Performing under Pressure; on the
Biology, Psychology and Sociology of
stress in high-performance professions
V - STRESS RELATED DISORDERS AND WHAT THEY CAN TEACH US ABOUT
PERFORMANCE
Disclaimer
I am not a psychiatrist! I am a scientist!
Especially if you are experiencing
mental health issues, do NOT try
anything we discuss today without first
consulting your specialist. Non of the
information discussed today reflects
individual differences and your
personal physician can judge much
better than I ever can, how this
information may affect you.
Through the study of stress related
disorders, we can gain knowledge
of the stress system in healthy
populations, that we would
otherwise not be privy to.
One example
 Attention deficit / hyperactive disorder
(ADHD)
 Diminished dopamine signalling in the frontal
cortex
 Short bursts of hyper focus
 Methylphenidate (Ritalin), a common
neurotropic treatment for ADHD, also
mitigates symptoms in PTSD
 If we can figure out how to hyper focus works
in ADHD and can be reproduced, we can
potentially increase cognitive and physical
output out put in non ADHD individuals
Mehta, T. R., Monegro, A., Nene, Y., Fayyaz, M., & Bollu, P. C. (2019). Neurobiology of ADHD: A Review. Current Developmental Disorders
Reports, 6(4), 235–240. https://doi.org/10.1007/s40474-019-00182-w
Antshel, K. M., Biederman, J., Spencer, T. J., & Faraone, S. V. (2016). The Neuropsychological Profile of Comorbid Post-Traumatic Stress
Disorder in Adult ADHD. Journal of Attention Disorders, 20(12), 1047–1055. https://doi.org/10.1177/1087054714522512
Aga-Mizrachi, S., Cymerblit-Sabba, A., Gurman, O., Balan, A., Shwam, G., Deshe, R., … Avital, A. (2014). Methylphenidate and
desipramine combined treatment improves PTSD symptomatology in a rat model. Translational Psychiatry, 4(9).
https://doi.org/10.1038/tp.2014.82
The role of stress in mental disorders
 Stress plays a role in most mental disorders. Even in disorders where it
does not play a causal role, it usually makes things much worse
 Three levels of analysis (which are completely artificial)
 Genetics
 Epigenetics
 Context
Genetic disruption of the stress
system
 Although there seem to be heritable components to stress sensitivity
and there are specific genetic disorders in which the stress system is
dysregulated, in general there is remarkably little evidence for genetic
‘determinism’. Potential exceptions:
 A polymorphism on the OPRM1 (protects against PTDS but increases
sensitivity to addiction)
 DAT Polymorphisms in major depression
 Rather many genes which code for components of the stress system
express dysfunctional if, and only if, certain conditions are met (i.e.
epigenetics).
Opmeer, E. M., Kortekaas, R., & Aleman, A. (2010). Depression and the role of genes involved in dopamine metabolism and signalling.
Progress in Neurobiology, 92(2), 112–133. https://doi.org/10.1016/j.pneurobio.2010.06.003
Gelernter, J., & Polimanti, R. (2021). Genetics of substance use disorders in the era of big data. Nature Reviews Genetics, 22(11), 712–729.
https://doi.org/10.1038/s41576-021-00377-1
Nugent, N. R., Lally, M. A., Brown, L., Knopik, V. S., & McGeary, J. E. (2012). OPRM1 and diagnosis-related posttraumatic stress disorder in
binge-drinking patients living with HIV. AIDS and Behavior, 16(8), 2171–2180. https://doi.org/10.1007/s10461-011-0095-8
Heritability
 Many mental disorders come with a certain level of heritability.
However this may not necessarily derive from genetic predispositions
alone.
 Prenatal influences (see lecture 3)
 Parental behaviour
 Societal interactions
Contextual influences on mental
disorders
 Sometimes, mental disorders are mostly the result of circumstances.
Of course, however, a certain susceptibility is required, so genetics
and epigenetics do play a role.
 Post-traumatic stress disorder
 Triggered by trauma
 Multiple personality disorder (nowadays dissociative Identity disorder)
and the satanic panic
Mulhern, S. (2008). Satanism , Ritual Abuse , and Multiple Personality Disorder : A Sociohistorical Perspective SATANISM ,
RITUAL ABUSE , AND MULTIPLE PERSONALITY DISORDER : 7144. https://doi.org/10.1080/00207149408409359
Spanos, N. P. (1994). Multiple Identity Enactments and Multiple Personality Disorder : A Sociocognitive Perspective. II(1),
143–165.
Mac Gillavry, D. W., & Ullrich, D. (2020). A novel theory on the predictive value of variation in the β-endorphin system on
the risk and severity of PTSD. Military Psychology, 1–14. https://doi.org/10.1080/08995605.2020.1730111
Stress in mental disorders I: It does not cause it,
but does make everything much worse.
 Schizotypal episodes
 Schizophrenia
 Delusions (usually auditory hallucinations) (dopaminergic component)
 Disordered thought
 Highly disturbing and stressful
 Schizotypal experiences
 Religious visions
 Random, usually non-stressful, experiences
Smith, L., Riley, S., & Peters, E. R. (2009). Schizotypy, delusional ideation and well-being in an American new religious movement population.
Clinical Psychology and Psychotherapy, 16(6), 479–484. https://doi.org/10.1002/cpp.645
Howes, O., McCutcheon, R., & Stone, J. (2015). Glutamate and dopamine in schizophrenia: An update for the 21st century. Journal of
Psychopharmacology, 29(2), 97–115. https://doi.org/10.1177/0269881114563634
Stress in mental disorders II: the trigger and
accelerator
 Major depression
 Strong evidence for a genetic predisposition
 Stress triggers the disorder (3-4 episodes of severe prolonged stress)
 After the first episode it becomes much easier to trigger the next one
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th. In American
Journal of Psychiatry. https://doi.org/10.1176/appi.books.9780890425596.744053
Symptoms and importance to stress
research
 The inability to get back on your feet after a period of grieving
 Symptom clusters
 Psychomotor retardation (noradrenergic disruption)
 Anhedonia (dopaminergic disruption)
 The inability to find comfort (serotonergic disruption)
Moret, C., & Briley, M. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment, 7(SUPPL.), 9–13.
https://doi.org/10.2147/NDT.S19619
Lutz, P. (2018). The opioid system and the social brain : implications for depression and suicide. (February), 1–13.
https://doi.org/10.1002/jnr.24269
Weele, C. M. V., Siciliano, C. A., & Tye, K. M. (2019). Dopamine tunes prefrontal outputs to orchestrate aversive processing. Brain
Research, 1713(August 2018), 16–31. https://doi.org/10.1016/j.brainres.2018.11.044
Kilpatrick, D. G., Ph, D., Koenen, K. C., Ph, D., Ruggiero, K. J., Ph, D., … Gelernter, J. (2007). The Serotonin Transporter Genotype and
Social Support and Moderation of Posttraumatic Stress Disorder and Depression in Hurricane-Exposed Adults. American Journal of
Psychiatry, 164(November), 1693–1699.
Stress induced mental disorders III:
disorders in which stress is the defining
feature
 Post-traumatic stress disorder
 Reaction to extreme stressor
 Acute or repeated exposure
 Hypervigilance
 Flashbacks and intrusive thoughts
 Nightmares
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th. In American Journal of
Psychiatry. https://doi.org/10.1176/appi.books.9780890425596.744053
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research
(pp. 155–157). pp. 155–157. https://doi.org/10.1002/1520-6505(2000)9:5<201::AID-EVAN2>3.3.CO;2-P
Neuromodulators involved in PTSD
 Noradrenaline & the locus coeruleus
 Dopamine
 β-endorphin
 Morphine
 Post-combat delayed onset
 Oxytocin
van Zuiden, M., Frijling, J. L., Nawijn, L., Koch, S. B. J., Goslings, J. C., Luitse, J. S., … Olff, M. (2017). Intranasal Oxytocin to Prevent Posttraumatic Stress
Disorder Symptoms: A Randomized Controlled Trial in Emergency Department Patients. Biological Psychiatry, 81(12), 1030–1040.
https://doi.org/10.1016/j.biopsych.2016.11.012
Ullrich, D., & Mac Gillavry, D. W. (2021). Mini-review : A possible role for galanin in post-traumatic stress disorder. Neuroscience Letters, 756(May), 135980.
https://doi.org/10.1016/j.neulet.2021.135980
Lee, J. C., Wang, L. P., & Tsien, J. Z. (2016). Dopamine rebound-excitation theory: Putting brakes on PTSD. Frontiers in Psychiatry, 7(SEP).
https://doi.org/10.3389/fpsyt.2016.00163
Pan, X., Kaminga, A. C., Wen, S. W., & Liu, A. (2018). Catecholamines in post-traumatic stress disorder: A systematic review and meta-analysis. Frontiers
in Molecular Neuroscience, 11(December). https://doi.org/10.3389/fnmol.2018.00450
Relevance to peak performance
 Most mental disorders, except perhaps under
certain specific circumstances PTSD, are
detrimental to peak performance.
 Dopamine and noradrenaline disruption can
massively affect physical and mental output.
 Conversely, practices that raise reactivity or
sensitivity of these neuromodulators can thus
protect or even boost output
 Cold exposure (see lecture 6)
 Nutritional solutions (see lecture 9)
 Behavioural practices
 Physical exercise
 Communal synchronisation
 Meditation