Psychopathology and Stress

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Cite as: Slavich, G. M. (in press). Psychopathology and stress. In H. L. Miller (Ed.), Encyclopedia of theory in psychology. Thousand Oaks, CA: Sage Publications.

Available at: www.uclastresslab.org

Psychopathology and Stress

George M. Slavich

Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095

Feeling anxious, sad, and discouraged are Three types of stress have been found to universal experiences that afflict nearly increase risk for psychopathology. They are: everyone from time to time. Such emotional acute life events, chronic difficulties, and reactions fall within the normal range of contextual stressors. Acute life events are human functioning and are common relatively discrete in nature and include responses to adverse life circumstances, such situations such as acute health problems or as preparing for a difficult job interview, illnesses, accidents, marriages, divorces, job failing an important exam, getting fired, or losses, births, and deaths. They can occur losing a loved one. Indeed, emotional once or multiple times, and can vary in reactions such as these are adaptive insofar impact from being relatively minor to very as they help us prioritize goals, communicate severe. Breaking up with a romantic partner feelings, and remember important life events. after two weeks of dating is typically a In some instances, however, emotional relatively minor acute life event, whereas reactions to stressful situations can become being physically or sexually attacked exaggerated or prolonged, leading to levels of constitutes a severe life event. Chronic distress than impact social and occupational difficulties, in contrast, are more prolonged in functioning. It is under these circumstances nature and include circumstances that persist that stress can contribute to the development for several months or years, such as ongoing of different forms of psychopathology. health, relationship, financial, housing, Specific disorders known to be precipitated by occupational, and educational difficulties. stress include Social Anxiety Disorder, Living in an apartment with limited personal Generalized Anxiety Disorder, Post-Traumatic space for two months is usually a relatively Stress Disorder, Substance Abuse Disorder, minor chronic difficulty, whereas taking care Schizophrenia, Bipolar Disorder, and Major of a dying spouse for five years constitutes a Depressive Disorder. Stress can also severe difficulty. Finally, contextual stressors contribute to the development of trait-like are societal- or macro-level circumstances personality disorders, such as Antisocial that form the general physical, social, and Personality Disorder and Borderline psychological environment in which people Personality Disorder, especially if the stress live. These stressors include experiences such exposure is prolonged or severe. This article as poverty, war, under-education, describes the types of stress that cause psychopathology, the vulnerability factors that Corresponding Author: contribute to individual differences in stress George M. Slavich, Ph.D., Cousins Center for reactivity, the mechanisms that link stress Psychoneuroimmunology, University of California, with psychopathology, and the processes that Los Angeles, UCLA Medical Plaza 300, Room 3156, underlie associations between stress, Los Angeles, CA 90095-7076, USA psychopathology, and physical disease. E-mail: [email protected] Slavich 2 unemployment, discrimination, crime, poor transduction theory, for example, cognitive, healthcare access, and social isolation. emotional, neural, physiologic, and genetic Because of their ubiquitous nature, contextual factors all play a role in linking stress with stressors often give rise to specific acute life psychopathology. From this perspective, stress events and chronic difficulties. For example, generates specific negative thoughts (e.g., people living in poverty are more likely to “I’m not good enough,” “I won’t get through experience stressors involving crime and this,” “This will never end”) and emotions physical danger, while those without access (e.g., anxiety, sadness, shame, humiliation) to healthcare are more likely to experience that produce distress. Stress also upregulates health- and illness-related stressors. biological systems including the sympathetic Although stress is ubiquitous, most people nervous system and hypothalamic-pituitary- who experience stress do not develop adrenal axis, which regulate components of psychiatric disorders. This is due in part to the the immune system involving inflammation severity and length of the stress exposure, that have profound effects on mood, cognition, with longer, more severe exposures being and behavior. Finally, as revealed most more likely to cause psychopathology. Another recently by work on human social genomics, critical factor that determines whether people some types of stress – such as social conflict, develop psychopathology following stress isolation, rejection, and exclusion – can reach involves level of vulnerability. Theories that deep inside the body to influence the activity account for both severity of stress exposure of the human genome. These biobehavioral and amount of personal vulnerability are called changes can be adaptive and enhance survival diathesis-stress theories, and they posit that when they occur intermittently and in response the amount of stress that is required for to actual physical threat. If activation of these psychopathology to develop differs depending systems is frequent or prolonged, however, on the vulnerability of the person. Theories substantial distress can develop, possibly such as cognitive theory of depression focus leading to psychiatric illness. mainly on cognitive vulnerability to stress that Finally, stress can also increase risk for comes in the form of negative views of the several physical disease conditions that self, others, or future. Vulnerability can be frequently co-occur with psychiatric illness, represented at other levels as well. According such as asthma, rheumatoid arthritis, chronic to stress sensitization and the kindling pain, metabolic syndrome, cardiovascular hypothesis, for example, people become more disease, obesity, certain cancers, and neurobiologically and behaviorally sensitive to neurodegeneration. In fact, one of the most stress over time because of prior recent discoveries in this area is the finding psychopathology or experiences with stress; as that inflammatory components of the immune a result, less stress is required for system that link stress with anxiety and psychopathology to develop in the future. In depression may also give stress the ability to addition, neuroticism, or the tendency to promote the physical diseases noted above. remain in a negative emotional state, has also The implications of this discovery are been shown to increase vulnerability to stress. profound, as they suggest that stress may be Finally, genetic factors that influence serotonin associated with both mental and physical and immune system activity also affect stress health through common underlying pathways. reactivity, leaving some individuals more likely If this is the case, targeting stress-related to develop psychopathology following stress biobehavioral processes may reduce risk not than others. just for psychopathology, but for physical Some of the most recent research on disease as well. psychopathology and stress has involved identifying mechanisms that give stress the ability to affect mental health. In social signal Slavich 3