TL;DR
A landmark April 2026 study of more than 115,000 people found that childhood adversity and chronic stress predicted bipolar disorder more strongly than genetic risk did. A polygenic risk score explained roughly 1.86% of the variance in bipolar disorder. Four or more Adverse Childhood Experiences raised the odds of bipolar disorder by 2.68 times. People with high environmental load and low genetic risk had the same rates of bipolar disorder as people with high genetic risk and low environmental load. Because the patterns laid down by experience are the patterns therapy is built to address, this finding strengthens the case for skills-based treatment alongside medication. DBT in particular targets the exact pathway the research describes.
You sat across from a doctor and heard the words. Bipolar disorder. Maybe they added something that was meant to be informative but landed like a sentence: “It’s genetic. It runs in families.” From that moment on, your biology felt less like part of you and more like a verdict. If your DNA built this, what hope is there of changing it?
There is a different story emerging from the research, and it deserves your attention. A landmark study released in April 2026, drawing on data from more than 115,000 people, found that what happened to you in childhood and the stress you have carried since may be a more powerful predictor of bipolar disorder than your genes. This finding does not minimize your diagnosis or dismiss the role of biology. It opens a door. It suggests that the conditions of a life shape the brain that lives it, and that the things shaped by experience can also be changed by experience, including therapy.
At STG Health Services, we work with adults across Saskatchewan who are living with bipolar disorder. This article walks through what the new research found, why it matters, and how DBT directly addresses the pathway the study describes.
What did the 2026 All of Us study actually find?
The research, titled “Considering social risk alongside genetic risk for bipolar disorder in the All of Us Research Program,” draws on one of the largest and most diverse health datasets ever assembled in North America. The investigators analyzed more than 7,000 people with bipolar disorder and over 108,000 controls, including participants of European, African, and Latino ancestry.
That diversity matters. Most genetic studies of psychiatric conditions have been conducted in populations of European descent, which limits how broadly their conclusions apply. By including people from multiple ancestry groups, this study offers a clearer picture of how genetic and social risk operate across communities, including communities historically underserved by research.
The headline genetic finding is sobering for anyone who has been told their bipolar disorder is “in their DNA.” A polygenic risk score, which combines the effects of many genetic variants, explained only about 1.86% of the variance in bipolar disorder among participants of European ancestry. In other ancestry groups, the genetic score explained even less. That means roughly 98% of the differences between who develops bipolar disorder and who does not is not captured by the genetic score at all.
A note on the study status
This study is currently a preprint, meaning it is publicly available but still moving through formal peer review. The dataset is large and unusually diverse, and the methods are standard for the field, but the findings should be read as strong preliminary evidence rather than a final word.
How much do childhood adversity and stress raise bipolar risk?
When the same researchers looked at social and environmental risk factors, the picture changed dramatically. The numbers that follow are the ones worth remembering.
Key statistics from the All of Us study
- Genetic risk: A polygenic risk score explained approximately 1.86% of the variance in bipolar disorder.
- Four or more ACEs: Odds ratio of 2.68 for bipolar disorder, compared with people reporting zero ACEs.
- Perceived stress: Odds ratio of 2.05 per standard deviation increase on a standard stress questionnaire.
- Equivalence finding: People with high social burden and low genetic risk had the same rates of bipolar disorder as those with high genetic risk and low social burden.
- Across ancestries: Social risk factors explained more variance than the genetic score in every ancestry group studied.
The most striking finding is one that deserves to be sat with for a moment. Individuals with a high social burden but low genetic risk had the same rates of bipolar disorder as those with high genetic risk but low social burden. In other words, a hard early life without a strong genetic loading produced roughly the same risk as strong genetic loading without the hard early life. The two pathways arrived at a similar place.
We have started calling this the social ledger. It is the running balance of environmental load a person has accumulated, and in this dataset it weighed roughly as much as the genetic ledger. Most accounts of bipolar disorder talk about only one of those two columns. The new research is asking us to read both.
That is not what most of us were taught about bipolar disorder. It is, however, consistent with what trauma-informed clinicians have observed for decades.
What are Adverse Childhood Experiences (ACEs)?
Adverse Childhood Experiences, or ACEs, are a defined set of difficult events that researchers began studying in the 1990s when Felitti and colleagues published the original ACE study and documented a dose-response relationship between childhood adversity and adult health.
The ten ACE categories
- Physical abuse
- Emotional abuse
- Sexual abuse
- Physical neglect
- Emotional neglect
- Witnessing domestic violence in the home
- Living with someone who had a substance use disorder
- Living with a parent or caregiver with a serious mental illness
- Having a parent or caregiver who was incarcerated
- Parental separation or divorce
The ACE score is simply the count of how many of these categories a person experienced before age 18, ranging from 0 to 10. A score of four or more is the threshold most strongly associated with elevated mental and physical health risk in adulthood, including the elevated bipolar risk found in this new study.
Why ACEs matter especially in Saskatchewan
Rural isolation, gaps in mental health and addictions services, the long shadow of residential schools, and intergenerational trauma in many Indigenous communities mean that ACEs are more common in this province than national averages would suggest. None of that is your fault. ACEs are not choices a child makes. They are conditions a child survives. Recognizing what you carried is not blame, it is information that finally fits.
How does childhood adversity actually get into the body?
If experience changes risk so substantially, the natural question is how. The biology is well documented, even if it is rarely explained outside of clinical settings.
When a child lives with chronic threat, unpredictability, or absence of safe caregiving, the body’s stress response system, called the HPA axis, is activated repeatedly during a period when it is still developing. Over time the system becomes sensitized. It learns to fire faster, harder, and at lower thresholds. Cortisol patterns shift. Inflammation rises. Sleep architecture changes. The brain regions that regulate mood, attention, and impulse control develop within that altered chemistry. None of this happens because a child is fragile. It happens because the nervous system is doing exactly what it is built to do, which is calibrate to the environment it is given.
Researchers call the cumulative wear of this chronic activation allostatic load. It is the bill the body pays for staying on alert too long. On top of that, early adversity can produce epigenetic changes, which are chemical marks on top of the DNA that change how genes are expressed without altering the genetic code itself. Your DNA does not get rewritten. The instructions for reading it do.
The environment shaped the biology. That is the mechanism. It is not mysterious, and it is not a flaw in you.
“Genes set possibilities. Experience, especially early experience, plays a large role in which possibilities become real.”
What does this finding mean if you already have bipolar disorder?
If you take only one idea from this article, let it be this. Your genes may have given you a vulnerability. The research now suggests that the environment contributed significantly, and sometimes primarily, to whether that vulnerability became a diagnosis. And unlike your genes, the effects of the environment can be addressed in treatment.
This is not a claim that bipolar disorder is “really just trauma,” and it is not a recommendation to stop medication. Mood-stabilizing medication remains a foundation of evidence-based care for many people, and we coordinate closely with prescribers. The point is broader. If a substantial portion of bipolar risk comes from sensitization, dysregulated stress responses, and patterns the nervous system learned in conditions you did not choose, then therapies that work directly on those patterns are not adjuncts. They are central.
The biosocial theory underlying Dialectical Behavior Therapy has held for more than thirty years that emotional disorders arise from the interaction of biological emotional sensitivity and an invalidating environment. The new research is, in effect, large-scale empirical support for that model applied to bipolar disorder.
Why is DBT particularly well-suited to bipolar disorder with an ACE history?
DBT was originally developed for chronic emotion dysregulation, and its skills translate directly to the difficulties many people with bipolar disorder describe between, and even during, mood episodes.
The biosocial model says: a biologically sensitive nervous system, plus an environment that did not consistently teach safe regulation, equals an adult nervous system that overshoots and struggles to recover. That is precisely the pathway the new study is describing in statistical form. Genetic vulnerability and environmental load combining to produce dysregulation that meets diagnostic criteria.
The four DBT skill modules and what they target
- Mindfulness builds the capacity to notice mood shifts before they take over. Read more in our overview of DBT individual skills.
- Distress tolerance offers concrete tools for surviving the highest-intensity moments without making them worse. We unpack this further in The Power of Distress Tolerance in DBT.
- Emotion regulation builds daily habits, including sleep, eating, movement, and balanced activity, that reduce the size of the swings. See how this applies to mood difficulties in Soaring Beyond Depression.
- Interpersonal effectiveness rebuilds the relational skills that an invalidating environment may not have taught. More on this in our piece on interpersonal effectiveness in DBT.
In our work with Saskatchewan clients living with bipolar disorder, we use these skills not to replace medication or psychiatric care but to build the daily stability that makes mood episodes less frequent, shorter, and less destructive when they do occur.
“If a substantial portion of bipolar risk comes from patterns the nervous system learned in conditions you did not choose, then therapies that work directly on those patterns are not adjuncts. They are central.”
What about sleep, chronotype, and lithium response?
There is one more piece of recent research worth holding alongside the social-risk findings, because it points to a different but compatible kind of hope.
A study published April 16, 2026 found that people whose genetic profile predisposes them to being “morning types,” meaning they wake easily and feel alert earlier in the day, respond significantly better to lithium than those with evening chronotypes. Some genes really do shape treatment response, which is genuinely good news for personalized care.
The practical implication is encouraging. Sleep timing and circadian consistency are modifiable. While you cannot change your underlying chronotype, you can dramatically influence sleep regularity, light exposure, and the rhythms that stabilize mood. DBT integrates sleep hygiene and behavioral activation directly into emotion regulation work. Environment and lifestyle continue to shape outcomes even within medication response.
How can you hold a bipolar diagnosis differently after this research?
Come back, for a moment, to the person at the start of this article. The one who left an appointment carrying a diagnosis like a verdict. The research increasingly suggests the verdict is not what they were told.
Bipolar disorder is shaped by what happened to you, not only by what you inherited. That is not a dismissal of biology. It is a fuller account of how biology actually works in a human life. Genes set possibilities. Experience, especially early experience, plays a large role in which possibilities become real. And the patterns experience built can be addressed, skill by skill, in therapy.
Your history matters. So does what you choose to do next.
Frequently Asked Questions
Is bipolar disorder genetic or environmental?
Both, but the 2026 All of Us study suggests the environmental contribution is substantially larger than commonly understood. A polygenic risk score explained about 1.86% of the variance in bipolar disorder, while social risk factors explained considerably more. People with high environmental load and low genetic risk had the same rates of bipolar disorder as those with high genetic risk and low environmental load.
How many ACEs does it take to raise the risk of bipolar disorder?
In the 2026 study, four or more Adverse Childhood Experiences was associated with 2.68 times the odds of having bipolar disorder, compared with people reporting zero ACEs. The risk increases progressively with each additional ACE, consistent with the dose-response pattern Felitti and colleagues first documented in 1998.
Can therapy change the course of bipolar disorder?
Therapy does not replace mood-stabilizing medication, but evidence increasingly supports skills-based therapies as central rather than adjunctive. Because much of bipolar risk appears to come from sensitized stress responses and learned dysregulation patterns, therapies like DBT that directly target those patterns can reduce episode frequency, severity, and duration.
Does this research mean I should stop my bipolar medication?
No. The study does not contradict the role of medication for bipolar disorder. It expands the picture by showing that environmental factors play a larger role than previously appreciated. Most people with bipolar disorder benefit from a combination of medication and skills-based therapy, and any medication change should always involve the prescriber.
Is DBT effective for bipolar disorder?
DBT was developed for chronic emotion dysregulation and has growing evidence supporting its use in bipolar disorder, particularly for the inter-episode instability, sleep disruption, and stress reactivity that drive relapse. At STG Health, DBT is delivered alongside, not instead of, psychiatric care. You can read more about how DBT supports both bipolar instability and BPD patterns and how it can help with depressive episodes.
Why are ACEs especially relevant in Saskatchewan?
Rural and northern access barriers, the historical and ongoing impact of residential schools, and intergenerational trauma in many Indigenous communities mean ACEs are more common in Saskatchewan than national averages suggest. Recognizing that context is part of trauma-informed care, not a way of assigning blame.
Reach Out
If you are living with bipolar disorder and want support that goes beyond medication management, including DBT skills for emotional regulation, distress tolerance, and building a life worth living, reach out to STG Health. We offer DBT programming for bipolar disorder across Saskatchewan via telehealth. You can start with an intake and have a clear next step within a week or two.
Sources
- Considering social risk alongside genetic risk for bipolar disorder in the All of Us Research Program. medRxiv preprint, April 2026. https://doi.org/10.64898/2026.04.06.26349528
- Sleep chronotype predicts lithium response in bipolar disorder. PubMed ID 41989970, April 2026. https://pubmed.ncbi.nlm.nih.gov/41989970/
- Felitti VJ, Anda RF, et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
