Understanding and using the diathesis-stress model

The diathesis-stress model is a framework for understanding psychological conditions. According to the model, everyone has some level of natural diathesis (or vulnerability) that could make them more likely to develop certain disorders.

The more vulnerable you are, the less stress you need to trigger a disorder. People who struggle with stress, perfectionism, or a specific disorder can use the model to help pinpoint how vulnerable they are using genetic factors or past trauma. 

Understanding the diathesis-stress model can help you proactively manage risk factors and stress to achieve personal well-being amid a stressful life.

Understanding the diathesis-stress model

The diathesis-stress model, also known as the vulnerability-stress model, is a theory created as a part of psychopathology. It helps psychologists understand why some people experience mental health challenges or struggle with stress or perfectionism while others don’t, even in similar situations.

According to the model, those with neurodiversity or who have mental disorders (like anxiety or schizophrenia) can be triggered by a stressful environment. How likely you are to experience the onset of a disorder in a stressful environment depends on three factors:

• Diathesis (your vulnerability): Diathesis refers to your predisposition or susceptibility to certain conditions.. This vulnerability could be caused by biological factors like genetics, early life experiences, or even your personality traits. For example, a family history of anxiety, schizophrenia, or depression could mean you’re more likely to face those challenges yourself.
• Stress (what life throws at you): Stressors could include everything from major life events, like losing a job or the loss of a loved one, to everyday struggles, like dealing with a busy schedule or financial stress. In the model, stress acts as a trigger that, according to your predisposition, could push you toward mental health issues like depressive symptoms if you’re already vulnerable.
• Protective factors (your resilience): Protective factors are behaviors that shield you from psychological stress or reduce its impact. They include things like having a strong support system, coping skills, or mental health resources. These protective factors can balance your diathesis, even when stress is high.

Psychiatry professionals of the 19th century were the first to see the difference between a person’s predisposition to develop mental health disorders and the stress that causes mental illness. Through the process of understanding why mental disorders develop, vulnerabilities like your genotype get placed into a different category from things like life events or childhood trauma.

Paul Meehl, Manfred Bleuler, and David Rosenthal created the modern diathesis-stress model in the 1960s while expanding earlier ideas from the 19th century to explain schizophrenia. They were the first to suggest that diathesis like genetics alone were not enough to cause a psychiatric illness, but when combined with stressful environmental factors, they could lead to its development. 

Distinguishing between mental health conditions and the stress that caused them is important because it explains why stress doesn’t always result in mental illness. It depends on the individual, particularly those with underlying vulnerabilities. This distinction has been a consistent framework for understanding mental health across generations.

Using this model can help you understand your own mental health, or that of a loved one, and provide insight into why some are more sensitive to stress than others.

The diathesis-stress model works by placing people on a scale using a specific graph, pictured below. In this graph, “mental health symptoms” describes your overall mental or emotional health. “Social environment” describes life stress; a negative environment is very stressful, whereas a positive one is not. An adverse outcome might be developing a disorder like anxiety, while a positive outcome would be good mental health.

A resilient individual, represented by the solid line, has not been exposed to the stressors that would put them at greater risk for developing a mental health disorder regardless of how their environment changes. Because of this, the solid line remains steady, meaning their mental health symptoms don’t change even when the environment does.

The vulnerable individual, represented by the dashed line, is a different story. Here, we see the mental health symptoms changing with the environment. This suggests that vulnerable people are more sensitive to negative environments and can struggle under stress, but positive experiences stop them from accumulating more stress.

To use this model, psychologists plot individuals on the graph to determine how at risk they are of developing a mental disorder under stress.

Resilient individuals maintain good mental health no matter how stressed they are. Conversely, vulnerable individuals are more likely to develop mental health issues in stressful environments when dealing with higher stressors than normal. However, it also shows that vulnerable people can improve their mental health by removing stress or building coping mechanisms that help make them less vulnerable.

Example: using the diathesis-stress model in everyday life

Say you’ve always struggled with perfectionism and then get a job in a demanding, fast-paced role. Growing up, you were punished for bad grades, which created a belief that mistakes were unacceptable. This vulnerability to perfectionism is your diathesis.

At work, tight deadlines, constant feedback from managers, and fear of criticism are stressors that trigger this vulnerability. On the graph, this interaction between your diathesis and stressful environment moves you along the dashed line toward mental health symptoms. You may feel overwhelmed, anxious, and burnt out.

But things change when you seek help from a coach or mental health professional, and develop healthier coping mechanisms. Adding protective factors, like better time management and self-compassion, helps balance your vulnerability. Other tools like sleep, physical activity, or social activity can also be good coping mechanisms. You move upward on the graph toward developing a mental illness, even though your underlying diathesis (perfectionism) remains. 

Now, you’re better prepared to experience improved mental and emotional well-being. Even with some stress in your life, a positive environment can make a big difference. This is similar to how vulnerable individuals benefit in the diathesis-stress model, where the right environment helps them thrive despite having a somewhat stressful life.

• List mental health challenges that run in your family, like anxiety, depression, or a depressive disorder, and think about stressful life events you’ve been through. Use this information to understand your personal diathesis.
• Consider creating a daily routine that includes stress-management techniques, like practicing 10 minutes of mindfulness meditation each morning or scheduling exercise three times a week. This can keep stress levels in check and avoid triggering symptoms.
• Reach out to friends more often or join a support group if your life stress is high or you know you have a high vulnerability to mental health issues. This active step builds a network you can rely on during stressful periods.
• Create a stress-reduction plan before a big change that could become a stressful life event, like moving to a new city. It should include taking time off work, practicing self-care, or saying “no” more often to avoid overwhelm during the transition.
• Schedule stress-relief activities like therapy sessions or quiet breaks before attending a high-stress event like a wedding or work presentation. This buffers the potential impact on your cognitive health so you don’t get overwhelmed.
• Apply the model to remind yourself to avoid self-blame when feeling anxious or depressed. Say to yourself, “I’m struggling because of these stressors and my vulnerabilities, not because I’m weak,” then focus on reducing those stressors.

Once you’ve identified situations or interactions that make you feel stressed, consider working with a coach or mental health professional to focus on developing coping mechanisms that help you manage that stress long-term.

• Anxiety disorders: A study published in the Journal of Anxiety Disorders shows that people with a family history of anxiety are more likely to develop anxiety themselves when exposed to significant stress. 
• Depression: Another study published in Molecular Psychiatry shows a family history or certain personality traits make it more likely that someone will develop a depressive disorder when they face high stress, like the loss of a job.
• Schizophrenia: The diathesis-stress model was created to explain schizophrenia and schizotypy and suggests that combining stress and genetics makes development more likely.
• Eating disorders: Another study published in Frontiers in Psychology suggests societal pressures, body image issues, or trauma, combined with stress, make it more likely someone could develop an eating disorder.

If you or a loved one has risk factors that could lead to developing one of these disorders, consider working with a mental health professional or coach that might use the diathesis-stress model to help you counteract your diathesis.

1. Practice mindfulness and meditation to focus on the present moment and calm your mind. Meditation can lower blood pressure by reducing the body’s stress response, which helps prevent heart disease and hypertension.
2. Exercise regularly to release endorphins and lower stress hormones. Regular exercise, such as jogging or yoga, improves cardiovascular health by reducing cortisol, which can prevent stress-related heart conditions and obesity.
3. Get enough sleep to allow your body and mind to recover from daily stressors. Sleeping seven to nine hours helps regulate hormones like cortisol, reducing the risk of high blood pressure and weakened immune function caused by chronic stress.
4. Practice deep breathing or progressive muscle relaxation to relieve physical tension. Deep breathing exercises lower heart rate and blood pressure, helping to reduce the risk of anxiety disorders and stress-induced cardiovascular issues.
5. Stay socially connected with friends or support networks to share burdens and gain emotional support. Having a strong support system decreases the body’s stress response, helping reduce the risk of depression, dysthymia (a persistent depressive disorder), and post-traumatic stress disorder (PTSD).
6. Do more hobbies or creative activities to give yourself a mental break. Activities like painting or gardening can reduce stress hormones and promote relaxation, especially during isolating times. Engaging in these relaxing pastimes decreases the likelihood of stress-related health problems such as insomnia and weakened immune function.

You don’t have to figure this out alone. Working with a BetterUp Coach can help you prioritize your mental health to build the resilience and coping skills you need to thrive.