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Loyalty is a virtue we value in relationships with family, friends, romantic partners, workplaces, organizations, religions, and nations. But what is loyalty, and why is it important?

This article explores the characteristics, benefits, and drawbacks of loyalty, as well as some strategies to build loyalty in relationships.

Characteristics of Loyalty

Loyalty is faithfulness, dedication, honesty, trust, and support in a relationship, says Sabrina Romanoff, PsyD, clinical psychologist and professor at Yeshiva University in New York City. It requires an emotional commitment and engenders a sense of identity. Below, Dr. Romanoff explains some of the characteristics of loyalty.

Steadfastness and Support

Loyalty involves accepting and loving someone for who they are and not threatening to leave when things become challenging. People display loyalty by weathering storms together, providing support, and sticking them out.

Consistency

Loyalty means being consistent in your treatment, behavior, and regard for another—being the person they can always count on. Loyalty also involves consistently treating the other person with kindness, fairness, and generosity of spirit.

Honesty and Transparency

Being vulnerable and not hiding parts of your identity or parts of your life are important aspects of loyalty. People who share their thoughts and feelings display a willingness to be known and to know others in an authentic, open way.

Benefits and Drawbacks of Loyalty

Loyalty can have both benefits and drawbacks, as Dr. Romanoff explains.

Benefits of Loyalty

Loyalty can strengthen relationships because people are more honest and forthcoming when they know the other person is loyal. It engenders trust and closeness in relationships.

This is true for romantic, work, family, and social relationships. When we feel others are loyal to us, we can be authentic and take off the socially acceptable filters that we tend to display our behaviors through.

Loyalty helps build support, which is important for mental, emotional, and physical well-being. Knowing you have people who have your back and will be there for you when you need them can help you feel secure.

Drawbacks of Loyalty

Some people remain in relationships that no longer serve them. In these instances, their sense of loyalty can cause them to become exploited or abused. Although loyalty is an important trait, it should never be used against someone.

Someone who is loyal can have difficulty recognizing when someone they love is manipulating them. An outside perspective from a friend, family member, colleague, or therapist who has their best interests at heart can be helpful.

You can’t always sever relationships completely, but setting boundaries with people who are taking advantage of your loyalty is important.

How to Build Loyalty

Dr. Romanoff suggests these tips—and some time—to help build loyalty.

• Show appreciation: Show that you value the person. Communicate how important their presence is in your life. Don’t take them for granted. Showing someone your loyalty can foster their loyalty, too.
• Be supportive: Offer encouragement when they’re struggling, and help them face their problems. Don’t give up on them when challenges arise. They should know you’re there for them through thick and thin.
• Maintain their confidence: If they share their secrets, hopes, plans, fears, or insecurities with you, respect their privacy and avoid passing judgment.
• Keep promises: Make it a point to follow through on commitments. Be honest if you can’t.
• Honor your relationship. Be faithful in whatever way you and your partner define that.
• Be honest: Don’t keep secrets. Be authentic with them, even when vulnerability is uncomfortable. Being your true self helps promote trust and loyalty.
• Act in their best interests: Acting on ulterior motives, talking behind their back, or embarrassing them in public shows disloyalty.
• Address problems within the relationship: Manage issues directly instead of talking about them to other people. This shows that you value your relationship and don’t seek or require external validation.
• Treat them fairly: If you’re having a disagreement, consider their perspective, even if it clashes with yours. Ignoring or avoiding difficult conversations can cause issues later on. 

“Hysteria” in Victorian times described a cluster of signs and symptoms such as hallucinations, nervousness, and partial paralysis thought to affect only women. These are now known to be common in psychological conditions such as dissociative and somatic disorders in both males and females. “Hysteria” is also modern slang for a state of excessive emotion and behavior, often amusement and laughter.

History of Hysteria

Hysteria referred to a psychological disorder in females as far back as 1900 BCE, when ancient Egyptians first described the condition as “spontaneous uterus movement.” It was also known as “wandering uterus.” To treat it, Egyptians placed bad-smelling or other scented substances near the woman’s vulva or face, depending on whether the uterus was thought to have moved up or down. The Greek physician Celsus suggested that both virginity and abstinence helped cure hysteria.

The notion that this condition affected only females was common until the early 1600s, when anatomist Thomas Willis concluded that hysteria did not originate in the uterus, but in the brain. This understanding opened the possibility that hysteria could affect men as well. Still, the term remained a common diagnosis for women, particularly in Victorian times. The second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1968, mentioned “hysterical neurosis”—a term deleted in 1980.

Today, people exhibiting “hysterical” symptoms might be diagnosed with somatic symptom disorder, dissociative disorder, or conversion disorder.

Hysteria and Psychoanalysis

Hysteria helped shape the field of psychoanalysis. In the 1800s, for example, French neurologist Jean-Martin Charcot used hypnosis to treat women suffering from hysteria. The famed Austrian psychoanalyst Sigmund Freud studied with Charcot, so he had firsthand experience observing these patients and Charcot’s treatment methods.

Freud’s work with colleague Josef Breuer on the case of Anna O, a young woman experiencing symptoms of hysteria, helped lead to the development of psychoanalytic therapy. Anna found that simply talking about her problems with a therapist had a major impact on her well-being and dubbed this treatment the “talking cure”—also known today as talk therapy. 

Freud’s colleague, Carl Jung, treated Sabina Spielrein, a young woman also thought to suffer from hysteria. Jung and Freud’s many discussions of Spielrein’s case helped give rise to their theories. Spielrein herself became a psychoanalyst who helped bring the psychoanalytic approach to Russia before the Nazis murdered her during World War II.

What Does Hysteria Feel Like?

Signs and symptoms considered characteristic of hysteria include:

Additional symptoms often associated with a hysterical state vary but include:

• Feeling as though in a trance
• Developing amnesia
• Experiencing paralysis
• Fainting or passing out (syncope)
• Having epileptic-like seizures
• Feeling increased pain sensations
• Rigid or spasming muscles

Hysteria’s Evolving Diagnoses

Now known as an outdated term for a cluster of signs and symptoms, hysteria can feature in several psychological disorders.

Dissociative Disorders

Dissociative disorders interrupt aspects of consciousness such as identity and memory. Disorders in this category include:

Somatic Symptom Disorder

Several conditions fall within this category, including:

In somatic symptom disorder, the person is preoccupied with physical symptoms such as weakness, pain, or shortness of breath, causing significant distress and difficulties with normal functioning. The person might (or might not) have a true physical problem, so it’s important to note that they aren’t faking an illness per se: They truly believe that they are ill. 

Causes of Hysterical Signs and Symptoms

Over time, theories about what causes hysteria have changed. Although they originally focused on the uterus, researchers now know that the causes of both dissociative and somatic disorders are often psychological.

Dissociative disorders are generally caused by some type of trauma, such as physical, sexual, or emotional abuse. Natural disasters and military combat experiences also can lead to a dissociative disorder.

Somatic symptom disorder can also arise from childhood abuse or parental neglect, as well as from extreme anxiety about bodily processes and illness combined with a low pain threshold.

Hysterical contagion, a form of social contagion, causes symptoms often associated with hysteria to spread among people. In this phenomenon, groups develop symptoms that could be attributed to a physical or contagious source; however, in reality, they stem from social and psychological influences.

Treatment for Hysteria

Treating hysteria-like symptoms associated with dissociative and somatic symptom disorders typically includes psychotherapy. Common treatment approaches include:

In some cases, medications are prescribed to help reduce symptoms—for example, amitriptyline, selective serotonin reuptake inhibitors (SSRIs), and St. John’s wort.

Coping With Hysteria

If you or a loved one experience symptoms once associated with hysteria—such as having emotional outbursts, losing sensation, or having hallucinations—seek the help of a mental health professional. In the meantime, here are a few tips to help you cope:

• Practice mindfulness. Concentrate on the present instead of focusing on yesterday or tomorrow. This can help you stay grounded.
• Engage in breathing exercises. Relax your feelings of anxiety by breathing in and out in specific patterns.
• Write in a journal. Get your feelings out on paper. Put the sources of your stress in black and white, then let them go.
• Get physically active. Go for a walk, hike, or bike ride. Physical activity helps boost mental health
• Develop a consistent sleep schedule. Give your body the rest it needs so you can deal with the symptoms and emotions you’re feeling.

A person who has been sexually assaulted will generally experience high levels of distress immediately afterward. The trauma of being assaulted can lead to fear, anger, guilt, anxiety, and sadness. The stigma associated with sexual assault may cause embarrassment or shame for some people.

In addition, survivors of sexual assault have an increased likelihood of developing symptoms of post-traumatic stress disorder (PTSD). They might feel as though they are always in danger or need to always be on guard, and may distrust other people.

Such symptoms can continue for months or even years without treatment. This article discusses how sexual assault can lead to an increased risk of PTSD. It also covers the symptoms that people might experience and what they can do to get help.

What Is Sexual Assault?

The term “sexual assault” refers to a range of behaviors that involve unwanted, coercive, or forceful sexual contact or conduct. Sexual assault can include rape, attempted rape, and any form of unwanted sexual touching.

Sexual assault occurs with alarming frequency in the United States. Additionally, survivors of childhood sexual assault have an increased likelihood of being assaulted again in adulthood.

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that causes a variety of troubling symptoms in the aftermath of a traumatic event like sexual assault.

PTSD is fairly common among people who have experienced sexual assault. In one study, nearly 75% of sexual assault survivors met the diagnostic criteria for PTSD one month after an assault, and nearly 48% still met the criteria one year after an assault.

Symptoms of PTSD may include re-experiencing the traumatic event, avoiding reminders of the trauma, startling easily, and having negative thoughts and beliefs.

Symptoms of PTSD After Sexual Assault

“Sexual assault is a devastating violation that undermines one’s feelings of safety and trust. It is common for sexual assault survivors to experience a host of symptoms in the immediate aftermath of their assault, including vivid flashbacks, nightmares, avoidance, feeling numb, guilty, or depressed, and being easily startled, jumpy, or irritable,” says Michele Cascardi, PhD, a licensed clinical psychologist and psychology professor at William Paterson University.

Survivors of sexual assault can experience severe and chronic symptoms of PTSD, such as:

• Body aches
• Fatigue
• Flashbacks
• Headaches
• Insomnia
• Nightmares

Survivors’ experience of PTSD might include:

• Avoidance, such as avoiding thoughts or feelings of the traumatic event (emotional avoidance); staying away from reminders of the trauma such as people, places, objects, or situations; and resisting conversations about what happened.
• Intrusive symptoms, such as repeated, unwanted memories of the event, recurrent nightmares, and flashbacks.
• Increased arousal, such as trouble falling or staying asleep, being easily startled or fearful, trouble concentrating, and hypervigilance to surroundings, and potential threats to safety.
• Changes in thoughts and feelings, such as ongoing, distorted beliefs about oneself or others; recurrent feelings of fear, horror, anger, guilt, shame, or hopelessness; loss of interest in once enjoyable activities; feeling detached from others or struggling to maintain close relationships; and difficulty experiencing positive feelings like joy or satisfaction.

Cascardi notes that while some of these symptoms can be a normal part of the healing process in the days and weeks after an assault, persistent symptoms that affect a person’s quality of life and ability to function normally may indicate the development of PTSD.

Other Effects of Sexual Assault

Sexual assault can take a toll on physical, sexual, and behavioral health for months or even years after the event took place.

Physical Health

A sexual assault can bring on a number of chronic physical conditions, which are also common among people with PTSD. For example, women who have been raped have been found to be more likely to experience:

• Arthritis
• Chronic pelvic pain
• Digestive problems
• Intense premenstrual symptoms
• Non-epileptic seizures

Additionally, people who are survivors of rape or attempted rape are at an increased risk of contracting a sexually transmitted infection (STI), which can lead to additional physical and emotional health problems.

Sexual Health

Enjoying sexual contact can be difficult after experiencing sexual trauma. Someone who has survived a sexual assault may experience low sexual desire and reduced sexual behavior.

Some survivors experience pain, fear, or anxiety with sexual contact. Shame and guilt stemming from the trauma can also interfere with desire for and satisfaction from sex.

Survivors of childhood sexual assault are likely to have more severe sexual problems. Penetration during sexual assault will also increase the risk for future sexual problems.

Behavioral Health

There is no single behavioral reaction to sexual assault. Some survivors avoid sex after experiencing assault, while others engage in risky sexual behaviors such as not using protection or having a greater number of sexual partners.

Survivors may also turn to unhealthy behaviors like substance use and self-harm in an effort to cope with the intense unpleasant emotions that come from being assaulted.

These feelings may subside over time for some people. Others, however, will continue to experience some form of psychological distress for months or years.

Treatments for PTSD After Sexual Assault

For many who survive sexual assault, these symptoms will subside over time. However, for some, these symptoms may linger and even get worse. Fortunately, there are treatments available that have been found to help.

Psychotherapy

Psychotherapy has been proven effective in treating symptoms of PTSD following sexual assault. Cascardi notes that there is growing evidence for the effectiveness of cognitive processing therapy, prolonged-exposure therapy, and eye movement desensitization and reprocessing therapy.

• Cognitive processing therapy (CPT) helps people confront unpleasant memories and thoughts associated with the sexual assault. During CPT, a therapist will also guide them to correct any maladaptive, unrealistic, or problematic thoughts driving their PTSD symptoms.
• Prolonged-exposure therapy targets any learned behaviors people engage in or avoid in response to situations, thoughts, and memories associated with the sexual assault. The hope is that by confronting feared emotions, thoughts, and situations, they can learn that anxiety and fear will lessen on their own.
• Eye movement desensitization and reprocessing (EMDR) therapy can also help treat trauma related to sexual assault. This type of therapy uses rhythmic bilateral eye stimulation to help reduce the emotional effects of traumatic memories. While individual responses can vary, research has found that this approach can be effective in treating PTSD.

Mays explains that treatments for trauma can involve either a top-down or bottom-up approach. “A top-down approach focuses on the person’s thinking, beliefs, and behaviors and works to create change in those areas. Cognitive Behavioral Therapy is an effective example of this,” she says. A bottom-up approach, such as EMDR, focuses on releasing the trauma a person holds in their body.

Support Groups

Joining an online or in-person support group provides the opportunity to connect with other survivors of sexual assault and get advice on overcoming the challenges associated with that trauma.

Support groups provide an excellent opportunity to develop supportive, trusting, and healthy relationships with other people with a shared experience. Your primary care physician or mental health professional is often the best place to start when searching for a local support group. 

Self-Help

In addition to talking to a therapist and/or joining a support group, there are some lifestyle changes and coping techniques you can do on your own to calm your body and mind and manage your symptoms.

• Spend time with supportive loved ones. Go for a walk, grab some morning coffee, or talk on the phone.
• Practice relaxation strategies. Find time for prayer, meditation, yoga, or progressive muscle relaxation.
• Go for a morning walk. Taking time to enjoy the outdoors, get some fresh air, and move your body can help regulate your mood and emotions.
• Keep a journal. A journal can offer a consistent place to write and process your feelings and experiences. 

How to Help a Loved One

“Healing sexual trauma is a process that takes time and that the person will go through many different emotions and experience the impact in different areas of their lives,” Mays explains.

If your partner or another loved one is experiencing symptoms of PTSD after a sexual assault, there are things you can do to help.

• Listen: Let your loved one feel like they can confide in you, but don’t pressure them to talk about their trauma. When they do decide to talk, focus on listening, being supportive, and validating what they are feeling.
• Avoid blame: Don’t focus on the events themselves or ask “why” questions that imply blame. People who have experienced sexual assault often struggle with not being believed or with being shamed and blamed for their assault. 
• Don’t pressure: Even if you feel like your loved one should take a certain action, whether it is talking to authorities or seeking treatment, focus on being supportive and respectful of how they want to handle the situation.
• Offer to help: If your loved one does want to talk to a healthcare provider or seek help from a mental help professional, look for ways that you can help. For example, you might offer to help them find a healthcare professional or go with them to their therapy appointments.

Having supportive relationships is important for people who have experienced trauma. Research has found that poor social relationships can impair PTSD recovery.

If you’re looking for a simple answer as to what causes mental health conditions, the answer is that there isn’t one. The fact is that mental conditions have *many* causes. However, experts believe that it’s often a combination of genetics and stress that contributes to their onset.

The diathesis-stress model is a theory suggesting that mental disorders and medical conditions are caused by a combination of an inherent predisposition and the person’s experience of stress. Also known as the vulnerability-stress model, it is a framework for understanding how existing vulnerabilities and environmental stresses interact to influence mental health conditions.

It also explains why prolonged stress often contributes to anxiety, depression, and other disorders. And while we can’t really change our genetic vulnerabilities, there are steps we can take to limit and manage our stress. According to the diathesis-stress model, doing so can play a big role in protecting your mental well-being.

Understanding Diathesis and Stress

While the term sounds unwieldy and complex, the phenomenon it explains is relatively easy to understand. 

• Diathesis refers to a predisposition or vulnerability to developing a mental disorder. This can be due to genetic factors, early life experiences, or other biological susceptibilities. 
• Stress refers to the environmental factors that trigger the onset of mental illness or exacerbate existing conditions. These can include significant life events, trauma, and daily stressors.

History of the Diathesis Stress Model

The model can trace its origins to the 1950s, although roots of this theory date to much earlier. Paul Meehl, in the 1960s, applied this approach to explain the origins of schizophrenia. Since then, it has also been utilized to understand the development of depression.

According to researchers who use this viewpoint, people with a predisposition for depression are more likely to develop the condition when exposed to stress. This theory was later expanded to include other mental health conditions, including anxiety and eating disorders. 

How the Diathesis Stress Model Works

Everyone has vulnerabilities due to genes, genetic abnormalities, or the complex interaction of various genes. But just because these predispositions exist does not mean that an individual will develop a particular condition. 

In many cases, a disorder will only emerge when stress-related pressures trigger the underlying diathesis. This exposure to stress can trigger the mental disorder’s onset or worsen existing symptoms.

The diathesis-stress model is one way to explain why some people are more vulnerable to mental illness than others. It also explains why some people may develop a mental disorder after exposure to stressful life events while others do not.

However, it is essential to remember that in most cases, no single gene is responsible for causing a mental disorder. Instead, it is often the result of many genes or other biological factors interacting with environmental variables that determine overall risk.

Types of Conditions Linked to Diathesis and Stress

The diathesis-stress model has been implicated in the onset of lots of different mental health conditions. This includes some of the most common mental disorders in the U.S., such as anxiety and depression. Some of many different types of mental health conditions include:

Anxiety Disorders

While the exact causes of anxiety disorders are unknown, genetic vulnerabilities and exposure to stressful life events can play a big part. Researchers note that anxiety disorders tend to run in families. Having an inherited predisposition means that traumatic experiences are more likely to trigger anxiety. Genetics can also impact how people manage stress.

Depression

A combination of factors is believed to contribute to the onset of depression, including genetics, a family history of depression, and exposure to stressful life events. The theory suggests that people with genetic vulnerabilities are more likely to become depressed when they are dealing with prolonged stress.

Financial problems, relationship issues, or trauma can trigger emotional and physical responses that overwhelm a person’s coping abilities. When these stresses surpass a person’s ability to cope, it can contribute to the development of depression.

Schizophrenia

Experts suggest that schizophrenia is caused by a combination of genetics and stressful events. For example, around 25% of individuals with 22q11.2 deletion syndrome (aka DiGeorge Syndrome) develop schizophrenia, indicating a significant genetic component.

However, not everyone with this genetic variation experiences schizophrenia, suggesting that environmental factors also play a part.

Eating Disorders

Genetic, environmental, and psychosocial factors are believed to contribute to the development of eating disorders. For many people, stressful life events that leave them feeling a loss of control can lead people with inherent vulnerability to extreme behaviors to control weight and food intake.

Uses for the Diathesis Stress Model

The diathesis-stress model has been used to help improve research, diagnosis, and treatment of mental disorders. Some uses for this model include:

• Understanding the causes of mental illness: Where other models of mental illness focus primarily on nature or nurture, the diathesis-stress model suggests that mental disorders are best understood as resulting from biological and environmental influences. 
• Reducing the stress that contributes to mental disorders: Because of the emphasis on the role stress plays in causing mental illness, this model encourages the use of stress reduction strategies to help limit disease risk. While genetic and other biological factors cannot be controlled, stress is a modifiable risk factor that people can address through lifestyle changes. This may include stress-relief techniques, such as relaxation and mindfulness.
• Exploring the interactions of biological and environmental influences: The diathesis-stress model is also helpful in understanding the complex interaction of biological and environmental factors in developing mental disorders. It can help guide research to identify the causes of mental illness, ultimately leading to the development of more effective treatments.
• Understanding the impact of genetics and environment: This model helps explain why some people are more likely to develop mental health conditions following stressful events and why others are not.

Impact of the Diathesis-Stress Model

The diathesis-stress model has influenced how researchers investigate mental health conditions. It has helped shift the focus of research from nature vs. nurture debates to a more nuanced understanding of how biological and environmental factors contribute to mental illness.

The diathesis-stress model has also helped change how mental disorders are treated. The model suggests that treatment should reduce stress and address the underlying diathesis to the degree possible. This has led to the use of new therapies, such as mindfulness-based stress reduction, that might mitigate these risks.

How to Manage Your Stress

Avoiding all sources of stress isn’t realistic (let’s face it, life *is* stressful sometimes). However, limiting your stress and developing strong stress management skills may help lower your health risks. Some things you can do include:

• Identify your sources of stress: Where is it coming from? What is it about the situation that is stressing you out?
• Explore ways to avoid or minimize your stress: Can you get rid of the stress? Are there things you can do to limit your exposure to the stress?
• Develop healthy coping mechanisms: Healthy coping skills can include self-care, relaxation, and problem-solving techniques.
• Use relaxation strategies: Try stress relief techniques such as deep breathing, progressive muscle relaxation, and guided meditation
• Exercise regularly: Research has shown that regular physical activity can help lower stress.
• Write in a gratitude journal: Gratitude interventions help you focus on the good things in your life, which can improve your ability to cope with stress.

Protective Factors

Stress and genetic factors work together to increase your vulnerability, but there are also protective factors that can help counteract some of the effects of stress. A few of these helpful protective factors that buffer the interaction of diathesis and stress include secure attachments, positive relationships, stress management skills, and emotional competence.