The role of adversity and stress in psychopathology: Some evidence and itsimplications for theory and research

Three lines of research-studies of extreme situations, epidemiological inve stigations of relations between socioeconomic status (SES) and psychiatric disorders, and a quasi-experimental test of the social causation-social sel ection issue raised by the epidemiological findings-provide strong evidence that environmental adversity is important in the occurrence not only of po st-traumatic stress disorder (PTSD) but also of other types of psychopathol ogy, including major depression, alcoholism, substance use disorders, antis ocial personality? disorder and nonspecific distress. Leads from this triad of studies are developed into a basic proposition about the nature of the role of adversity and stress. The core of this proposition is that the like lihood of onset of the above types of disorder increases with two factors: (I) the proportion of the individual's usual activities in which uncontroll able negative changes take place following a major negative event; and (2) how central the uncontrollable changes are to the individual's important go als and values. The role of environmental adversity in bringing about these uncontrollable changes varies with gender; ethnic/racial status, and SES i n our own and other modern, urban societies. The types of psychopathology, that develop and their course vary with both the types of adversity (e.g., whether life threat is involved) and with the personal predispositions of t he individuals who experience the adversity and stress (e.g., family histor y of particular types of psychopathology).