How Are Stress And Schizophrenia Connected?
People with schizophrenia often experience a disconnect from reality. They may hallucinate, have strong beliefs that aren’t true, and experience disorganized thinking and behavior. Researchers have dedicated many studies to understanding both what causes schizophrenia and how best to treat and manage the condition.
Although stress isn't necessarily the sole cause of schizophrenia, evidence suggests that stress can be a risk factor for the disorder and can potentially trigger symptoms. In addition, people who have schizophrenia may experience more stress than is typical because of the ways the disorder impacts their lives. At the same time, they may be especially sensitive to stress and find that stress exacerbates their symptoms. Schizophrenia symptoms may sometimes increase stress in the lives of the loved ones of individuals with this disorder as well. Therapy is one evidence-based stress management technique that may be helpful to anyone experiencing high levels of stress.
Stress-related schizophrenia hypotheses
Experts have developed two hypotheses to describe the role stress might play in the development of schizophrenia. These hypotheses are the diathesis-stress hypothesis and the dopamine hypothesis. Schizophrenia usually involves complex brain regulatory systems, so one single theory may not perfectly explain how it develops or worsens. It's likely that dopamine, the HPA axis, microglia, and other factors, like unusual changes in the stress hormone cortisol, all contribute to the development of schizophrenia in response to stress.
The diathesis-stress hypothesis of schizophrenia
The diathesis-stress model generally argues that a person develops a mental illness like schizophrenia for two main reasons: They are genetically vulnerable to the condition (diathesis), and they experience a traumatic event, chronic stress, or a specific stressor that triggers it to develop. Psychosocial stress like rejection or physical stress like an illness or injury could be activators.
Over the last two decades, researchers have also studied the neurobiology of the diathesis-stress model. They've found that changes in what is called the hypothalamic-pituitary-adrenal (HPA) axis likely play a role in the development of psychotic symptoms and disorders like schizophrenia. Research has also found that immune cells in the central nervous system called microglia may become overactivated by stress, which could then cause schizophrenia symptoms. These are two ways in which a person with schizophrenia or a risk of developing the condition may have a disrupted stress regulatory system.
The dopamine hypothesis of schizophrenia
Dopamine can be defined as a neurotransmitter that plays a role in many physical and mental processes, including mood and movement. The dopamine hypothesis of schizophrenia may further illuminate what might be happening in the brain when a stressor triggers or exacerbates the disorder in a person. This hypothesis primarily argues that the brains of people who experience psychotic symptoms have a disrupted stress response that involves difficulty regulating striatal dopamine release.
This may mean that the brain of a person who is predisposed to schizophrenia creates or releases more dopamine than normal in response to stressors. This increased release of dopamine can be seen in the front of the brain, or the prefrontal cortex. Research suggests that dysregulated dopamine activity may worsen as a person moves from being at risk for schizophrenia to actually developing the disorder. Dysregulated dopamine may also worsen during periods of psychotic symptoms.
Stressors that may contribute to schizophrenia
Studies have found that stress and schizophrenia may be linked in multiple ways. Various types of stressors that impact a person throughout their lifetime may play a role in triggering or worsening the disorder. These studies and their findings are explored below.
Stress before birth
Schizophrenia research suggests that the stress a person experiences in the womb could play a role in their risk of developing the disorder. Having a mother who experienced more psychological stress during pregnancy or experienced an infection generally increases a person's risk of developing schizophrenia. Having a mother who didn't gain enough weight during pregnancy may also increase a person's risk of developing schizophrenia and other psychiatric disorders, like bipolar disorder and depression.
Researchers suggest that when a pregnant woman experiences stressful life events, her stress hormones may impact the growing fetus. As a result, the development of a major part of the fetus's own stress system, called the hypothalamic-pituitary-adrenal (HPA) axis, may be impacted. Other research suggests that HPA axis activity could play a role in why stressors may trigger schizophrenia in a person later in life.
Adverse childhood experiences (ACEs)
The development of schizophrenia tends to be more likely among people who have experienced adverse childhood experiences (ACEs). These experiences may include physical abuse, sexual abuse, emotional abuse, parental neglect, severe bullying, or growing up in a home with adults who are addicted to alcohol or other substances. ACEs can also be linked to other mental health challenges, like depression and substance misuse.
If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.
Often, people experience cognitive symptoms in what is called the “prodromal phase,” or the period immediately before they develop schizophrenia. Prodromal symptoms can include trouble thinking, impaired IQ, difficulty focusing one's attention, and memory problems. Research suggests that ACEs may contribute not only to the development of schizophrenia, but to cognitive impairments found both in people who later develop schizophrenia and those who do not.
Traumatic events
Experiencing a traumatic event may make a person more likely to develop schizophrenia, especially in the first five years after the traumatic event occurred. Traumatic events can be defined as happenings that are perceived as frightening, dangerous, and shocking. Natural disasters, acts of violence, terror attacks, abuse, and car crashes may all be experienced as traumatic events. Because schizophrenia may be linked to traumatic events, the condition may also be linked to trauma-related disorders, like post-traumatic stress disorder (PTSD) and acute stress reaction (ASR). More research is likely needed, but treating traumatic stress could potentially reduce a person's risk of developing schizophrenia or other psychotic disorders afterward.
Chronic stress
- Urban living, which is typically associated with more noise and crime
- Immigrant or migrant status
- Poverty or low-income status
- Social isolation or a lack of belonging
- Lack of educational or material resources
Stressful life events
One study found that 46% of people with schizophrenia had experienced a stressful life event in the months before developing the disorder. Sometimes, stress of many types may accumulate over time, and one final event may seem to trigger the disorder, rather than the disorder being triggered by the final event alone. Stressful life events may include the death of a loved one, divorce or separation, serious illness or injury, being fired from a job, and more.
Schizophrenia stress management strategies
Often, people with schizophrenia experience a symptom pattern in which they experience psychosis, enter remission, and then relapse into psychosis again months or years later. Research suggests that stress can be a risk factor for psychosis relapse. For this reason, managing stress can be part of a schizophrenia treatment plan. Strategies for managing stress in schizophrenia can include the following:
- Avoiding the use of alcohol, recreational substances, and nicotine
- Practicing relaxation techniques, like yoga, meditation, or tai chi
- Learning about schizophrenia to better understand how to manage the condition
- Maintaining a strong social support network
- Receiving one-on-one therapy from a qualified provider
- Attending family therapy, which can reduce stress in family members as well
- Joining group therapy programs or social support groups
- Receiving social skills and communication training
- Entering a training and employment program that can lead to stable work
Therapy for schizophrenia
One-on-one talk therapy can be a useful part of a broader treatment strategy for schizophrenia that includes doctor-prescribed medication and other stress management tools. Remote therapy may be an especially attractive option. With remote therapy, a person can attend sessions from the comfort of their home or from wherever they feel most comfortable. Since schizophrenia can involve social discomfort, some people with the disorder may prefer meeting with a therapist remotely instead of traveling and potentially interacting with others. BetterHelp can connect anyone looking for remote therapy with providers best suited to their needs. However, those currently experiencing acute psychosis may require in-person support.
Researchers have concluded that remote treatment options for schizophrenia can be viable alternatives to in-person therapy sessions. Multiple studies have looked at remote treatment options, including cognitive behavioral therapy (CBT) conducted over messaging and phone conversations. Some studies found that remote CBT helped people with schizophrenia continue taking their medication. Online CBT also reduced hallucinations, promoted coping strategies, and improved social skills for many individuals.
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