A cognitive vulnerability–stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context LAUREN B. ALLOY, a LYN Y. ABRAMSON, b PATRICIA D. WALSHAW, a JESSICA KEYSER, a and RACHEL K. GERSTEIN a a Temple University; and b University of Wisconsin–Madison Abstract 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. Bipolar disorder is often a severe, recurrent or unremitting disorder with significant impair- ment such as erratic work history, divorce, suicide, and substance abuse ~Angst, Stassen, Clayton, & Angst, 2002; Goodwin & Jamison, 1990; Strakowski, DelBello, Fleck, & Arndt, 2000!. Indeed, bipolar disorder was ranked as the sixth leading cause of disability among both physical and psychiatric disorders world- wide ~ Murray & Lopez, 1996!. Bipolar disor- der affects about 1.5% of the US population ~ Hyman, 2000! and between 0.5 and 3.5% of the world population ~ Kleinman et al., 2003!. Within the bipolar category, a group of disor- ders appears to form a spectrum of severity from the milder subsyndromal cyclothymia, to bipolar II disorder, to full-blown bipolar I disorder ~Akiskal, Djenderedjian, Rosenthal, & Khani, 1977; Akiskal, Khani, & Scott- Strauss, 1979; Cassano et al., 1999; Depue et al., 1981; Goodwin & Jamison, 1990; Klein, Depue, & Slater, 1985; Waters, 1979!. Thus, we consider the full range of bipolar spectrum disorders in this article. Preparation of this article was supported by National In- stitute of Mental Health Grants MH 52617 ~to L.B.A.! and 52662 ~to L.Y.A.!. Address correspondence and reprint requests to: Lau- ren B. Alloy, Department of Psychology, Temple Univer- sity, 1701 N. 13th St., Philadelphia, PA 19122; E-mail: lalloy@temple.edu. Development and Psychopathology 18 ~2006!, 1055–1103 Copyright © 2006 Cambridge University Press Printed in the United States of America DOI: 10.10170S0954579406060524 1055