The diathesis–stress model is a psychological theory that attempts to explain a disorder, or its trajectory, as the result of an interaction between a predispositional vulnerability and a stress caused by life experiences. The term diathesis derives from the Greek term (διάθεσις) for a predisposition, or sensibility. A diathesis can take the form of genetic, psychological, biological, or situational factors. A large range of differences exists among individuals' vulnerabilities to the development of a disorder.
The diathesis, or predisposition, interacts with the individual's subsequent stress response. Stress is a life event or series of events that disrupts a person's psychological equilibrium and may catalyze the development of a disorder. Thus the diathesis–stress model serves to explore how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia.
The use of the term diathesis in medicine and in the specialty of psychiatry dates back to the 1800s; however, the diathesis–stress model was not introduced and used to describe the development of psychopathology until it was applied to explaining schizophrenia in the 1960s by Paul Meehl. The diathesis–stress model is used in many fields of psychology, specifically for studying the development of psychopathology. It is useful for the purposes of understanding the interplay of nature and nurture in the susceptibility to psychological disorders throughout the lifespan. Diathesis–stress models can also assist in determining who will develop a disorder and who will not. For example, in the context of depression, the diathesis–stress model can help explain why Person A may become depressed while Person B does not, even when exposed to the same stressors. More recently, the diathesis–stress model has been used to explain why some individuals are more at risk for developing a disorder than others. For example, children who have a family history of depression are generally more vulnerable to developing a depressive disorder themselves. A child who has a family history of depression and who has been exposed to a particular stressor, such as exclusion or rejection by his or her peers, would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers.
The diathesis–stress model has also served as useful in explaining other poor (but non-clinical) developmental outcomes.
Protective factors, such as positive social networks or high self-esteem, can counteract the effects of stressors and prevent or curb the effects of disorder. Many psychological disorders have a window of vulnerability, during which time an individual is more likely to develop disorder than others. Diathesis–stress models are often conceptualized as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. The differential susceptibility hypothesis is a recent theory that has stemmed from the diathesis–stress model.
The term diathesis is synonymous with vulnerability, and variants such as "vulnerability-stress" are common within psychology. A vulnerability makes it more or less likely that an individual will succumb to the development of psychopathology if a certain stress is encountered. Diatheses are considered inherent within the individual and are typically conceptualized as being stable, but not unchangeable, over the lifespan. They are also often considered latent (i.e. dormant), because they are harder to recognize unless provoked by stressors.
Diatheses are understood to include genetic, biological, physiological, cognitive, and personality-related factors. Some examples of diatheses include genetic factors, such as abnormalities in some genes or variations in multiple genes that interact to increase vulnerability. Other diatheses include early life experiences such as the loss of a parent, or high neuroticism. Diatheses can also be conceptualized as situational factors, such as low socio-economic status or having a parent with depression.
Stress can be conceptualized as a life event that disrupts the equilibrium of a person's life. For instance, a person may be vulnerable to become depressed, but will not develop depression unless he or she is exposed to a specific stress, which may trigger a depressive disorder. Stressors can take the form of a discrete event, such the divorce of parents or a death in the family, or can be more chronic factors such as having a long-term illness, or ongoing marital problems. Stresses can also be related to more daily hassles such as school assignment deadlines. This also parallels the popular (and engineering) usage of stress, but note that some literature defines stress as the response to stressors, especially where usage in biology influences neuroscience.
It has been long recognized that stress plays a significant role in understanding how psychopathology develops in individuals. However, psychologists have also identified that not all individuals who are stressed, or go through stressful life events, develop a psychological disorder. To understand this, theorists and researchers explored other factors that affect the development of a disorder  and proposed that some individuals under stress develop a disorder and others do not. As such, some individuals are more vulnerable than others to develop a disorder once stress has been introduced. This led to the formulation of the diathesis–stress model.
Protective factors, while not an inherent component of the diathesis–stress model, are of importance when considering the interaction of diatheses and stress. Protective factors can mitigate or provide a buffer against the effects of major stressors by providing an individual with developmentally adaptive outlets to deal with stress. Examples of protective factors include a positive parent-child attachment relationship, a supportive peer network, and individual social and emotional competence.
Throughout the lifespan
Many models of psychopathology generally suggest that all people have some level of vulnerability towards certain mental disorders, but posit a large range of individual differences in the point at which a person will develop a certain disorder. For example, an individual with personality traits that tend to promote relationships such as extroversion and agreeableness may engender strong social support, which may later serve as a protective factor when experiencing stressors or losses that may delay or prevent the development of depression. Conversely, an individual who finds it difficult to develop and maintain supportive relationships may be more vulnerable to developing depression following a job loss because they do not have protective social support. An individual's threshold is determined by the interaction of diatheses and stress.
Windows of vulnerability for developing specific psychopathologies are believed to exist at different points of the lifespan. Moreover, different diatheses and stressors are implicated in different disorders. For example, breakups and other severe or traumatic life stressors are implicated in the development of depression. Stressful events can also trigger the manic phase of bipolar disorder and stressful events can then prevent recovery and trigger relapse. Having a genetic disposition for becoming addicted and later engaging in binge drinking in college are implicated in the development of alcoholism. A family history of schizophrenia combined with the stressor of being raised in a dysfunctional family raises the risk of developing schizophrenia.
Diathesis–stress models are often conceptualized as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. For example, a child with a family history of depression likely has a genetic vulnerability to depressive disorder. This child has also been exposed to environmental factors associated with parental depression that increase his or her vulnerability to developing depression as well. Protective factors, such as strong peer network, involvement in extracurricular activities, and a positive relationship with the non-depressed parent, interact with the child's vulnerabilities in determining the progression to psychopathology versus normative development.
Some theories have branched from the diathesis–stress model, such as the differential susceptibility hypothesis, which extends the model to include a vulnerability to positive environments as well as negative environments or stress. A person could have a biological vulnerability that when combined with a stressor could lead to psychopathology (diathesis–stress model); but that same person with a biological vulnerability, if exposed to a particularly positive environment, could have better outcomes than a person without the vulnerability.
- Ingram, R. E. & Luxton, D. D. (2005). "Vulnerability-Stress Models." In B.L. Hankin & J. R. Z. Abela (Eds.), Development of Psychopathology: A vulnerability stress perspective (pp. 32-46). Thousand Oaks, CA: Sage Publications Inc.
- Ormel J.; Jeronimus, B.F.; Kotov, M.; Riese, H.; Bos, E.H.; Hankin, B. (2013). "Neuroticism and common mental disorders: Meaning and utility of a complex relationship". Clinical Psychology Review. 33 (5): 686–697. doi:10.1016/j.cpr.2013.04.003. PMC 4382368. PMID 23702592.
- Oatley, K., Keltner, D. & Jenkins, J. M. (2006b). "Emotions and mental health in childhood."Understanding emotions (2nd ed.) (pp. 321-351). Oxford, UK: Blackwell Publishing.
- Prevention Action. Diathesis-stress models Retrieved from http://www.preventionaction.org/reference/diathesis-stress-models Archived 2012-06-03 at the Wayback Machine
- Lazarus R. S. (1993). "From psychological stress to the emotions: A history of changing outlooks" (PDF). Annual Review of Psychology. 44 (1): 1–21. doi:10.1146/annurev.ps.44.020193.000245. PMID 8434890.
- Paul E. Meehl (1962). "Schizotaxia, schizotypy, schizophrenia". American Psychologist. 17 (12): 827–838. CiteSeerX 10.1.1.462.2509. doi:10.1037/h0041029.
- Sigelman, C. K. & Rider, E. A. (2009). Developmental psychopathology. Life-span human development (6th ed.) (pp. 468-495). Belmont, CA: Wadsworth Cengage Learning.
- Oatley, K., Keltner, D., & Jenkins, J. M. (2006a). "Emotions and mental health in adulthood." Understanding Emotions (2nd ed.) (pp. 353-383). Oxford, UK: Blackwell Publishing.
- Gazelle H.; Ladd G. W. (2003). "Anxious solitude and peer exclusion: A diathesis stress model of internalizing trajectories in childhood". Child Development. 74: 257–278. doi:10.1111/1467-8624.00534.
- Administration for Children and Families (2012). Preventing child maltreatment and promoting well-being: A network for action. Department of Health and Human Services. Retrieved from http://www.childwelfare.gov/pubs/guide2012/guide.pdf#page=9
- Barlow, D. H. & Durand, V. M. (2009). Abnormal psychology: An integrative approach. Belmont, CA: Wadsworth Publishing Company.
- Masten A. S. (2001). "Ordinary magic: Resilience processes in development". American Psychologist. 56 (3): 227–238. doi:10.1037/0003-066X.56.3.227. PMID 11315249.
- Belsky J.; Pluess M. (2009). "Beyond diathesis stress: Differential susceptibility to environmental influences". Psychological Bulletin. 135 (6): 885–908. doi:10.1037/a0017376. PMID 19883141.
- Jeronimus B.F.; Kotov, R.; Riese, H.; Ormel, J. (2016). "Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants". Psychological Medicine. 46 (14): 2883–2906. doi:10.1017/S0033291716001653. PMID 27523506.
- Jeronimus, B.F.; Ormel, J.; Aleman, A.; Penninx, B.W.J.H.; Riese, H. (2013). "Negative and positive life events are associated with small but lasting change in neuroticism". Psychological Medicine. 43 (11): 2403–15. doi:10.1017/s0033291713000159. PMID 23410535.
- Nolen-Hoeksema, S. (2008). "Suicide". Abnormal Psychology (4th ed.) (pp. 350-373). New York, NY: McGraw-Hill.
- Monroe S. M.; Simons A. D. (1991). "Diathesis-stress theories in the context of life stress research: Implications for depressive disorders". Psychological Bulletin. 110 (3): 406–425. doi:10.1037/0033-2909.110.3.406.
- Cummings, M. E., Davies, P. T., & Campbell, S. B. (2000). Developmental psychopathology and family process: Theory, research, and clinical implications. New York, NY: The Guilford Press.
- Media related to Diathesis–stress model at Wikimedia Commons