but do not become the cause of disease directly. In the same family, some persons with the variation in genetic predisposition will get the disease while some remain healthy.

On the development of a specific disease, genetic variation either has a small or large effect. The following example explains this:

Mutation (genetic variation) in the BRCA1 or BRCA2 genes can increase the chances of breast cancer and ovarian cancer in the person. Certain mutations in the BARD1 and BRIP1 genes also increase the chances of breast cancer. The contribution of these alterations has a smaller chance of developing cancer.
In persons along with genetic predisposition, certain other factors can be risk factors for disease. They include other modified genetic factors, certain environmental or lifestyle factors. Such disease which is caused by several factors is termed multifactorial. The genetic makeup of the person cannot be modified but changes in the environment or adopting a healthy lifestyle can reduce the chances of having the disease. (Plus, 2021)

Lifestyle habits that apparently cause cancers are alcohol use and a sedentary lifestyle. They can therefore be regarded as precipitating factors that could lead to breast cancer.

Latest Developments

Nowadays the focus of scientists is on doing such research in which they came to know about such genetic changes that although have minimal effect on developing the disease they are common as well as frequent in the overall population.

Although these variations are very minor in developing the disease, alterations in several genes will significantly increase the chances of developing the disease. Small changes in many genes will increase the chances of having certain diseases, such as obesity, cancer, cardiac disease, mental illness, diabetes, etc. Nowadays researchers are trying to find out the approximate chances of having a common or general disease based on the combination of variants in certain genes across the genome. This type of study is known as the Polygenic Risk Score. The results of this study help in making better decisions for health in the future.

Try to answer the quiz below to check what you have learned so far about precipitating factors.

Reference

Biopsychosocial Model. (2013). Physiopedia. https://www.physio-pedia.com/Biopsychosocial_Model
CrisisPrevention.com. (2021). Examples of Precipitating Factors. Retrieved 21 Dec, 2021, from https://www.crisisprevention.com/Blog/Causes-of-Aggressive-Behavior
Martin, J.L, Badr, M.S., Zeineddine, S. (2018). Sleep Disorders in Women Veterans. Sleep Med Clin 13:433.
MedlinePlus.gov. (2021). Genetic predisposition to a disease. Retrieved 20 Dec, 2021, from https://medlineplus.gov/about/using/usingcontent/
PsychBD.com (2021). Biopsychosocial Model and Case Formulation. Retrieved 20 Dec, 2021, from https://www.psychdb.com/teaching/biopsychosocial-case-formulation
Wright, C. D., Tiani, A. G., Billingsley, A. L., Steinman, S. A., Larkin, K. T., & McNeil, D. W. (2019). A Framework for Understanding the Role of Psychological Processes in Disease Development, Maintenance, and Treatment: The 3P-Disease Model. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.02498‌‌