Alicia Lieberman writes that risk and protective factors are central to understanding developmental influences on psychopathology. Risk factors are variables that increase the likelihood of an adverse outcome, while protective factors mitigate risk and promote successful outcomes. Developmental psychopathology emphasises the importance of understanding the multilevel nature of contexts that contribute toward the development of psychopathology.

A single risk factor can be associated with a variety of outcomes (Multifinality). Child abuse may lead to different kinds of psychopathology in adulthood. Or it may lead to successful adaptation, depending on other variables such as constitutional factors, the presence of protective adults and other positive influences. Different risk factors can lead to the same outcome. Aggressive behaviour in childhood can result from injury to the frontal lobes, harsh parenting, abuse, or the interplay of several different factors such as genetic predisposition and parental rejection. Pregnancy and the perinatal period may be a maturational stage that is receptive to positive influences to re-story a trajectory of healthy development. Risk factors during pregnancy include poverty, community violence, racism, marginalisation and discrimination which raise the risk for psychiatric conditions like anxiety, depression and PTSD. Other risk factors includes a history of psychopathology, substance abuse, past or current trauma exposure like childhood maltreatment, IPV, an unwanted pregnancy and prior pregnancy loss.

Uri Bronfenbrenner argued for an ecological approach that includes the influence of the interpersonal, community, institutions and society on the developing person to predict outcomes. Developmental psychopathology came in response to growing evidence of the biological, social and cultural influences on the individual. Psychopathology emerges from the interaction between risk and protective factors. These influences are probalistic rather than deterministic in prediction of outcomes. Affective bonds between mother and infant is a key aspect of development but it is important to include a broader examination of caregiver influences in understanding individual and group outcomes starting in infancy. While Winnicott said ‘there is no such thing as a baby’ (only a mother-infant dyad) it might also be true to say that there is no such thing as a mother or a father or a family, independent of the context and culture in which they operate.

Parents who were maltreated as children but did not maltreat their own children were more likely to have received emotional support from another non-abusive adult, and/or to have participated in a therapy experience that lasted longer than six months, at some point in their lives. Also, those who broke this cycle were often found to have a supportive mate in adulthood. All of these change-promoting factors involve relationships. Mothers who broke the cycle were found to be able to integrate past abusive experiences into a coherent sense of self. Mother’s who re-enacted their maltreatment on their children have experienced more life stress and were more likely to be anxious, depressed, dependant and immature. These mothers had more dissociative symptoms and often recall their early experiences in a fragmented, idealised or unintegrated way. The ability to integrate early caregiving experiences is linked with positive parenting. Denial or the inability to integrate these experiences is linked with the re-enactment of harsh experiences.