The role of adversity and stress in psychopathology: some evidence and its implications for theory and research.

Three lines of research--studies of extreme situations, epidemiological investigations of relations between socioeconomic status (SES) and psychiatric disorders, and a quasi-experimental test of the social causation-social selection issue raised by the epidemiological findings--provide strong evidence that environmental adversity is important in the occurrence not only of post-traumatic stress disorder (PTSD) but also of other types of psychopathology, including major depression, alcoholism, substance use disorders, antisocial 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 likelihood of onset of the above types of disorder increases with two factors: (1) the proportion of the individual's usual activities in which uncontrollable negative changes take place following a major negative event; and (2) how central the uncontrollable changes are to the individual's important goals and values. The role of environmental adversity in bringing about these uncontrollable changes varies with gender, ethnic/racial status, and SES in 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 the individuals who experience the adversity and stress (e.g., family history of particular types of psychopathology).