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Bipolar Causes: Diathesis-Stress Hypothesis

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA Updated: Feb 27th 2017

The process of medical research is influenced by current ideas and cultural issues. Medical research into the causes and origins of bipolar illness has been influenced by an idea known as the Diathesis-Stress Hypothesis. This model has been applied to many medical and mental health disorders.

The basic diathesis-stress hypothesis proposes that people have vulnerabilities (known as predispositions) for illnesses (known as diatheses). Some people have more of these vulnerabilities than others, for varying reasons having to do with their genetics, biology and experience. However, just having a vulnerability for an illness alone is not enough to trigger that illness into action. Instead, people's vulnerabilities must interact with life stresses to prompt the start of the illness. The greater a person's natural tendency for developing an illness, the less stress is necessary to get the illness started. Where there is a smaller vulnerability for developing an illness, a greater amount of stress is required to produce the illness. Until this critical amount of stress is reached (however much or little of it is necessary in a given case) people cannot be said to have an illness. Their vulnerabilities are said to be "latent" or hidden.

The current thinking regarding the causes of bipolar disorder are essentially that bipolar disorder results when bipolar diatheses (hidden vulnerabilities) meet a source of sufficient stress necessary to activate them and cause the disease to start.

It's not quite as simple as that last statement may sound, of course. For instance, various sources of stress may combine to produce the releasing effect. These stressors can be psychological, social, and biological. For example, trauma, family stress, depression, viruses, and birth complications can be forces powerful enough to raise the vulnerability towards bipolar disorder. Other stresses that can add to vulnerability include sleep deprivation (known to trigger mania), Major Depressive Disorder with a Seasonal Pattern (previously SAD), alcoholism and drug abuse, imbalances in brain chemicals, hormones, infections, and premenstrual syndrome in women. Although the relationship between menstrual cycles and bipolar disorder is still unclear, this connection may contribute to the fact that more women experience depressive episodes than men. It is important to remember that the events or stresses that set an illness in motion can be very different from those that keep it going once it has started.

Evidence that bipolar disorder is biological in nature comes from a wide range of studies in the genetics, neurochemistry, endocrinology and immunology fields.


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Life After Diagnosis - Neil Renfree - Sep 11th 2010

Hi, I am a 63 y.o. male who was diagnosed in 1977. My illness would be Cat 1, slow cycling and I am well maintained on Quilonum SR [lithium] and Epilim 500 [valporate] I would like to encourage readers concerning the benefits of lithium [discovered by an Australian] and the valporate "safety net". I am writing because I am interested to discover whether a life changing 5 day interrogation course I undertook in the army may have generated enough stress to "trigger" my latent condition. [near total sleep deprivation, stress positions. close confinement, noise, shaming, claustraphobia, hooding] i.e Kubarak Manual used by US forces in Viet Nam and Abu Grav - I seem to have got a lot more than I expected from a training program. Life since has been full and rewarding although plagued by high achievement drive In retirement I enjoy helping others on their journey. Your thoughts would be appreciated... thankyou

Thank you - Kelly Davidson - Mar 25th 2009

I would like to thank the previous poster for  sharing her personal story with all of us. It relieves me greatly to know at 78 she is living a good, although not easy, life. My husband, age 48,  is bipolar.  Finding medication that will give him stability is a problem. His Dr. has not suggested Lithium yet, but I will ask her if it is a possibility. He's tried over twenty others, and so far Lamictal is the only one that has done anything positive for him. However, he is still just a shell of the man he used to be. Although he looks the same, the differences are like night and day. I only see glimpses of my husband I know and love for a couple of weeks, two to three times a year. I really miss him. 

Diagnosed in 2007 - Theodore O'Donnell - Sep 18th 2008

I have called myself an alchohalic, and an epileptic.  Last year I finally discovered why I had some of the problems in life that I have had.  I was diagnosed with having bipolar, and I started crawling out of the hole that I found myself.  Today, I will do whatever is necessary to make sure that I do not return to that spot.  I realized that I may never see my children again.

In fact that is why I found myself on this web site in the first place.  I was looking for an answer that was rolling around in my head.  I work from midnight to 8 a.m. in the darkness at youth treatment facility, on my days off I maintain the identical sleep schedual, and I believe moving to a different shift would be healthy.  Comments?



that is not who I am - Kristin - May 29th 2008

Hello I was diagnosed as bipolar approx 5 yrs ago at age 35, and am thought to have been so my whole life. Was taking Lithium voluntary? Was that the intervention needed to help stop the drinking? Do you know approximately how long you may have been bipolar? Maybe a trigger?

I went into a severe depression soon after the diagnosis, and hospitalized myself, but it only took a week to get meds on board that worked. Meanwhle I lost custody of my son. I had previusly made a left field decision leading to me leaving a job in the Cardiovascular field, to follow more artistic paths. I have not kept in touch with friends from the hospital I worked in because of not wanting to admit my condition. How do you get past this? I have admitted openly to more recent groups and individuals the diagnosis, but as with any mental illness it is looked upon with much stigmatism. I am trying to separate myself from the diagnosis, because that is not who I am. But I am reminded of it so often.

If you read this, please share.

On Lithium for 32 years - Anne Cisneros - May 27th 2007

I was diagnosed with manic depression in 1964.  I was hospitalized 4 years out of 5.  I was unable to take care of my family although I was able to function after being released from the hospital.  I married again and moved to Washington State, still not on medication.  Another depression after another divorce forced another hospitalization.  I was put on Lithium and within two weeks was functioning on an adult level.  It is now 2007. I am 78 years old.  I am a recovering alcoholic of 17 years.  I have been widowed for 14 years.  I have rheumatoid arthritis.  I believe that Lithium saved my life. My life  has not been easy or smooth but I have been able to cope with the highs and lows and suicidal thoughts have not been a problem.  I still consider my self "mentally ill" but I am able to live life.

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