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
uAttention deficit / hyperactive disorder (ADHD)
uDiminished dopamine signalling in the frontal cortex
uShort bursts of hyper focus
uMethylphenidate (Ritalin), a common neurotropic treatment for ADHD, also mitigates symptoms in
PTSD
uIf 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
u
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
uStress plays a role in most mental disorders. Even in disorders where it does not play a causal
role, it usually makes things much worse
u
uThree levels of analysis (which are completely artificial)
uGenetics
uEpigenetics
uContext

Genetic disruption of the stress system
uAlthough 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:
uA polymorphism on the OPRM1 (protects against PTDS but increases sensitivity to addiction)
uDAT Polymorphisms in major depression
u
uRather 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
uMany mental disorders come with a certain level of heritability. However this may not necessarily
derive from genetic predispositions alone.
u
uPrenatal influences (see lecture 3)
u
uParental behaviour
u
uSocietal interactions

Contextual influences on mental disorders
uSometimes, mental disorders are mostly the result of circumstances. Of course, however, a certain
susceptibility is required, so genetics and epigenetics do play a role.
uPost-traumatic stress disorder
uTriggered by trauma
u
uMultiple 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.
uSchizotypal episodes
uSchizophrenia
uDelusions (usually auditory hallucinations) (dopaminergic component)
uDisordered thought
uHighly disturbing and stressful
u
uSchizotypal experiences
uReligious visions
uRandom, 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
uMajor depression
u
uStrong evidence for a genetic predisposition
u
uStress triggers the disorder (3-4 episodes of severe prolonged stress)
u
uAfter the first episode it becomes much easier to trigger the next one
u
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
uThe inability to get back on your feet after a period of grieving
u
uSymptom clusters
uPsychomotor retardation (noradrenergic disruption)
uAnhedonia (dopaminergic disruption)
uThe inability to find comfort (serotonergic disruption)
u
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
uPost-traumatic stress disorder
uReaction to extreme stressor
uAcute or repeated exposure
uHypervigilance
uFlashbacks and intrusive thoughts
uNightmares
u
u
u
u
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
uNoradrenaline & the locus coeruleus
u
uDopamine
u
uβ-endorphin
uMorphine
uPost-combat delayed onset
u
uOxytocin
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
uMost mental disorders, except perhaps under certain specific circumstances PTSD, are detrimental
to peak performance.
u
uDopamine and noradrenaline disruption can massively affect physical and mental output.
u
uConversely, practices that raise reactivity or sensitivity of these neuromodulators can thus
protect or even boost output
uCold exposure (see lecture 6)
uNutritional solutions (see lecture 9)
uBehavioural practices
uPhysical exercise
uCommunal synchronisation
uMeditation