Modifiers of stress

Stress has been described as the aetiological agent for AD. Vulnerability to stress is another risk factor. Diverse variables and modifiers are involved regarding who will experience AD following a stress. Cohen(22) argues as follows:

1. acute stresses are different from chronic stresses in both psychological and physiological terms;

2. the meaning of the stress is affected by 'modifiers' (e.g. ego strengths, support systems, prior mastery);

3. manifest and latent meanings of the stressor(s) may be associated with differential impact (e.g. loss of job may be a relief or a catastrophe).

AD with maladaptive denial of pregnancy, for example, can be a consequence of a stressor such as separation from a partner. (52) An objectively overwhelming stress may have little impact on one individual, whereas a minor stress could be regarded as cataclysmic by another. A recent minor stress superimposed on a previous underlying (major) stress that has no observable effect on its own may have a significant additive impact (i.e. concatenation of events) (B. Hamburg, personal communication, 1990).

The chronological relationship of the stressor and symptoms has been examined less extensively. Depue and Monroe (53) and Skodol et al.(54) identified significant methodological problems in evaluating the quality, quantity, and timing of both stressors and symptoms. Depue and Monroe (53> and Rahe(55) state that the model of a single stressor impinging on an undisturbed individual to cause symptoms at a single point in time is insufficient to account for the many presentations of stress and illness in the clinical situation.

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