I believe for those of us who have genetic PN, it lies dormant in our systems until it is activated by a stressful event, or string of events, and it is finally activated.... like people with cancer. It is in your genetic dna, it just lies dormant until something activates it.

For myself, it was 18 months of catastrophic events... Dad with cancer, Mom committed suicide, 16 year old daughter had a baby, husband had an affair, and 18 year old daughter moved in with her gang member boyfriend and started using Meth, oh, add to that I got a divorce, got laid off, and lost my home! So, yes, I was under a LOT of stress! If I was an alcoholic, I guess I would have gone on a binge. Instead, I had to stay strong to take care of my daughter and new granddaughter. I had to get a job and provide for them. So, there was more added stress. Add to that experimenting with medications and making it a challenge to do your job.