Psychological stress

For other kinds of stress, see stress (disambiguation).
Video explanation

In psychology, stress is a feeling of strain and pressure. Small amounts of stress may be desired, beneficial, and even healthy. Positive stress helps improve athletic performance. It also plays a factor in motivation, adaptation, and reaction to the environment. Excessive amounts of stress, however, may lead to bodily harm. Stress can increase the risk of strokes, heart attacks, ulcers, dwarfism, and mental illnesses such as depression.[1]

Stress can be external and related to the environment,[2] but may also be created by internal perceptions that cause an individual to experience anxiety or other negative emotions surrounding a situation, such as pressure, discomfort, etc., which they then deem stressful.

Humans experience stress, or perceive things as threatening, when they do not believe that their resources for coping with obstacles (stimuli, people, situations, etc.) are enough for what the circumstances demand. When we think the demands being placed on us exceed our ability to cope, we then perceive stress.

Popular conflation of types

A very much overlooked side of stress is its positive adaptations.[3] Positive psychological stress can lead to motivation and challenge instead of anxiety. The effects of experiencing eustress, which is positive stress, versus distress, which is negative stress, are significant. While colloquially lumped together, the various types of stress should be treated as separate concepts.

Variations

Selye proposed that there are four variations of stress.[4] On one axis, there is good stress (eustress) and bad stress (distress). On the other is overstress (hyperstress) and understress (hypostress). The goal is to balance these as much as possible. The ultimate goal would be to balance hyperstress and hypostress perfectly and have as much eustress as possible.[5] It is extremely useful for a productive lifestyle because it makes working enjoyable instead of a chore, as seen with distress.

Differentiation between eustress and distress

Eustress comes from the Greek root “eu” which means good as in euphoria.[6] Eustress is when a person perceives a stressor as positive.[7] Distress stems from the Latin root “dis” as in dissonance or disagreement.[6] Distress is a threat to the quality of life. It is when a demand vastly exceeds a person’s capabilities.[7]

Health effects

There is likely a connection between stress and illness. Theories of the stress–illness link suggest that both acute and chronic stress can cause illness, and several studies found such a link.[8] According to these theories, both kinds of stress can lead to changes in behavior and in physiology. Behavioral changes can be smoking and eating habits and physical activity. Physiological changes can be changes in sympathetic activation or hypothalamic pituitary adrenocorticoid activation, and immunological function.[9] However, there is much variability in the link between stress and illness.[10]

Stress can make the individual more susceptible to physical illnesses like the common cold.[11] Stressful events, such as job changes, may result in insomnia, impaired sleeping, and health complaints.[12] Research indicates the type of stressor (whether it's acute or chronic) and individual characteristics such as age and physical well-being before the onset of the stressor can combine to determine the effect of stress on an individual.[8] An individual's personality characteristics (such as level of neuroticism),[13] genetics, and childhood experiences with major stressors and traumas [14] may also dictate their response to stressors.[8]

Chronic stress and a lack of coping resources available or used by an individual can often lead to the development of psychological issues such as depression and anxiety (see below for further information).[15] This is particularly true regarding chronic stressors. These are stressors that may not be as intense as an acute stressor like a natural disaster or a major accident, but they persist over longer periods of time. These types of stressors tend to have a more negative impact on health because they are sustained and thus require the body's physiological response to occur daily. This depletes the body's energy more quickly and usually occurs over long periods of time, especially when these microstressors cannot be avoided (i.e.- stress of living in a dangerous neighborhood). See allostatic load for further discussion of the biological process by which chronic stress may affect the body. For example, studies have found that caregivers, particularly those of dementia patients, have higher levels of depression and slightly worse physical health than noncaregivers.[16]

Studies have also shown that perceived chronic stress and the hostility associated with Type A personalities are often associated with much higher risks of cardiovascular disease. This occurs because of the compromised immune system as well as the high levels of arousal in the sympathetic nervous system that occur as part of the body's physiological response to stressful events.[17]

However, it is possible for individuals to exhibit hardiness—a term referring to the ability to be both chronically stressed and healthy.[18] Many psychologists are currently interested in studying the factors that allow hardy individuals to cope with stress and evade most health and illness problems associated with high levels of stress. Stress can be associated with psychological disorders such as delusions,[19] general anxiety disorder, depression, and post-traumatic stress disorder. However, it is important to note that everyone experiences some level of stress, and diagnosis of stress disorders can only be performed by a licensed practitioner.

It has long been believed that negative affective states, such as feelings of anxiety and depression, could influence the pathogenesis of physical disease, which in turn, have direct effects on biological process that could result in increased risk of disease in the end. However recent studies done by the University of Wisconsin-Madison and other places have shown this to be untrue, it isn't stress itself that causes the increased risk of illness or death, it is actually the perception that stress is harmful.[20][21] For example, when humans are under chronic stress, permanent changes in their physiological, emotional, and behavioral responses are most likely to occur.[13][22] Such changes could lead to disease. Chronic stress results from stressful events that persist over a relatively long period of time, such as caring for a spouse with dementia, or results from brief focal events that continue to be experienced as overwhelmingly long after they are over, such as experiencing a sexual assault.

Experiments show that when healthy human individuals are exposed to acute laboratory stressors, they show an adaptive enhancement of some markers of natural immunity but a general suppression of functions of specific immunity. By comparison, when healthy human individuals are exposed to real-life chronic stress, this stress is associated with a biphasic immune response where partial suppression of cellular and humoral function coincides with low-grade, nonspecific inflammation.

Even though psychological stress is often connected with illness or disease, most healthy individuals can still remain disease-free after confronting chronic stressful events. Also, people who do not believe that stress will affect their health do not have an increased risk of illness, disease, or death.[21] This suggests that there are individual differences in vulnerability to the potential pathogenic effects of stress; individual differences in vulnerability arise due to both genetic and psychological factors. In addition, the age at which the stress is experienced can dictate its effect on health. Research suggests chronic stress at a young age can have lifelong impacts on the biological, psychological, and behavioral responses to stress later in life.[23]

Cancer

In animals, stress contributes to the initiation, growth, and metastasis of select tumors, but studies that try to link stress and cancer incidence in humans have had mixed results. This can be due to practical difficulties in designing and implementing adequate studies.[22]

Neutral stressors

Stress is a non-specific response.[5] It is neutral, and what varies is the degree of response. It is all about the context of the individual and how they perceive the situation. Selye defined stress as “the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic.”[5] This includes the medical definition of stress as a physical demand and the colloquial definition of stress as a psychological demand. A stressor is inherently neutral meaning that the same stressor can cause either distress or eustress. It is individual differences and responses that induce either distress or eustress.[24]

Types of stressors

A stressor is any event, experience, or environmental stimulus that causes stress in an individual.[25] These events or experiences are perceived as threats or challenges to the individual and can be either physical or psychological. Researchers have found that stressors can make individuals more prone to both physical and psychological problems, including heart disease and anxiety.[26]

Stressors are more likely to affect an individual's health when they are "chronic, highly disruptive, or perceived as uncontrollable".[26] In psychology, researchers generally classify the different types of stressors into four categories: 1) crises/catastrophes, 2) major life events, 3) daily hassles/microstressors, and 4) ambient stressors.

Crises/catastrophes

This type of stressor is unforeseen and unpredictable and, as such, is completely out of the control of the individual.[26] Examples of crises and catastrophes include: devastating natural disasters, such as major floods or earthquakes, wars, etc. Though rare in occurrence, this type of stressor typically causes a great deal of stress in a person's life. A study conducted by Stanford University found that after natural disasters, those affected experienced a significant increase in stress level.[26] Combat stress is a widespread acute and chronic problem. With the rapid pace and the urgency of firing first, tragic episodes of accidentally killing friendly forces (“brother” killing “brother” or fratricide) may happen. Prevention requires stress reduction, emphasis on vehicle and other identification training, awareness of the tactical situation, and continual risk analysis by leaders at all echelons.[27]

Major life events

Common examples of major life events include: marriage, going to college, death of a loved one, birth of a child, moving houses, etc. These events can be either positive or negative. Research has found major life events are somewhat rare to be major causes of stress, due to its rare occurrences.[26]

The length of time since occurrence and whether or not it is a positive or negative event are factors in whether or not it causes stress and how much stress it causes. Researchers have found that events that have occurred within the past month generally are not linked to stress or illness, while chronic events that occurred more than several months ago are linked to stress and illness [28] and personality change.[13] Additionally, positive life events are typically not linked to stress—and if so, generally only trivial stress—while negative life events can be linked to stress and the health problems that accompany it.[26] However, positive experiences and positive life changes can predict decreases in neuroticism.[13][14]

Daily hassles/microstressors

This category includes daily annoyances and minor hassles.[26] Examples include: making decisions, meeting deadlines at work or school, traffic jams, encounters with irritating personalities, etc. Often, this type of stressor includes conflicts with other people. Daily stressors, however, are different for each individual, as not everyone perceives a certain event as stressful. For example, most people find public speaking to be stressful, nevertheless, a seasoned politician most likely will not.

There are three major psychological types of conflicts that can cause stress.

Travel-related stress results from three main categories: lost time, surprises (an unforeseen event such as lost or delayed baggage) and routine breakers (inability to maintain daily habits).[29]

Ambient stressors

As their name implies, these are global (as opposed to individual) low-grade stressors that are a part of the background environment. They are defined as stressors that are "chronic, negatively valued, non-urgent, physically perceptible, and intractable to the efforts of individuals to change them".[30] Typical examples of ambient stressors are pollution, noise, crowding, and traffic. Unlike the other three types of stressor, ambient stressors can (but do not necessarily have to) negatively impact stress without conscious awareness. They are thus low on what Stokols called "perceptual salience".[30]

Organizational stressors

Studies conducted in military and combat fields show that some of the most potent stressors can be due to personal organizational problems in the unit or on the home front.[31] Stress due to bad organizational practices is often connected to "Toxic Leadership", both in companies and in governmental organizations.[32]

Management

Stress management refers to a wide spectrum of techniques and psychotherapies aimed at controlling a person's levels of stress, especially chronic stress, usually for the purpose of improving everyday functioning.it involves controlling and reducing the tension that occurs in stressful situations by making emotional and physical changes.

Prevention and resilience building

Although many techniques have traditionally been developed to deal with the consequences of stress considerable research has also been conducted on the prevention of stress, a subject closely related to psychological resilience-building. A number of self-help approaches to stress-prevention and resilience-building have been developed, drawing mainly on the theory and practice of cognitive-behavioural therapy.[33]

Biofeedback may also play a role in stress management. A randomized study by Sutarto et al. assessed the effect of resonant breathing biofeedback (recognize and control involuntary heart rate variability) among manufacturing operators; depression, anxiety and stress significantly decreased.[34]

Coping mechanisms

The Lazarus and Folkman model suggests that external events create a form of pressure to achieve, engage in, or experience a stressful situation. Stress is not the external event itself, but rather an interpretation and response to the potential threat; this is when the coping process begins.[35]

There are various ways individuals deal with perceived threats that may be stressful. However, people have a tendency to respond to threats with a predominant coping style, in which they dismiss feelings, or manipulate the stressful situation.[35]

There are different classifications for coping, or defense mechanisms, however they all are variations on the same general idea: There are good/productive and negative/counterproductive ways to handle stress. Because stress is perceived, the following mechanisms do not necessarily deal with the actual situation that is causing an individual stress. However, they may be considered coping mechanisms if they allow the individual to cope better with the negative feelings/anxiety that they are experiencing due to the perceived stressful situation, as opposed to actually fixing the concrete obstacle causing the stress. The following mechanisms are adapted from the DSM-IV Adaptive Functioning Scale, APA, 1994.

Highly adaptive/active/problem-focused mechanisms

These skills are what one could call as “facing the problem head on”, or at least dealing with the negative emotions experienced by stress in a constructive manner. (generally adaptive)

Coping through laughter
“The Association for Applied and Therapeutic Humor defines therapeutic humor as ‘any intervention that promotes health and wellness by stimulating a playful discovery, expression or appreciation of the absurdity of or incongruity of life’s situations. This intervention may enhance health or be used as a complementary treatment of illness to facilitate healing or coping whether physical, emotional, cognitive, or spiritual”.[38]
Sigmund Freud, a well known neurologist, suggests the humor was an excellent defensive strategy in emotional situations.[35] When one laughs during a tough situation they feel absent from their worries, and this allows them to think differently.[38] When one experiences a different mind set, they feel more in control of their response, and how they will go about dealing with the event that caused stress.
Lefcourt (2001) suggests that this perspective-taking humor is the most effective due to its ability to distance oneself from the situation of great stress.[39] Studies show that the use of laughter and humor creates a sense of relief of stress that can last up to 45 minutes post-laughter[38]).
Also, most hospitalized children have been seen to use laughter and play to relieve their fear, pain and stress. It has been discovered that there is a great importance in the use of laughter and humor in stress coping.[38] Humans should use humor as a means to transcend their original understanding of an external event, take a different perspective, in which their anxiety may be minimized by.

The final path model fitted well (CF1 = 1, RMSEA = 0.00) and showed that direct quality of life paths with β = -0.2, and indirect social support with β = -0.088 had the most effects on reduction of stress during pregnancy.[42]

Other adaptive coping mechanisms include anticipation, altruism, and self-observation.

Mental inhibition/disavowal mechanisms

These mechanisms cause the individual to have a diminished (or in some cases non-existent) awareness about their anxiety, threatening ideas, fears, etc., that come from being conscious of the perceived threat.

Other inhibition coping mechanisms include undoing, dissociation, denial, projection, and rationalization. Although some people claim that inhibition coping mechanisms may eventually increase the stress level because the problem is not solved, detaching from the stressor can sometimes help people to temporarily release the stress and become more prepared to deal with problems later on.

Active mechanisms

These methods deal with stress by an individual literally taking action, or withdrawing.

Health promotion

There is an alternative method to coping with stress, in which one works to minimize their anxiety and stress in a preventative manner. If one works towards coping with stress daily, the feeling of stress and the ways in which one deals with it as the external event arises becomes less of a burden.

Suggested strategies to improve stress management include:[45]

  1. Regular exercise – set up a fitness program, 3–4 times a week
  2. Support systems – to listen, offer advice, and support each other
  3. Time management – develop an organizational system
  4. Guided imagery and visualization – create a relaxing state of mind
  5. Progressive muscle relaxation – loosen tense muscle groups
  6. Assertiveness training – work on effective communication
  7. Journal writing – express true emotion, self-reflection
  8. Stress management in the workplace – organize a new system, switch tasks to reduce own stress.

Depending on the situation, all of these coping mechanisms may be adaptive, or maladaptive.

Physiological response

Physiological responses to stress that affect communication

The body responds to stress in many ways. Readjusting chemical levels are just one of them. Here are some examples of adjustments and changes that affect communication.

General adaptive syndrome

In terms of measuring the body's response to stress, psychologists tend to use Hans Selye's general adaptation syndrome. This model is also often referred to as the classic stress response, and it revolves around the concept of homeostasis. General adaptive syndrome occurs in three stages:

  1. The alarm reaction. This stage occurs when the stressor is first presented. The body begins to gather resources to deal with the stressor. The pituitary gland begins releasing hormones such as adrenaline, nonepinephrine, and cortisol into the bloodstream to adjust bodily processes. These hormonal adjustments increase energy levels, increase muscle tension, reduce sensitivity to pain, slow down the digestive system, and cause a rise in blood pressure.[46][47]
  2. The stage of resistance. The body continues building up resistance throughout the stage of resistance, until either the body's resources are depleted, leading to the exhaustion phase, or the stressful stimulus is removed. As the body uses up more and more of its resources people become increasingly tired and susceptible to illness. This stage is where psychosomatic disorders first begin to appear.[47][48]
  3. The stage of exhaustion. The body is completely drained of the hormones and resources it was depending on to manage the stressor. The person now begins to exhibit behaviors such as anxiety, irritability, avoidance of responsibilities and relationships, self-destructive behavior, and poor judgment. If someone is experiencing these symptoms they have a much greater chance of lashing out, damaging relationships, or avoiding social interaction at all.[47]

This physiological stress response involves high levels of sympathetic nervous system activation, often referred to as the "fight or flight" response. The response involves pupil dilation, release of endorphins, increased heart and respiration rates, cessation of digestive processes, secretion of adrenaline, arteriole dilation, and constriction of veins. This high level of arousal is often unnecessary to adequately cope with micro-stressors and daily hassles; yet, this is the response pattern seen in humans, which often leads to health issues commonly associated with high levels of stress.[49]

Quality of sleep

Sleep allows people to rest and reenergize for another day filled with interactions and tasks. If someone is stressed it is extremely important for them to get enough sleep so that they can think clearly. Unfortunately, chemical changes in the body caused by stress can make sleep a difficult thing. Glucocorticoids are released by the body in response to stress which can disrupt sleep. Sleep comes in four stages and the deepest, most restful sleep can only be attained after having been asleep for an hour. If someone’s sleep is constantly disrupted, they won’t feel fully rested. This will make them irritable and less inclined to communicate effectively.[50]

Stressful social experiences that affect communication

When someone is stressed, many challenges can arise; a recognized challenge being communication difficulties. Here are some examples of how stress can hinder communication.

Cultural differences: individualistic vs. collectivistic

The cultures of the world generally fall into two categories; individualistic and collectivistic.[50]

These cultural differences can affect how people communicate when they are stressed. For example, a member of an individualistic cultural would be hesitant to ask for pain medication for fear of being perceived as weak. A member of a collectivistic culture would not hesitate. They have been brought up in a cultural where everyone helps each other and is one functional unit whereas the member of the individualistic culture is not as comfortable asking others for aid.[50]

Language barriers

Language barriers can also diminish communication due to stress.[51] All languages have their own way of using names, titles, and just interacting. These differences can make inter lingual communication relatively stressful. Not speaking the same languages, different ways of showing respect, and different use of body language can make things difficult. Being uncomfortable with the communication around a person can discourage them from communicating at all.[51]

Changes in the home

Divorce, death, and remarriage are all disruptive events in a household.[50] Although everyone involved is affected by events such as these, it can be most drastically seen in children. Due to their age, children have relatively undeveloped coping skills. For this reason a stressful event may cause some changes in their behavior. Falling in with a new crowd, developing some new and sometimes undesirable habits are just so of the changes stress may trigger in their lives.[50]

A particularly interesting response to stress is talking to an imaginary friend. A child may feel angry with a parent or their peers who they feel brought this change on them. They need someone to talk to but it definitely won’t be the person with whom they are angry. That’s when the imaginary friend comes in. They “talk” to this imaginary friend but in doing so they cut off communication with the real people around them.[50]

Social support and health

Researchers have long been interested in how an individual's level and types of social support impact the effect of stress on their health. Studies consistently show that social support can protect against physical and mental consequences of stress.[52][53] This can occur through a variety of mechanisms. One model, known as the "direct effects" model, holds that social support has a direct, positive impact on health by increasing positive affect, promoting adaptive health behaviors, predictability and stability in life, and safeguarding against social, legal, and economic concerns that could negatively impact health. another model, the "buffering effect", says that social support exerts greatest influence on health in times of stress, either by helping individuals appraise situations in less threatening manners or coping with the actual stress. Researchers have found evidence to support both these pathways.[54]

Social support is defined more specifically as psychological and material resources provided by a social network that are aimed at helping an individual cope with stress.[55] Researchers generally distinguish among several types of social support: instrumental support – which refers to material aid (e.g., financial support or assistance in transportation to a physician's appointment), informational support (e.g., knowledge, education or advice in problem-solving), and emotional support (e.g., empathy—although negative correlation has been demonstrated between stress and empathy to strangers,[56] reassurance, etc.).[55] Social support can reduce the rate of stress during pregnancy.[57]

Communicating with someone who is stressed

Social support from friends and the community can be very beneficial to helping someone communicate while stressed. Social support is giving a person the knowledge that they are part of a mutual network of caring, interested others, that enable them to lower levels of stress and be better able to cope with the stress that they undergo.[58] The social and emotional support people provide for each other demonstrates that they are important and valued members of social networks.[58]

The stress of a person can greatly affect those around them, especially in families. “Families can experience many conflicting emotions when placed in the position of providing protected care for a loved one. Compassion, protectiveness, and caring can be intermingled with feelings of helplessness and being trapped." [59] Emotional support is crucial to helping families cope with the challenge of supporting their loved one (stressed person).[59] This emotional support can be expressed through many communication methods.

In order to be able to effectively communicate with someone who is stressed, it is important to know how to interact with them in a way that can be beneficial for them. Therapeutic communication techniques can help with different types of communication. These techniques include but are not limited to listening, making open-ended comments, reducing distance, restating, seeking clarification, reflecting, and planning.[60] Actively listening to someone when they are stressed can help them release frustrations and cope with their problems. Listening shows that you are interested in the person, and can have great therapeutic value. It is important to show that the stressed person's needs are above the caregiver's in order for the interaction to be therapeutic.[60] It is important that you remain prepared mentally, emotionally, and physically to assist him or her. It is favourable to remain punctual and polite in the manner of relating to them, and that the best methods are used to promote their well-being and comfort.[60]

Verbal communication methods

Nonverbal communication methods

How to prevent misunderstanding while communicating when stressed

Communication is an important stress-management skill. Although this seems like an easy skill, there is much more to communication than simply speaking. In fact, communication can cause problems such as misunderstandings when not used effectively. When miscommunication happen there tends to be more problems, anger and resentment then if communication were effective in the first place. There are certain things that need to be done to achieve effective communication [61]

The first guideline is to be clear about is what is wanted or needed when speaking with others.

This technique requires the individual’s recognition of distorted and exaggerated expectations and thoughts.

An easy way to meet this guideline is by reflecting the purpose of the conversation in the statement. By reflecting what the desired outcome of the conversation is, there is little room for miscommunication.

The second guideline for effective communication is to use assertive communication.

An assertive statement is non-judgemental, expresses feelings and opinions and reaffirms perceived rights [61] The best way to use the assertive technique is with manipulating the following formula I feel [emotion], when you [the behaviour], because [explanation].

When people are stressed, they cannot verbalize their feelings correctly. When the receiver in the conversation cannot understand the needs of the person, miscommunications happen and the person may feel victimized and blame others for not understanding. The third guideline is empathy which is defined as the ability to consider another person’s perspective and to communicate this perspective back to that person.

The final guideline to prevent misunderstandings when communicating while stressed is cognitive restructuring which facilitates assertive communication as it requires the person to identify their thoughts and feelings Some ways to restructure cognitively is by stopping and understanding what the conversation holds.

Breathing deeply as this will release any tension and promote relaxation which will allow you to reflect on the true emotions.

Reflecting on how you feel emotionally and how you feel immediately allow you to choose the right answer.

Choosing the more realistic and helpful way of thinking allows the communication to be straight forward and upfront leaving little room for miscommunication.

By following the above techniques and guidelines, the chance of a miscommunication in a conversation will decrease. Once the ability to communicate with assertive techniques is worked into everyday life, the frequency of misunderstandings will decrease significantly.

The importance of understanding how to communicate assertively is critical for daily life. With the knowledge of how to properly communicate, whether stressed or not, the ability to communicate will become easier and result in less misunderstandings and frustrations which can contribute to one’s stress [61]

Scales

Life events scales can be used to assess stressful things that people experience in their lives. One such scale is the Holmes and Rahe Stress Scale, also known as the Social Readjustment Rating Scale, or SRRS.[62] Developed by psychiatrists Thomas Holmes and Richard Rahe in 1967, the scale lists 43 stressful events.

To calculate one's score, add up the number of "life change units" if an event occurred in the past year. A score of more than 300 means that individual is at risk for illness, a score between 150 and 299 means risk of illness is moderate, and a score under 150 means that individual only has a slight risk of illness.[26][62]

Life event Life change units
Death of a spouse 100
Divorce 73
Marital separation 65
Imprisonment 63
Death of a close family member 63
Personal injury or illness 53
Marriage 50
Dismissal from work 47
Marital reconciliation 45
Retirement 45
Change in health of family member 44
Pregnancy 40
Sexual difficulties 39
Gain a new family member 39
Business readjustment 39
Change in financial state 38
Death of a close friend 37
Change to different line of work 36
Change in frequency of arguments 35
Major mortgage 32
Foreclosure of mortgage or loan 30
Change in responsibilities at work 29
Child leaving home 29
Trouble with in-laws 29
Outstanding personal achievement 28
Spouse starts or stops work 26
Begin or end school 26
Change in living conditions 25
Revision of personal habits 24
Trouble with boss 23
Change in working hours or conditions 20
Change in residence 20
Change in schools 20
Change in recreation 19
Change in church activities 19
Change in social activities 18
Minor mortgage or loan 17
Change in sleeping habits 16
Change in number of family reunions 15
Change in eating habits 14
Vacation 13
Minor violation of law 10

A modified version was made for non-adults. The scale is below.[26]

Life Event Life Change Units
Unwed pregnancy 100
Death of parent 100
Getting married 95
Divorce of parents 90
Acquiring a visible deformity 80
Fathering an unwed pregnancy 70
Jail sentence of parent for over one year 70
Marital separation of parents 69
Death of a brother or sister 68
Change in acceptance by peers 67
Pregnancy of unwed sister 64
Discovery of being an adopted child 63
Marriage of parent to stepparent 63
Death of a close friend 63
Having a visible congenital deformity 62
Serious illness requiring hospitalization 58
Failure of a grade in school 56
Not making an extracurricular activity 55
Hospitalization of a parent 55
Jail sentence of parent for over 30 days 53
Breaking up with boyfriend or girlfriend 53
Beginning to date 51
Suspension from school 50
Becoming involved with drugs or alcohol 50
Birth of a brother or sister 50
Increase in arguments between parents 47
Loss of job by parent 46
Outstanding personal achievement 46
Change in parent's financial status 45
Accepted at college of choice 43
Being a senior in high school 42
Hospitalization of a sibling 41
Increased absence of parent from home 38
Brother or sister leaving home 37
Addition of third adult to family 34
Becoming a full-fledged member of a church 31
Decrease in arguments between parents 27
Decrease in arguments with parents 26
Mother or father beginning work 26

The SSRS is used in psychiatry to weight the impact of life events.[63]

See also

References

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