The diathesis-stress model, or the vulnerability–stress model, is a psychological theory suggesting that mental disorders result from a combination of genetic risk factors interacting with environmental factors. This model explains that individuals with a genetic or biological predisposition for a certain disorder are more likely to develop it if significant life stressors are also present.1
What Is the Diathesis-Stress Model?
Paul Meehl, Manfred Bleuler, and David Rosenthal developed the diathesis-stress model in the late 1960s to understand risk factors for schizophrenia. They were the first to bring together the concept of diathesis, which refers to genetic and biological predisposition in combination with environmental stressors for determining risk for certain conditions.2
What Is Diathesis?
Diathesis refers to the genetic, historical, or biological vulnerabilities that can predispose an individual to certain mental health conditions when environmental stressors are also present. Diathesis can be understood as a vulnerability. It is not inevitable that the disorder will develop, but it puts a person at higher risk. The diathesis puts a person at risk, but environmental stressors precipitate the disorder.3
Diathesis includes any predisposing factors that make a person more vulnerable to developing a mental or physical condition should environmental stressors arise. These factors include genetics, traumatic experiences, cognitive or biological factors, and temperament. According to the diathesis-stress model, these factors make someone vulnerable to certain conditions, which are then triggered by environmental stressors.
Causes of diathesis include:
- Genetics: Genetic or hereditary factors can contribute to susceptibility to stress-related conditions. These factors are passed down through generations and are often not identified ahead of time.
- Childhood trauma: Childhood trauma has been shown to make individuals more vulnerable to developing mental health disorders, psychosis in particular.4
- Cognitive factors: Cognitive and neurological factors in the brain can make a person susceptible to developing post-traumatic stress disorder (PTSD) and other disorders.
- Situational factors: Stressful life events have been shown to increase the risk of developing major depressive disorder, especially when those situations created a feeling of loss of control.5
- Social predisposition: Certain social dispositions, including an avoidant attachment style and chronic loneliness, were shown to increase the risk of suicidal ideation during the Covid 19 pandemic.6
- Temperament: Differences in temperament that result in difficulty dealing with negative emotions can create a predisposition for developing anxiety or depression. In particular, this type of temperament combined with family history, stress, and experience of parenting can increase risk.7
What Is Stress?
Stress refers to adverse events, environmental factors, life changes, or difficulties that can impact a person’s well-being. Stressors can be negative or positive events. For instance, getting married is stressful, as is getting a promotion, buying a new house, or welcoming a new family member. Stressors activate the sympathetic nervous system and trigger the release of stress hormones like cortisol and adrenaline.
According to the diathesis-stress model, disorders develop when a person with a predisposition or vulnerability is exposed to stress. Not everyone who goes through a stressful situation will develop a disorder, of course. According to this model, however, people with those predisposing factors are at much greater risk when stressors arise.
Examples of stress include:
- Death of a loved one
- A breakup or divorce
- Diagnosis of chronic illness
- Moving to a new residence
- Getting married
- Getting divorced
- Adding new members to a family through birth or adoption
- Change to relationship status
- Problems at work or school
History of Diathesis-Stress Model
Between 1800 and 1910, the predisposition-excitation framework (PEF) explained differences in how people react to stress. Predisposing factors included hereditary and constitutional factors as well as education, occupation, sex, and marital status. The stressors believed to create the onset of mental illness included physical illness, pregnancy, and substance abuse.
The diathesis-stress model was applied to mental disorders in the late 1960s when Meehl, Bleuler, and Rosenthal utilized it to describe the risk factors for schizophrenia. Since then, the model has evolved to explain the onset of many disorders, including depression, PTSD, and suicidality. Over time, researchers have come to understand the relationship between diathesis and stress as fluid and ever-changing, not static as previously believed.10
How Diathesis & Stress Interact
The diathesis-stress model explains that a predisposition or diathesis for a certain condition is present due to hereditary, biological, temperamental, or other pre-existing factors. This creates a vulnerability for the condition, but it may never develop unless a significant stressor arises to trigger the disorder. The theory has become more flexible over time and has been linked to many different vulnerabilities and disorders.
The modern model allows for a more fluid understanding of the interaction between diathesis and stress. A person’s predisposition may change over time, and someone who may have been vulnerable to developing a condition previously may no longer be at risk. The model continues to be applied to different disorders, and there are also many changing factors, such as how severe the stressor needs to be to cause the disorder to develop.
Types of Conditions Linked to the Diathesis-Stress Model
The diathesis-stress model links mental health conditions with stress by explaining that specific predisposing factors combined with a stressful event can lead to different mental disorders. For instance, the factors that increase the risk of anxiety may be different from the factors that increase the risk of depression. The diathesis-stress model seeks to identify and understand these correlations.
Conditions linked to the diathesis-stress model include:
- Anxiety Disorders: Women with certain traits, including sensitivity to anxious feelings, low assertiveness, and high neuroticism, have been found to be more likely to develop anxiety and panic disorders when faced with workplace stress.
- Depression: Depression has been found to be more likely among people with specific genetic factors combined with later stressful events. Research shows that this effect is even more pronounced among women.
- Schizophrenia: Schizophrenia was the first disorder to be studied using this model. More recent studies show that this link may be due to infection affecting the nervous system earlier in life, which later triggers inflammation following a stressful event.11
- Eating Disorders: Eating disorders have been shown to be linked with female hormones during adolescence. This hormonal predisposition, combined with social and emotional factors, can increase the risk of developing an eating disorder.12
- Substance Dependence: Addiction and alcoholism have been found to have a genetic component, but not everyone with that genetic predisposition will become dependent. There are other factors linked to substance dependence as well, such as neurodivergence and trauma. When these factors are present, a precipitating stressor can lead to increased substance use, paving the way for dependence.
Protective Factors & the Diathesis-Stress Model
Just as there are factors that put someone at increased risk of developing a mental disorder, there are also protective factors that can decrease that risk. These factors increase resilience and mitigate against vulnerability. These are also factors that decrease the negative and toxic effects of chronic stress.
Examples of protective factors include:
- A positive relationship with a caregiver, such as a parent or teacher
- Social support
- Positive coping skills
- Access to healthcare
- Self-esteem
- A stable and nurturing environment
How Is the Diathesis-Stress Model Used?
The diathesis-stress model can be used to identify individuals at higher risk to provide them with early intervention. It can be helpful for professionals to take a thorough history and identify all potential risk factors when making a diagnosis. It also helps researchers further understand the complicated interplay between nature and nurture that puts a person at risk.
Some uses for the diathesis-stress model include:
- Assessing risk: Understanding all potential risk factors is helpful when assessing and diagnosing mental conditions. This gives professionals an opportunity to address risk factors with early intervention and provide customized care.
- Diagnosis: To make an accurate diagnosis, which informs treatment, it is important to take a thorough history of all potential risk factors as well as significant stressful events.
- Research: This model gives researchers a basis for further study when seeking to understand the causes of mental disorders.
- Studying Resilience: This model provides insight into the protective factors that decrease the risk of developing a disorder even when other factors are the same. This can provide researchers and professionals with helpful information for future risk reduction interventions and planning.
8 Tips for How to Reduce Stress
Knowing what the diathesis-stress model teaches us about the role of stress in developing mental conditions, stress management becomes even more important. While stress can be useful in the short term for finishing an important deadline or outrunning a predator, it is not meant to be sustained. Practicing stress management tools can lower the risk of serious stress-related problems.
Here are eight tips on how to reduce stress:
- Improve sleep hygiene: Good sleep is critical for stress reduction. Some tips to improve sleep hygiene include setting a good nighttime routine, sleeping in a dark room, and avoiding screens 1 hour before bed.
- Practice mindfulness: Mindfulness is a wonderful tool for stress reduction. There are many great apps with guided meditations to help you get started. Even just 2 minutes a day can make a big difference, and you can build from there.
- Breathe: Breath practice can help slow your heart rate, lower your blood pressure, and reduce the effects of stress. Try taking three deep breaths with a nice long exhale.
- Get some movement: Getting up and moving your body is one of the best-known ways to mitigate the effects of stress. it doesn’t have to be a major workout. A walk around the block is a great start.
- Spend time with supportive friends: Spending time with people who really understand you and who you feel comfortable with can help you talk through your feelings and reduce your stress.
- Watch or listen to something funny: The saying “laughter is the best medicine” exists for a reason! Having a great laugh gives you endorphins, reducing the toxic effects of stress.
- Listen to music: Many people find music to be a great stress reducer! Whether you like listening to calm, upbeat or hard music, give it a try!
- Make systemic changes: Sometimes, internal self-care tools like these are not enough. If you are in an unhealthy or unsustainable environment, a bigger change may be necessary to reduce your stress level.
When to Seek Professional Support
Anytime sleep, appetite, or the ability to function at work or school are impacted, those are signs that it may be time to seek out help. Most types of therapy are helpful for stress reduction, including ART, EMDR, or CBT. An online therapist directory or online therapy platform can be a good choice for finding a therapist who specializes in stress.
In My Experience
In my experience as a clinical social worker and therapist, I find this theory to hold true. I specialize in trauma, and most of the clients I serve who experience symptoms of PTSD after a dramatic event also have a history of childhood trauma or mistreatment. The idea behind EMDR is that the things that happen earlier in life set the stage for future trauma.
If you also consider cognitive, neurological, or biological factors that cause someone to process something differently, it makes perfect sense to me that they would be more at risk. The good news is, knowing these factors can be very normalizing, and can also provide clues into what tools and coping skills would be most helpful in alleviating the effects of stress.
Diathesis-Stress Model Infographics
