Schizophrenia, similarly to other psychotic disorders, has proved to be genetic. Subsequently, if one of the monozygotic twins with identical genotypes develops the disease, another one is at incredibly high risk. Therefore, Carolyn may still be probable to develop schizophrenia, considering that the paranoid type cannot be excluded at any age (Morrison, 2014). However, genetic predisposition is not the only risk factor for psychoses in general and schizophrenia in particular.
There is a range of social factors that may become fatal, most notably, in combination with the other. One of them is possibly social isolation, as most patients used to be somewhat reserved in their childhood and youth (Morrison, 2014). According to Carolyn’s memories, she focused on being no less intelligent and creative than her sister. Presumably, she devoted much time to acquire new knowledge and skills, which presupposes extensive communication. Meanwhile, Pamela, who is said to be intellectual by nature, may have been too self-sufficing to seek social interactions apart from school.
Another possible risk factor for the development of schizophrenia in the future is childhood trauma, for instance, being abused, pressed, or bullied. Even sporadic but severe stress can cause a period of psychosis also in a person with no hardwired disorders (Morrison, 2014). It follows that continuous tension can evoke an onset of schizophrenia in a predisposed individual. Pamela may have suffered from psychological pressure both at school and at home. Her classmates may have bullied her for her academic performance, and her parents may have rested too many hopes on her while she was in fear of disappointing them. Chronic stress, presumably coupled with an isolated lifestyle, could have triggered schizophrenia in Pamela.
References
Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. The Guilford Press.