Patients want a single answer. 'Is it chemical?' 'Is it my childhood?' 'Is it my job?' The honest clinical answer is — usually all of the above, weighted differently for each person.

The four-factor model I use

1) Biological — genetic vulnerability, neurotransmitter regulation, hormonal shifts, physical health. 2) Developmental — early attachment, childhood adversity, learned coping. 3) Current environment — sleep, nutrition, exercise, relationships, financial stress, work load. 4) Meaning — the narrative the mind tells about the symptoms, often the strongest amplifier.

Why this matters for treatment

Different weights need different interventions. Mostly biological → medication carries more weight. Mostly environmental → lifestyle and CR-based regulation. Mostly meaning-driven → cognitive and existential work. A good clinician maps the weights before choosing the plan.