Stress Reactivity and Psychotic Disorders

Stress reactivity refers to the physiological and psychological responses that occur when an individual encounters challenging or threatening situations. In people vulnerable to psychotic disorders, even minor daily stressors can trigger a cascade of neural and hormonal changes, heightening the risk of hallucinations, delusions and other positive symptoms. Central to this process is dysregulation of the hypothalamic–pituitary–adrenal axis, which, in the face of chronic or repeated stress, leads to elevated allostatic load and altered immune signalling. Experience sampling studies have demonstrated that heightened sensitivity to social, environmental and interpersonal stressors is tightly linked to momentary increases in negative affect and psychotic experiences. Early adversities, such as childhood trauma or bullying, appear to prime maladaptive coping styles and strengthen the link between stress and symptom emergence. By elucidating these pathways, researchers aim to inform preventive strategies, personalise interventions and reduce relapse rates across clinical populations worldwide.

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Stress Reactivity and Psychotic Disorders publication trend

The graph below shows the total number of articles in stress reactivity and psychotic disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Stress reactivity: The pattern of hormonal, neural and emotional responses elicited when an individual faces a stressor.

Allostatic load: The cumulative physiological burden imposed by repeated activation of stress response systems.

Experience sampling method (ESM): A study design involving repeated, real-time prompts to assess participants’ current thoughts, emotions and context in daily life.

Aberrant salience: The inappropriate assignment of importance to otherwise neutral stimuli, often linked to the formation of psychotic symptoms.

References

1. The association between psychosocial stress, interpersonal sensitivity, social withdrawal and psychosis relapse: a systematic review. Schizophrenia (2023).
2. Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study. Schizophrenia Bulletin (2016).
3. Elevated allostatic load early in the course of schizophrenia. Translational Psychiatry (2018).
4. A history of childhood trauma and allostatic load in patients with psychotic disorders with respect to stress coping strategies. Psychoneuroendocrinology (2020).