Grief and Psychological Disorder: Understanding the Diathesis-Stress Model

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 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 early on 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 that 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.  It 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, these are things 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).

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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 engage in your daily 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).

You’ve gotten this far, I suppose you should probably just subscribe.


COMMENTS

Chelsea

Posted on 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.

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Eleanor

Posted on May 27, 2015 at 9:40 pm

Hey Chelsea,

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.

Eleanor

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Wendy

Posted on 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.

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Eleanor

Posted on May 27, 2015 at 9:48 pm

Hey Wendy,

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.

Eleanor

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Janna

Posted on 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.

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Eleanor

Posted on June 14, 2015 at 1:08 pm

Janna,

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.

Eleanor

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linda

Posted on 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

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Bill

Posted on 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?

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Tam

Posted on 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.

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Susan

Posted on July 14, 2016 at 7:49 am

I recently was part of a three-person team of family who made the agonizing decision to take my father-in-law off of life support. He was a strong, handsome, virile, robust man of 80 and walked into the hospital with pneumonia and never left. My husband and I are both only children and my mother-in-law was an emotional wreck. There were no other siblings to confer with (read: share burden with), he wasn’t my father and I knew, at the time, I was the one who was, by default, who would be looked at as the most objective. I agreed 100% with my MIL and husband’s decision, but now, a month later, i find myself quieter, either unable to sleep or sleeping a lot, unmotivated to do anything…even cook, although I do, uninterested in doing anything. I am professor and have this summer “off” so thank God I don’t have to show up for work, but maybe that too is unhealthy. I think human beings have a sympathy quotient and I am seeing the eyes of my loved ones glaze over when I try to talk with them about this. It is frightening to most, I understand: raw and ugly, but I am scared I will never recover. I am 30 years sober, so taking a diazopen or “a glass of wine before bed” is not an option for me. I admit I did smoke some pot recently (after over 30 years; pot never worked even when I wasn’t sober) and had a MASSIVE anxiety attack, so that’s out. I am 57 and think to myself that I somehow should “know” how to do this grief thing, but I am absolutely devastated as is my husband who is chipping away recently on drugs to “get him through.” It’s so messed up. I feel lonely, angry, lethargic, afraid.

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Sandy

Posted on 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.

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Heather Potter

Posted on 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.

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