The Role of Heredity in Mental Illness

Strands of DNA
Image by victoria_art_music from Pixabay

Probably many of us living with mental illness have wondered at some point where the heck it came from. Nature? Nurture? A hodgepodge of both? Heredity, i.e. what we get from our genes, often seems to play at least some role, but genes aren’t the only game in town. This post looks at what some of the different players are.

Genes and heredity

Our genetic makeup is determined at the time of conception by the genetic content of the sperm and the egg that we’re made from. We normally have 23 chromosome pairs, and one of these 23 pairs is the sex chromosomes, with an X chromosome from the mother and either an X or a Y from the father. Each chromosome is made up of between 200-2000 genes. Genes are made up of DNA and provide the code for our cells to make proteins. The normal state of DNA, when there’s no code-reading action going on, is a double helix configuration. The rungs of the helix are made up of bonds between bases, known for short as A, C, G, and T. This sequence of bases codes for amino acids, which are the building blocks of proteins.

Once you’ve got them, your genes generally aren’t changing much, although spending too much time in the Chernobyl exclusion zone can certainly throw a monkey wrench in things.


Our DNA is wrapped up nice and cozy in proteins called histones. When a section of DNA is needed to do its thing, the histones in that section open up so the code can be read, kind of like a barcode, to make the corresponding RNA. This RNA is then used to make proteins. Epigenetics refers to the way that genes are accessed and used, or not accessed/used, to make the proteins that they code for.

Epigenetic changes can be inherited, but they can also occur as a result of environmental factors (childhood trauma is a big one). This means that unlike genetics, which are mostly consistent through the lifespan, epigenetic changes can happen over time. This could potentially create additive risk for the development of some form of disorder on top of whatever baseline risk you might have from what your DNA code contains.


Heritability refers to how big a factor the genes (i.e. DNA) you inherit are in you developing an illness or other condition. Twin studies are the most common way of estimating heritability. Identical (monozygotic) twins share exactly the same genetic makeup. Fraternal (dizygotic) twins have different genetic makeups, much like siblings who weren’t born twins, but they share the same in utero environment and exposures. The more heritable a condition is, the greater the difference will be in the pairs of identical twins with the disorder compared to pairs of fraternal twins.

Sometimes a single genetic mutation will automatically produce either a disorder or a very high risk for a disorder. Examples of single mutations that can significantly elevate risk are particular variants of the BRCA-1 and BRCA-2 genes, which significantly increase the risk of breast cancer. Huntingdon’s disease involves a mutation in a single gene that is inherited from one parent (referred to as autosomal dominant), while cystic fibrosis involves one gene but there have to be copies from both parents for the condition to occur (autosomal recessive).

Mental illness

Mental illness isn’t like that. A 2009 study found thousands of genetic variants that could contribute to the likelihood of developing schizophrenia. Given the complexity of the whole shebang, science hasn’t got it all figured out quite yet.

One thing that’s really interesting is that having a family history of a mental disorder increases your chance of having a mental disorder across the board. It doesn’t necessarily have to be the same disorder, or even a similar disorder. This cross-over of genetic risk is seen in particular with schizophrenia, autism, bipolar disorder, major depression, ADHD, and anxiety disorders. It’s also interesting that non-psychiatric neurological disorders don’t have that same kind of shared risk.

The overlapping mental illness risk suggests that the categories that the DSM diagnostic manual uses for disorders don’t correspond to what’s going on in the brain. Then again, the DSM never claimed to do that; it describes symptoms and groups like symptom presentations together. It includes information about what studies have indicated about heritability, but it makes no attempt to say why or how an illness happens biologically.

Genetic factors can account for different percentages of the overall risk. Huntingdon’s disease is all genetic. Among mental illnesses, schizophrenia, bipolar disorder, ADHD, and autism spectrum disorder have the strongest genetic contribution, accounting for around 80% of the overall vulnerability. For major depressive disorder, genetics account for about 30% of the overall risk.

Environmental factors

If heredity only accounts for part of the risk, where does the rest of the vulnerability come from? That’s where the environment comes in, but not just in terms of nurture.

Our genetic makeup is set at the time of conception, but for the next nine months, everything that happened to our mom happened to us too. That can influence our risk of developing a condition later on. There are indications that maternal infection in the first trimester increases the risk of the child developing schizophrenia as an adult.

There are also epigenetic changes that may occur as a result of conditions we’re exposed to, which bridges nurture and biology. Then there are all kinds of psychosocial factors.

A diathesis-stress model conceptualizes illness as occurring when the combined effects of vulnerability and environmental stress reach a certain threshold. The higher the pre-existing vulnerability, the lower the amount of environmental stress that it takes to push someone over the threshold into illness territory. Regardless of the relative roles that different factors play, the idea of a single root cause for mental illness seems pretty unlikely.

Still a long way to go

I find the cross-over heritability really interesting. I have a family history of schizophrenia but not depression, which I’d thought was kind of odd, but I guess it’s not actually odd after all. All in all, it sounds like there’s a whole lot that that science hasn’t figured out yet. Perhaps at some point, things will get narrowed down to the point where new and more effective treatment options can be identified.

How much of an impact do you think heredity may have had for you?


20 thoughts on “The Role of Heredity in Mental Illness”

  1. “spending too much time in the Chernobyl exclusion zone”, yeah that Butlins camp was a bit mad 😅
    We determined my Borderline was certainly a genetic link with my mother’s side and trauma growing up. Especially being a single child.

  2. There’s a lot of mental illness, neurological disorders (autism, ADD, ADHD) and suspected mental illness and neurological disorders in my family, although a lot of it was swept under the carpet due to stigma or just accepted as personality quirks or the like. In particular, my great-grandmother seems to have spent the last years (decades?) of her life in some kind of institution for some kind of mental illness, but even decades later no one would really talk about it, and now most if not all of those who knew the details are dead.

    1. I suspect there was a lot of that back in the day. The side of my dad’s family that has mental illness didn’t really get talked about, and my dad mostly knew because a couple of of his uncles were quite symptomatic.

  3. OCD everywhere in my fam, some in my ex’s, and manifesting in different ways, including eating disorders (now thought to be a subset of OCD), in me and my kids.

  4. I feel that trauma throughout the generations ie incest alcoholism suicide as threats to get way etc have plagued my family tree. I often felt my genetics due to these things in history did and have effected me. It’s like a family curse. I found this super interesting thank you for sharing.

  5. I’d forgotten twins were mono or dizygotic. Is that a word? It’s always a thrill, remembering forgotten facts.

    My mother comes from a long line of depression and mental illness via the maternal line. My dad has ADHD he likes to pretend isn’t a thing. That being the case, my diagnosis of depression wasn’t a surprise. The other diagnoses I resisted, mostly because I’m contentious, to a degree.

    I looked into ideas about heritability when I was pregnant and found that adding me to his dad’s bipolar DNA left my son with an 80% chance of something. He got my smarts, my affection for sarcasm and deadpan (those are probably nurture), and some ADHD.

      1. It’s fascinating. It’s be nice if we could skip ahead a few hundred years and get some more complete science answers about stuff 😊

  6. There is no direct line between my bipolar condition and someone else’s in my family. So my bipolar appears to have come out of the blue. There is a mystery story about my great grandmother’s death so that is potentially part of the story. Strangely put I am thankful for the nurture part of the equation as being relevant in the genetics of bipolar illness. The more my husband and I are able to create a safe environment for our daughter, the more likely she may be to sidestep the bipolar diagnosis. I would say she may be a candidate for moderate anxiety or depression though.

    This is an issue near and dear to my heart. Thank you for sharing it.

  7. Most of the research on heritability comes from comparing identical and fraternal twins raised in different environments, so the fraternal twin group essentially acts as a control for variability in nurture, but also consistent in utero environment, so it becomes possible to separate out the role of genetics. If a trait or condition is more common in twins with the identical DNA than twins with different DNA that shared the same in utero conditions, that points to the DNA playing a role.

    There’s also the common misconception that there’s typically a “gene for” something, which is rarely the case and isn’t the approach that genetic researchers use. With risk for mental disorders, the research that’s been done has mapped out a whole whack of different points on the genome where there seems to be overlap.

    I’m a fan of Steven Pinker, who’s a cognitive psychologist. He takes a pretty middle of the road approach, acknowledging that genetic variations account for some, but certainly not all, human differences, and there are many environmental, social, and other factors that come into play. I think the important part of that is that those different factors aren’t mutually exclusive. Genes playing some role in condition X doesn’t exclude the possibility that environment could play a much bigger role. In heredity studies, they often give a percentage of variability that genetics accounts for in how a trait is distributed across a population, which may be 10%, 50%, but only 100% in something fully genetic like Huntingdon’s.

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