Grief and Psychological Disorder: Understanding the Diathesis-Stress Model
Understanding Grief : Eleanor Haley/
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Sometimes grief can cause such extreme distress that it becomes unclear to the person what they are really dealing with. I don't mean in the first few months after a loss, because the first few months are almost always hell. In fact, up until recently, clinicians were advised not to diagnose things like major depression and anxiety in individuals within the first two months following a death. Although this has changed somewhat, clinicians are still advised to use caution—not because the person might not very well have these things, but because it can be hard to tell where grief ends and a true disorder begins.
I'm a regular WebMD abuser. I've been diagnosed with a great many things, despite the fact that I haven't seen a doctor in 4 years. My tendency to seek out, use, and abuse the internet to medicalize myself is exactly why I hesitate to cover concepts that might lead to someone thinking their grief is abnormal, atypical, or pathological. Still, I believe in the old adage "Knowledge is power," and you never know what idea or concept might lead to someone's a-ha!" moment. I'm not going to tell you that grief is ever pathological, but there are obviously very real reasons why people sometimes get stuck... And these circumstances are worth discussing.
The diathesis-stress model is a widely accepted psychological theory (remember, theories are just one way of looking at something) that attempts to explain why some people develop certain disorders such as post-traumatic stress disorder (PTSD), anxiety disorders, and major depression. This model is complex and nuanced and a full explanation is well beyond the scope of this article, but even a basic understanding helps us to conceptualize why someone might struggle after experiencing the death of a loved one in a way they've never struggled before.
Additionally, the diathesis-stress model helps to explain why some people develop disorders when others do not. For example, it explains why 10 people could experience a traumatic situation where they are under the same stress, feel the same level of fear, and witness the same horrors; yet only two people go on to develop PTSD, 1 person develops depression, and the other 7 people are—to varying degrees—able to cope with and integrate the experience.
Basically, the model asserts that some people have a genetic predisposition to develop disorders like depression, anxiety, and PTSD. Even though we all may have some level of vulnerability to certain disorders, having this genetic trait makes you more vulnerable than others. t does not guarantee that you will develop a disorder, but it puts you at risk—especially when combined with other environmental influences.
By environmental influences, we mean factors such as early life experiences, social support, and exposure to other stressors. Some environmental influences can have a protective effect, such as having a strong social network of support, high self-esteem, and early life experiences that foster a sense of control, security, predictability, and the ability to cope with emotional pain. Having a good amount of these experiences might safeguard someone with a genetic vulnerability from developing a psychological disorder.
On the other hand, some circumstances can have an opposite negative effect, such as having limited social support, low self-esteem, life experiences that create the sense that events are out of one's control, unpredictable, and which foster avoidance. Having one or more of these types of experiences might come together to create a second psychological vulnerability for developing psychological disorder (I.e., it makes things worse).
Despite having genetic and psychological vulnerabilities, a person still might not develop depression, anxiety, or PTSD unless something happens to trigger it. This is where the 'stress' in the diathesis-stress model comes in. Stressors might include a whole slew of experiences, but most relevant to our conversation is—you guessed it—the death of a loved one or other significant loss. This might explain why those who never had major depression, debilitating anxiety, or even substance use disorder before the death of a loved one might all of a sudden find themselves unable to get out of bed, obsessively worrying, panicking, or in the throws of addiction afterwards.
As I said earlier, sometimes it's hard to see where grief ends and a true disorder begins. In fact, there is even a popular school of thought that says grief sometimes is a disorder in and of itself. What the diathesis-stress model helps us to understand is that sometimes the events surrounding the death of a loved one could lead to both grief and psychological disorders such as PTSD, depression, or anxiety disorders simultaneously.
It's important to remember, grief can result in normal responses that feel completely foreign and distressing to the person who's experiencing them. What feels abnormal to you, may just be the result of the intense emotions and stress associated with the death of someone you love. That being said if you're experiencing emotions, behaviors, and thoughts which are distressing and limit your ability to function for a prolonged amount of time, it never hurts to talk to a mental health professional (again, preferably a licensed clinician with training in grief and bereavement).
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24 Comments on "Grief and Psychological Disorder: Understanding the Diathesis-Stress Model"Click here to leave a Comment
Ruthie January 19, 2023 at 6:08 pm
I just buried my 90 yr old mother. I FEEL like I am okay with her loss because she had a long, good quality, healthy, happy life and just got sick about month bf she died. I believe a longer life would not have been a better life. My problem is that I had a mental breakdown 13 years ago when I thought my 19 year old daughter would die from a pulmonary embolism. My daughter is fine today. I am making myself crazy worrying that I will have another breakdown when my mother’s death “hits” me. I don’t know if I am grieving or of her death hasn’t hit me yet. I am just scared to death I will lose my mind again. I am just waiting on the next shoe to fall and it is driving me crazier! P!ease, any words of wisdom from anyone would be appreciated.
Litsa January 20, 2023 at 8:27 am
Ruthie, I am so sorry for what you are feeling. If you worked with a therapist in the past, I would suggest you reach back out now or find a therapist if you haven’t had one, just to help with coping with some of the worries you’re having. It sounds like you are having ‘anxiety about anxiety’ – which is incredibly common! Our brains are very good at trying to protect us from things it knows have been terrible or painful. The brain’s way of doing that is to worry, so we can prepare and won’t be caught off guard if they worst happens. Unfortunately, that means we often worry about things no matter how likely the are to happen! It sounds like you are processing your mom’s death in a healthy way. It doesn’t sound like you are avoiding or compartmentalizing, but instead reflecting on the life your mom lead and understanding of the reality that an even longer life doesn’t always mean mean a quality life. I imagine this is quite different than what the situation looked and felt like when your daughter was at such high risk of dying. It is important to remember that when a loved one has an unexpected, traumatic event that puts them at risk of death, that often activates shock and the acute stress response in the family members. When that uncertainty continues, the stress hormones in our body and our nervous system get taxed in all sorts of intense ways that can cause people to deal with panic and even post traumatic stress. That is a very particular and different set of circumstances than what you are describing now, when you mom was older, went through a period of a month of illness where you brain likely had time to more slowly process what was happening without your nervous system being activated in the same way as with your daughter. This is a very significant difference. The grief and sadness of missing your mom will undoubtedly be hard in many moments, but that does not mean it is likely to impact you the way such a traumatic situation with your daughter did. I always suggest that talking with a therapist is helpful, especially if you are worried about your mental health or have had challenges in the past. But also keep in mind that 90% of people adjust after a loss without professional support, so there is no reason to fear that the experience of grief usually causes mental health issues — that is very much the exception and not the rule. Please take good care of yourself. If you are looking for space to connect with others and get a bit more grief support/education, we do have a membership group to help people cope after loss – https://whatsyourgrief.com/online-grief-community – and if you need help locating a therapist, please contact us and we can help you find someone in your area.
Teen July 12, 2021 at 2:12 am
Husband had ptsd, he abused me for years.I had no money no where to go. I loved him so much.We married late in life both being divorce. We were married for 20 years. He past away 2 years ago. I now have anxiety so bad I don,t leave house can not drive due to panic attacks. All alone.i have a lot of symptoms of ptsd. EXCEPT I would never mean to anyone.He was nice to every one except me. Is there hope for me.?
Erica November 24, 2021 at 5:30 pm
There is always hope, there are always ways forward. It may take time to find what works best for you, but there are so many treatment and therapy options. If one thing doesn’t work or resonate with you, move on to something (or someone) else. This is your time to love and trust yourself.
HB February 19, 2021 at 11:40 pm
I lost my grandmother in 2016 when I lost my job and my dad did hospice with her, and then his little brother, my uncle, had to get chemo and died of it, and my dad hospiced him until death 2017, and then my dad passed Nov. 5 2019, and I went through hospice him. It was a stroke, and I lived by hospital bed for a month watching every emergency happen, and never sleeping, then 4 days in hospice and he was gone. Then pandemic, 3 friends have committed suicide, and my cat of 15 years passed this Dec. for the last 3 years my body has starting failing me from EDS ( a whole nother kind of grief) and I am a mover and dancer who cannot anymore. I am infertile do not have kids or spouse. I have never felt so alone in my life. Every day is a chore and tears. I am the end of my genetic line, just wondering what all this is for anyway. I am not living life just waiting for my turn…I am 48, but I feel I have lost everything, even things I never had or will have.
Isabelle Siegel February 22, 2021 at 2:08 pm
HB, I am so sorry to hear that you’re being forced to go through all of this. I recommend you check out this article on cumulative grief: https://whatsyourgrief.com/cumulative-grief-aka-grief-overload/ I want you to know that, no matter how you feel, you are NOT alone. Have you tried reaching out to a therapist trained in grief and bereavement? You can find one here: https://complicatedgrief.columbia.edu/for-the-public/find-a-therapist/. All the best to you.
David January 8, 2022 at 5:34 pm
The anxiety and stress of losing family is unmatched. To those who do not know what it is like, they say get over it, move on, take care of yourself, time heals…. well it’s not easy. Then when you lose your unconditional love with your pet it hits you harder, you do things, say things that arent really real or true to try to blame yourself for something to ease the loss and pain of the loss. It is all part of it and yes it all is terrible. The reality is this will be with you forever and dulls with time but you never get over it, you learn to live with it. Life is never the same and you think it’s over and your biding your time. All I can say after losing my entire family, all gone no one left, is take it day by day and you’ll find survival. Remember the majority of the people you have around you care but don’t really care, they don’t have time for the down ness we are having and only think you’re a drain on them, which is true. Find the 1-2-3 people you can trust as friends, let the others be acquaintances, and never take anything they say as gospel. It is tough and lonely but there is zero we can do about it, be present with yourself and be nice to yourself as blaming yourself is not the key, saying thing that aren’t true to make yourself feel some blame is not the key just do your best and try that is all you can do.
Lorna Burns March 30, 2020 at 4:25 pm
As someone with PTSD already I have had my suspicions that i’m processing my beloved husband’s death in a dysfunctional PTSD manner. He died suddenly and I had to perform CPR on my beloved. I am having flashbacks, nightmares and can’t sleep. It is now so painful to look at his pictures and I can feel that I am trying to avoid feeling the pain and agony of his passing. I feel numb and dissociated from life and what has happened. It is just too painful to face and i’m pretending to the world that i’m ok when in fact I feel like I’ve died too.
J Dale January 25, 2020 at 6:28 am
In the last 2 years I have been to 5 funerals.
A close friend of over 30 years who I found dead in her home.
A dear friend who had been so kind for over 20 years.
A friend of 20 years who died suddenly at the same age as me mid 60s.
Sad as they are, I could cope with all of those, I can’t cope with losing my life long partner only 3 months after my mother died.
Suddenly and unexpectedly within 3 hours of leaving home. I can never live with that loss, his loss of life at an early age with no warning. The loss of our longed for retirement together. The shock of that night will be with me forever.
Family relationships are strained, they’re upset and want to help but usually make me feel worse and under pressure to be “normal” again, so I have lost them as well.
Nothing helps ease the pain, I’m alive but my life means absolutely nothing to me , it’s just a painful , pointless daily struggle. We should have gone together which is where we belong , together.
Mksager7@gmail.com June 13, 2018 at 7:54 am
All of the posts are helping me understand grief a little more. I was married with two step children. I loved them as my own, as I do not have children if my own. Our marriage ended and my ex refuses to let me ever see them again. It has been over two years since this happened. I loved them so much . I am crying as I write this post. I truly loved them with all my heart. Never seeing them again has left me so lost. So full of anger and self pity. I no longer know who I am. I go to therapy and things have gotten better but I remain lost. I made so many mistakes after the divorce. The pain overwhelmed me from all the losses. I simply wanted to post my experience. There are days I feel almost human and then there are days the pain hurts so acutely I want it to end. I grieve the children I lost the family we where. I grieve the lost interest in life and fear the constant low level pain could get worse. Only recently have I healed enough to read about grief and I am thankful to everyone that shared. I hope we all find a peace that helps us heal.
Heather Potter August 5, 2016 at 6:16 am
In 2005 a very dear brother in law died at the age of 53
In 2006 my mum died at 84
In 2007 my Dad died at 84
In 2008 my dog Monty died
In 2009 my dog Saladin died
In 2010 my Sister died age 59
In 2011 my last Auntie died age 90
In 2011 my Brother died age 63
For the last 11 years I have been surrounded with death and Grief, even after therapy for complex grief some days I am a wreck, but I have acknowledged that I will never come to terms with so much loss and grief, I have put my emotions and energy into researching my family tree, to find out who my family were.
This helps me to cope.
Sandy July 25, 2016 at 3:04 pm
IT’S EASY FOR SOMEONE TO SAY SEEK PROFESSIONAL HELP, IN MY OPINION, THE PERSON GIVING YOU HELP, CAN’T FEEL THE PAIN YOUR EXPERIENCING. IT’S YOUR LOSS NOT THEIRS, SO ITS USELESS TO TALK TO THEM SO CALLED PROFESSIONALS, WHEN YOU LOOSE A LOVED ONE THAT YOU DEDICATED YOUR WHOLE LIFE TO, IT TAKES A DEVASTATING EFFECT IN YOUR BODY AND MIND. AND THE PAIN NEVER GOES AWAY, SO I DON’T KNOW HOW ANYBODY CAN JUDGE. BASED ON YOUR PAIN, REMEMBER IT’S OUR LOSS NOT YOURS, SO YOU ARE NOT GOING TO UNDERSTAND OUR PAIN, OUR LOSS IS EXCRUCIATING, AND WILL CAUSE PHYSICAL AND MENTEL PAIN PROBABLY FOR THE REST OF OUR LIVES, BECAUSE WE CARED AND SHOWED LOVE FOR OUR LOVED ONE WHO PASSED, LIFE WILL NEVER BE THE SAME WITHOUT OUR LOVED ONES, UNTIL WE REUNITE WITH THEM IN THE AFTERLIFE. I MISS MY TOBY BOY HE WAS MY LIFE, MY 11YR 10 MONTH OLD WOLF/SHEPARD.DIED 6-8-15, I WILL SEE YOU IN THE KINGDOM OF HEAVEN. I ADORE YOU FOREVER TOBY.
Heather Crossley FB October 2, 2019 at 9:07 am
People don’t realise how losing a dog can devastate . Your love shines through.What a lucky dog he was! Now, somewhere, there is a sad pitiful unloved little fella waiting for YOU. Yes, You. I lost my beautiful husband, and l think, from your letter, your grief is as bad as mine. I can’t do anything to help me, but you can. I am hoping you already have. Go and help another little boy…he will love you. With my very best wishes Heather-Juliette am on FB
Suzanne Utts January 21, 2020 at 1:50 pm
If people have never had a pet or have never lost one, they do not understand the grief. Our animals are our 4-footed-furry-family members. I had a dog that I picked out of a litter—well really, he picked ME. He was 4 weeks old. He lived to be close to 18. So I understand the pain and grief you are going through. The only way I felt better was to go to petfinder.com and look at dogs who needed a home. After about 4 months I found a little Cairn Terrier at a no-kill shelter. We adopted him. He helped heal my grieving heart. My love for Murphy and all my other dogs who are gone is still there fully in my heart, but God opened up another pocket in my heart where love for Rocky grew and grew. It also helped me to know that animals go to Heaven. After all, animals never sin. They don’t need a Redeemer. We sin, so we do and that’s what Christ did for us by dying on the cross and raising from the dead. My dogs will be there to greet me when I die.
I really hope this helps you a little today~
Tam December 2, 2015 at 2:35 am
Bill, I am going through something similar. I have a LOT of anger, and I am isolating myself more and more. I know much of it is my own fault, but I can’t help but have expected more from people who claimed to care about me, and feeling so let down and forgotten and ignored during the worst time of my life. Complicating it further is the fact that anger seems to be how I manifest most pain or depression. As a child I was basically not “allowed” to have feelings my mother found inconvenient (which was pretty much most of them), and any expression of them brought punishment, so I know where the root of the problem lies. But knowing it hasn’t helped me change it, so here I am feeling like I’m way past due getting off this crummy planet because I’m so tired of all my fears and anger and of feeling alone and uncared for, and knowing I am only making it worse with people. I have no advice or comfort to give anyone…I can’t even help myself. Just wanted you to know that yeah, some of us are in that anger/isolation boat. I hope you find some sort of answers and inner peace. I hope I do too.
Esther R Gueits February 21, 2019 at 2:58 am
Tam..you took the words right out of my mouth and heart. I lost my reason for living (my beautiful husband) on June 1, 2018. I can find no reason to carry on except that no one would care for the pets we both loved. My soul is so tired and I miss my love with my whole being. I pray that God lets me die soon.
Bill September 20, 2015 at 6:47 pm
I lost my Dad, then my brother almost a year to the day later, and then my oldest sister about year and a half after that. I was very close to my Dad and brother. My sister had ran off with a cult when I was young, and with her being 12 years older, we were never that close.
What I have experienced has been anger and rage. Much of it stemming from the seemingly apathetic response from my “friends”. It has made me feel like my Dad and brothers’ lives were minuscule and unimportant. I guess deep inside, the fear of a person’s life just not mattering that much is terrifying.
Unfortunately, it has become destructive to my mental and physical health. I have exploded at remaining family members, as well as the one true friend I feel I have left. I moved across country about 15 years ago, and it’s as if I’m now “out of sight and out of mind” to those back east.
What I have found really terrifying, is that the angrier I become inside, the more isolated I’ve become and the more I feel like the world could give a shit. I’m free to rage and have tantrums, but I do NOT believe anyone cares anymore.
Has anyone experienced similar feelings?
Janna May 29, 2015 at 5:49 pm
Awwww…..what timing this article is. This December it will be five years since my son’s death. I ‘thought I was doing so well.’ I have had a job change and it’s totally undone me. I’ve had all kinds of weird physical symptoms and my MD has done some simple rule outs that have all come back normal. She sat me down and we talked about the ‘physical’ triggers of grief and depression. I don’t want to admit that it might be time for help, but maybe it is.
Eleanor June 14, 2015 at 1:08 pm
Sorry it took me so long to respond. For some reason seeking help with our emotional pain seems so much more difficult than seeking help for physical pain, but it truly never hurts to talk to someone. I hope you figure out what it is that’s making you feel so crappy. I’m sorry about your son’s death.
linda September 15, 2016 at 3:30 am
Reading your posts has made me feel i ain’t alone .Its coming up 6yrs can’t believe iv’e even written that.My life since the sudden loss of my son is non excisting my only reason for getting up in the morning is my daughter as i lost both my parents after my son .I have been to all sorts of counselling and nothing makes me feel any better.Actually sometimes i get bitter at them ,as i sit snd say to myself do you know what its like to loose your only son your best friend ,its the worst pain a mother can go through i hear times a great healer and oh you will learn to live with it.How wrong for me i cannot come to terms with my son’s death i miss him so much .I do not leave my house only to go to cemetary once a week with my daughter by car.I lost all contact with friends i just cry and cry and i am in so much physical pain my heart is broken and i live one day at a time that i will see my son again
Wendy May 27, 2015 at 7:48 pm
Thank you Eleanor for touching on disorders brought on after a death.
My daughter developed an eating disorder ( with some social anxiety) after my mother, her grandmother, passed.
For a few months after, I thought she was just grieving and not eating as much.
But as it went on and I did a little research, I found she was in the throws of an ED.
Great! My mom dies and now I have to deal with a sickly girl…while I’m mourning.
They were close when she was younger and she also saw how hard in was on me being mom’s caregiver, crying at the dinner table every night. She had no control on the situation and I even shielded her from as much pain as possible. Was that right? Should I have involved her more in mom’s last few weeks? My daughter was 21 at the time.
I eventually sort of understood how she dealt with her grief- by controlling her food intake, which she says actually started while grandma was getting worse.
We all deal differently and from this article it’s no surprise to see now that she had a genetic vulnerability. And when mental illness is in the family, grief is just gonna be harder. But how weird that it can skip some in the family. I feel I have been grieving now for 2 years fairly well. Using your blog has been so helpful. So, thank you girls!!
And my daughter is recovering well and learning to grieve better.
Eleanor May 27, 2015 at 9:48 pm
I’m sorry about your mother’s death. I really appreciate your comment, I think it perfectly illustrates why we feel like this conversation is valuable. Although grief and anxiety disorders are entirely different things, it may happen that a death precipitates both and with the complicated and individual nature of grief it’s really easy to think that emotions and behaviors are only grief (because many times they are!).
I’m glad to hear everyone is doing well, I can imagine that your daughter’s healing as well as your own has taken immense strength. I’m glad to know that we have been of some help, that’s what we’re here for!! Again, thanks for your comment.
Chelsea May 27, 2015 at 6:26 pm
Personally from my own experience, you don’t go “back to normal”. That implies that the world you lived in before, complete with your loved one, one of my best friends in my case, in it still exists, and of course that can never be. That vase is broken and there will always be a missing piece, so we do what we can and must, pick up the rest of the pieces of our lives and build a new normal.
I for one am always skeptical of the idea that unless we “move on” after a certain point or if it includes certain feelings/behaviors it’s a “problem”. Probably because I must have been given that speech a dozen times by people who don’t understand but still think they have the right to tell me how to feel and what to do.
Still I’ll be the first to admit that losing my best friend Matthew when I was just a kid changed me forever in ways both positive and negative. It’s been almost 12 years since i felt truly secure with anyone. When my other bestie moved out of state this past summer and promised she’d come back and visit and that I’d see her again someday all I could think was “That’s what Matt said too…” recalling when he moved a year and a half before his death. That’s just one example but i fully admit that I can be clingy and possessive and insecure, all stretching back to when I lost Matthew. Maybe if I’d had some grief therapy or even just gone to his funeral it wouldn’t be that way.
Still I think the people who would tell me I’m depressed or something just because it dawned on me that he should have graduated high school last spring or that I mark his birth-day and his Deathaversery with a play-through of my “missing you” soundtrack and watching a little league game are exaggerating the issue.
Eleanor May 27, 2015 at 9:40 pm
Thanks for your comment, I completely agree that you never go “back to normal” rather you have to find a new sense of normalcy. Also, as we noted, this doesn’t mean you get over your grief or even find contentment – you just learn to integrate the loss, find ways to cope, and manage to make it through the day. We also agree that there is no formula or timeline associated with grief.
I’m sorry about Mathew’s death and I think it’s always normal to have those moments where you feel sad about a loss – especially at those times when he would have graduated or celebrated his birthday. Feeling down about these days, even years and years later is completely normal. Experiencing waves of grief is something entirely different than depression, a fact I think we both wish more people understood. That’s why this issue can seem so confusing because while grief and depression are different things they can sometimes co-occur. Thank you so much for your insights.