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Diathesis Stress Model: 19 Examples Of Risk and Protective Factors

| What is Diathesis-Stress Model | What Is Diathesis | The Dual Risk Model | Diathesis And Stress Interaction | Diathesis Stress Model Examples |

Although stress is an inevitable part of a person’s life, it has different effects on different people.

Some people develop a disorder after exposure to major environmental stressors, while others do not.

Scientists have been trying to find out and explain what causes this difference in outcomes.

The diathesis-stress model is one explanation based on scientific understanding.

What is the diathesis-stress model?

The diathesis-stress model describes how the interaction of predisposition (diathesis) and stressful situations (stress) can trigger physical or mental health disorders. It is also known as the stress-vulnerability model or stress-diathesis model.

What is diathesis?

Diathesis is a person’s predisposition or vulnerability to a medical condition, which can be a psychological or physical disorder. This terminology was first used in psychiatry in the study of schizophrenia and later depression and other disorders.

Predispositions can be inherited genetically​1​, created by environmental stressors early in life, or caused by the genetics x environment interaction (GxE) ​2​.

According to the diathesis-stress theory, stress is more likely to develop physical or mental illnesses in someone predisposed to it than in someone without the disposition​3​.

girl covers up her face with her palms. A child's vulnerability can be explained by the diathesis stress model.

The Dual Risk Model

The diathesis-stress model is also known as the dual risk model​4​ because the effects of stress play two roles.

A person’s predisposition can be genetic or acquired after birth.

Certain early life experiences can lower an individual’s threshold for developing mental disorders and allow subsequent stressors to trigger disorders more easily. Therefore, environmental risk factors in early life can increase a person’s predisposition later in life.

Stress, therefore, plays a dual role​5​:

  • Early stress exerts a formative influence on children increasing their underlying vulnerability to disorders.
  • Later stress exerts a precipitating or triggering influence by activating the actual onset of the disorders.
guy sits at a corner on the ground

Diathesis And Stress Interaction

According to the Diathesis-Stress Model, mental health problems can be triggered by the presence of both diatheses and stress.

This is a plausible explanation for why some people develop mental disorders when facing stressful life events while others don’t.

At first glance, this model suggests that diathesis and stress are two independent qualities that could exist on their own without the other. In this early version of the Diathesis-Stress Model, the interaction between vulnerability and stress was clear-cut: Stress activated the diathesis, which in turn brought about the onset of the disorder​6​.

But in recent years, researchers have discovered several ways in which diathesis and stress may interact and influence each other.

Top view of a woman sleeping on the desk near a laptop is an example of stress vulnerability model

Diathesis Can Cause Stress

One possible interaction between diathesis and stress is that the underlying predisposition may cause or affect the experience of stress. That is, having certain vulnerabilities may increase one’s likelihood of incurring a high level of stress.

For instance, a genetic vulnerability may cause a person to cope with life in a way that creates a stressor that normal people without the trait will not experience.

This bidirectional influence can be seen in some individuals predisposed to depressive symptoms.

These individuals may exhibit irritability, fatigue, and social withdrawal. These symptoms can cause problems in their interpersonal relationships and employment. If those problems end up causing the loss of a close relationship or job, those experiences become the stressors that catalyze the onset of major depressive disorder​5​.

In this scenario, stress is not just a random event but a consequence of vulnerability.

Another type of interaction is that vulnerabilities can alter a person’s perception of stress.

For example, a vulnerable person may perceive an ordinary experience as highly stressful. The vulnerabilities essentially cause high levels of psychological distress. Less stress is required to trigger a disorder. For these people, a disorder may develop even without experiencing extreme stress.

Stress Can Cause Diathesis

While diathesis can lead to stress, stress can also lead to diathesis. As previously discussed, environmental stress can cause a person to develop vulnerability.

In the depression scar hypothesis, the first episode of a person’s major depression may cause them to form negative thinking patterns. These new thinking patterns become the vulnerability and lead to later episodes of depression when further stressful events are encountered​7​.

In recent years, scientists have found another pathway for stressful events to create a biological vulnerability. They found that some environmental factors can modify gene expression through epigenetic processes. Such modifications are independent of the genetic makeup of a person.

That means even if a person is not born with a genetic predisposition, certain environmental or social factors can still alter the person’s DNA to create a biological predisposition.

toddler girl cries

Diathesis Stress Model Examples

The diathesis stress theory is a complicated psychological theory that keeps evolving as scientists continue to gather new information. Meanwhile, this model helps to explain why some people seem more resilient than others.

It clarifies the roles of biological factors and situational factors in the development of a disorder. There is no longer a debate on nature-vs-nurture because disorders can be caused by a combination of nature and nurture.

This model also consolidates existing research on parenting, proving that parenting matters because parents can contribute to risk and protective factors.

Examples of Risk Factors

  1. punitive parenting style​8​
  2. overprotective parenting style
  3. childhood maltreatment
  4. physical or sexual abuse​9​
  5. being a young girl​10​
  6. family history of depression​11​
  7. domestic violence​12​
  8. community violence​13​
  9. witnessing violence​14​
  10. school bullying​12​
  11. life-threatening event
  12. the traumatic loss of a parent
  13. impulsive temperament

Examples of Protective Factors

Protective factors in early life likely buffer against the onset of disorders following negative events for vulnerable children.

  1. warm, responsive parenting style​15​
  2. caring adults
  3. consistent care, structure, and supervision
  4. emotionally supportive environment​16​
  5. high self-esteem​17​
  6. less “adventurous” temperament​18​

References

  1. 1.
    Brown AS. Prenatal Infection as a Risk Factor for Schizophrenia. Schizophrenia Bulletin. Published online February 9, 2006:200-202. doi:10.1093/schbul/sbj052
  2. 2.
    Toyokawa S, Uddin M, Koenen KC, Galea S. How does the social environment ‘get into the mind’? Epigenetics at the intersection of social and psychiatric epidemiology. Social Science & Medicine. Published online January 2012:67-74. doi:10.1016/j.socscimed.2011.09.036
  3. 3.
    Hertenstein MJ, Dean RS, Patanella D, et al. Diathesis-stress Model. In: Encyclopedia of Child Behavior and Development. Springer US; 2011:502-503. doi:10.1007/978-0-387-79061-9_845
  4. 4.
    Richters J, Weintraub S. Beyond diathesis: toward an understanding of high-risk environments. In: Rolf J, Masten AS, Cicchetti D, Nuchterlein KH, Weintraub S, eds. Risk and Protective Factors in the Development of Psychopathology. Cambridge University Press; :67-96. doi:10.1017/cbo9780511752872.007
  5. 5.
    Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin. Published online 1991:406-425. doi:10.1037/0033-2909.110.3.406
  6. 6.
    Ingram RE, Luxton DD. Vulnerability-Stress Models. In: Development of Psychopathology: A Vulnerability-Stress Perspective. Sage Publications, Inc.; 2005:32-46.
  7. 7.
    Rohde P, Lewinsohn PM, Seeley JR. Are people changed by the experience of having an episode of depression? A further test of the scar hypothesis. Journal of Abnormal Psychology. Published online 1990:264-271. doi:10.1037/0021-843x.99.3.264
  8. 8.
    Loginova SV, Slobodskaya HR. Interactions Between Child Personality and Parenting in Relation to Child Well-Being: Support for Diathesis–Stress and Differential Susceptibility Patterns. Front Psychol. Published online August 3, 2021. doi:10.3389/fpsyg.2021.558224
  9. 9.
    McKeever VM, Huff ME. A Diathesis-Stress Model of Posttraumatic Stress Disorder: Ecological, Biological, and Residual Stress Pathways. Review of General Psychology. Published online September 2003:237-250. doi:10.1037/1089-2680.7.3.237
  10. 10.
    Reinelt E, Stopsack M, Aldinger M, John U, Grabe HJ, Barnow S. Testing the diathesis-stress model: 5-HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder. Am J Med Genet. Published online March 8, 2013:253-261. doi:10.1002/ajmg.b.32142
  11. 11.
    Nielsen JD, Mennies RJ, Olino TM. Application of a diathesis-stress model to the interplay of cortical structural development and emerging depression in youth. Clinical Psychology Review. Published online December 2020:101922. doi:10.1016/j.cpr.2020.101922
  12. 12.
    Swearer SM, Hymel S. Understanding the psychology of bullying: Moving toward a social-ecological diathesis–stress model. American Psychologist. Published online 2015:344-353. doi:10.1037/a0038929
  13. 13.
    Solberg VSH, Carlstrom AH, Howard KAS, Jones JE. Classifying At-Risk High School Youth: The Influence of Exposure to Community Violence and Protective Factors on Academic and Health Outcomes. The Career Development Quarterly. Published online June 2007:313-327. doi:10.1002/j.2161-0045.2007.tb00086.x
  14. 14.
    Macdonald A, Danielson CK, Resnick HS, Saunders BE, Kilpatrick DG. PTSD and comorbid disorders in a representative sample of adolescents: The risk associated with multiple exposures to potentially traumatic events. Child Abuse & Neglect. Published online October 2010:773-783. doi:10.1016/j.chiabu.2010.03.006
  15. 15.
    Kochanska G, Kim S. Difficult temperament moderates links between maternal responsiveness and children’s compliance and behavior problems in low-income families. Journal of Child Psychology and Psychiatry. Published online October 11, 2012:323-332. doi:10.1111/jcpp.12002
  16. 16.
    Yeung R, Leadbeater B. Adults make a difference: the protective effects of parent and teacher emotional support on emotional and behavioral problems of peer-victimized adolescents. J Community Psychol. Published online January 2010:80-98. doi:10.1002/jcop.20353
  17. 17.
    DuBois DL, Flay BR. The Healthy Pursuit of Self-Esteem: Comment on and Alternative to the Crocker and Park (2004) Formulation. Psychological Bulletin. Published online May 2004:415-420. doi:10.1037/0033-2909.130.3.415
  18. 18.
    Rioux C, Castellanos-Ryan N, Parent S, Séguin JR. The interaction between temperament and the family environment in adolescent substance use and externalizing behaviors: Support for diathesis–stress or differential susceptibility? Developmental Review. Published online June 2016:117-150. doi:10.1016/j.dr.2016.03.003

About Pamela Li

Pamela Li is a bestselling author. She is the Founder and Editor-in-Chief of Parenting For Brain. Her educational background is in Electrical Engineering (MS, Stanford University) and Business Management (MBA, Harvard University). Learn more

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