The three-hit concept of vulnerability and resilience: toward understanding adaptation to early-life adversity outcome

Nikolaos P Daskalakis, Rosemary C Bagot, Karen J Parker, Christiaan H Vinkers, E R de Kloet

Research output: Contribution to journalReview articleAcademicpeer-review

401 Citations (Scopus)


Stressful experiences during early-life can modulate the genetic programming of specific brain circuits underlying emotional and cognitive aspects of behavioral adaptation to stressful experiences later in life. Although this programming effect exerted by experience-related factors is an important determinant of mental health, its outcome depends on cognitive inputs and hence the valence an individual assigns to a given environmental context. From this perspective we will highlight, with studies in rodents, non-human primates and humans, the three-hit concept of vulnerability and resilience to stress-related mental disorders, which is based on gene-environment interactions during critical phases of perinatal and juvenile brain development. The three-hit (i.e., hit-1: genetic predisposition, hit-2: early-life environment, and hit-3: later-life environment) concept accommodates the cumulative stress hypothesis stating that in a given context vulnerability is enhanced when failure to cope with adversity accumulates. Alternatively, the concept also points to the individual's predictive adaptive capacity, which underlies the stress inoculation and match/mismatch hypotheses. The latter hypotheses propose that the experience of relatively mild early-life adversity prepares for the future and promotes resilience to similar challenges in later-life; when a mismatch occurs between early and later-life experience, coping is compromised and vulnerability is enhanced. The three-hit concept is fundamental for understanding how individuals can either be prepared for coping with life to come and remain resilient or are unable to do so and succumb to a stress-related mental disorder, under seemingly identical circumstances.

Original languageEnglish
Pages (from-to)1858-73
Number of pages16
Issue number9
Publication statusPublished - Sept 2013
Externally publishedYes


  • Adaptation, Psychological
  • Animals
  • Avoidance Learning
  • Disease Models, Animal
  • Epigenesis, Genetic
  • Female
  • Gene-Environment Interaction
  • Genetic Predisposition to Disease
  • Glucocorticoids/physiology
  • Humans
  • Hypothalamo-Hypophyseal System/physiopathology
  • Maternal Behavior
  • Maternal Deprivation
  • Models, Neurological
  • Models, Psychological
  • Neuronal Plasticity
  • Pituitary-Adrenal System/physiopathology
  • Pregnancy
  • Prenatal Exposure Delayed Effects
  • Primates
  • Rats
  • Resilience, Psychological
  • Stress Disorders, Post-Traumatic/physiopathology
  • Stress, Psychological/physiopathology
  • Vulnerable Populations

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