Stress (psychological)

For other kinds of stress see Stress.

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, and mental disorders 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.

General types

Popular conflation

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. Distress causes a slowing of working pace while eustress can lead to motivational states such as flow.^[4]

Variations

Selye proposed that there are four variations of stress.^[5] 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.^[6] 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.^[7] Eustress is when a person perceives a stressor as positive.^[8] Distress stems from the Latin root “dis” as in dissonance or disagreement.^[7] Distress is a threat to the quality of life. It is when a demand vastly exceeds a person’s capabilities.^[8]

Neutral stressors

Stress is a non-specific response.^[6] 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. He defined stress as “the nonspecific (that is, common) result of any demand upon the body, be the effect mental or somatic.”^[6] 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.^[9]

Impact on health

Types of stressors

A stressor is any event, experience, or environmental stimulus that causes stress in an individual.^[10] 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.^[11]

Stressors are more likely to affect an individual's health when they are "chronic, highly disruptive, or perceived as uncontrollable".^[11] 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.^[11] 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.^[11]

Major life events

Common examples of major life events include: marriage, going to college, death of a loved one, birth of a child, etc. These events can be either positive or negative. Research has found major life events are somewhat rare major causes of stress, due to their infrequent occurrences.^[11]

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^[12] 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.^[11] However, positive experiences and positive life changes can predict decreases in neuroticism.^[13][14] Finally, some people experience more stressful events than others, due to their temperament.^[15][16]

Psychological stress in Human Factor Research: The Six-Types-of-Stress Model

The literature distinguishes six levels of stress, identified by the Italian researcher Daniele Trevisani (2009)^[17] who makes a clear differentiation in six categories, with a specific attention to stress as the outcome of the confrontation between goals and the energy levels of the individual. The six typologies are:

1. Bio-energetic stress: heavier overwhelming physical stressors whose energy requirement is lower than the bodily energy resources that the individual can express in a given moment. The Human-Factor aspects that can increase bio-energetic stress are all the activities that can reduce bodily energies, such as wrong diet, lack of sleep and resting, change in biorhythms, localized pain.
2. Psycho-energetic stress: chronic or acute anxiety, emotional troubles, mental rumination, altered states of consciousness, feelings of loneliness and not being understood, lack of social acceptance, deprivation of interpersonal communication, forced social relationships.
3. Micro-Skills stress: appears when the individual has only partial abilities in pivotal skills that can change the course of action and determine the success in a performance.
4. Macro-Skills stress: It consists of missing of insufficient competences in the personal portfolio of skills, in a changing environment, accompanied by the lack of any proactive action to find a way to cover the skills-gap incongruity (e.g. complete lack of knowledge of English language if one wished to work and live in an English-speaking country).
5. Lack-of-Planning Stress: low ability in time-management and in defining goals and steps, lack of confidence and expertise in transforming ideas or goals into planned and achievable goals and steps.
6. Values stress: loss of sense and purpose, loss of ideals and values, feeling that there’s nothing more to believe in, or reality seems to have no sense, feeling of internal value-emptiness (Trevisani, 2009).

In this Human Energy-Based model, the six levels can be co-present or instead dominated by one or more specific stress levels during different stages of the lifetime of the individual. The response needs therefore to be found into two different paths: (1) reduction strategy: the reduction of objectives, the reduction of target levels, in order to fit the present energy levels of the individual, or (2) the empowerment of the individual, based on the acquisition of tools and instruments specific for the specific area, by means of coaching, training, counseling, and life-style changes that can help the individual in restoring right energy-levels needed to achieve the desired tasks.

Daily hassles/microstressors

This category includes daily annoyances and minor hassles.^[11] 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.

• The approach-approach conflict occurs when a person is choosing between two equally attractive options, i.e. whether to go see a movie or to go see a concert.^[11]
• The avoidance-avoidance conflict, where a person has to choose between two equally unattractive options, for example, to take out a second loan with unappealing terms to pay off the mortgage or to face foreclosure on one's house.^[11]
• The approach-avoidance conflict.^[11] This occurs when a person is forced to choose whether or not to partake in something that has both attractive and unattractive traits—such as whether or not to attend an expensive college (meaning taking out loans now, but also meaning a quality education and employment after graduation).

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).^[18]

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".^[19] 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".^[19]

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.^[20]

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.^[20]

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).

• Affiliation – involves dealing with stress by turning to a social network for support, but an individual does not share with others in order to diffuse or avoid the responsibility.^[21][22]
• Humor – the individual steps outside of a situation in order to gain greater perspective, and also to highlight any comic aspect to be found in their stressful circumstances.^[21]

“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”.^[23]

Sigmund Freud, a well known neurologist, suggests that humor was an excellent defensive strategy in emotional situations.^[20] When one laughs during a tough situation they feel absent from their worries, and this allows them to think differently.^[23] 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.^[24] 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.^[23]

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.^[23] 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.

• Sublimation – allows an “indirect resolution of conflict with neither adverse consequences nor consequences marked by loss of pleasure".^[25] Essentially, this mechanism allows channeling of troubling emotions or impulses into an outlet that is socially acceptable.
• Positive reappraisal – redirects thoughts (cognitive energy) to good things that are either occurring or have not occurred. This can lead to personal growth, self-reflection, and awareness of the power and benefits of one's efforts.^[26]

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.

• Displacement – This is when an individual redirects their emotional feelings about one situation to another, less threatening one.^[27]
• Repression – Repression occurs when an individual attempts to remove all their thoughts, feelings, and anything related to the upsetting/stressful (perceived) threat out of their awareness in order to be disconnected from the entire situation. When done long enough in a successful way, this is more than just denial.
• Reaction formation – An individual substitutes their feelings or thoughts or behavior with the exact opposite. An attempt to remove any “unacceptable thoughts” from one's consciousness by replacing them with the exact opposite.^[28]

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

Active mechanisms

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

• Acting out – Often viewed as counter-normative, or problematic behavior. Instead of reflecting or problem-solving, an individual takes maladaptive action.^[22]
• Passive aggression – When an individual indirectly deals with his or her anxiety and negative thoughts and feelings stemming from their stress by acting in a hostile or resentful manner towards others. Help-Rejecting Complaining can also be included in this category.

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:^[29]

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.

Stress 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.^[30]

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.^[31]

Impact on communication

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, shut down the digestive system, and cause a rise in blood pressure.^[32][33]
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.^[33][34]
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.^[33]

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.^[35]

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.^[36]

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.^[36]

• An individualistic culture, like that of the United States, where everyone is an independent entity defined by their accomplishments and goals.
• A collectivistic culture, like that of many Asian countries, prefers to see individuals as interdependent on each other. They value modesty and family.

These cultural differences can affect how people communicate when they are stressed. For example, a member of an individualistic culture 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 culture 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.^[36]

Language barriers

Language barriers can also diminish communication due to stress.^[37] All languages have their own way of using names, titles, and just interacting. These differences can make interlingual 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.^[37]

Changes in the home

Divorce, death, and remarriage are all disruptive events in a household.^[36] 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 some of the changes stress may trigger in their lives.^[36]

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.^[36]

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.^[38][39] 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.^[40]

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.^[41] 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,^[42]—reassurance, etc.).^[41] Social support can reduce the rate of stress during pregnancy.^[43]

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 gives a person the knowledge that they are part of a mutual network of caring, interested others, and this reduces their level of stress and helps them cope better with the stress that they undergo.^[44] The social and emotional support people provide for each other demonstrates that they are important and valued members of social networks.^[44]

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 protective care for a loved one. Compassion, protectiveness, and caring can be intermingled with feelings of helplessness and being trapped." ^[45] Emotional support is crucial to helping families cope with the challenge of supporting their loved one (stressed person).^[45] 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.^[46] Actively listening to someone when they are stressed can help them release frustrations and cope with their problems. Listening shows that one is 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.^[46] It is important that one 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.^[46]

Verbal communication methods

• Making open-ended comments can allow the person who is stressed to decide the direction that the interaction can take and encourages them to keep talking.^[46]
• In order to validate that the message is being interpreted properly, it is a good idea to restate what the person has said. Seeking clarification can also help to ensure the understanding of what they’re communicating.^[46]
• Try reflecting about what the stressed person has said. It will show that the other person sees and understands the importance in his or her feelings, ideas and interpretations. It is important to avoid being judgmental and rejecting what the person has said. It may make them feel that they are personally being rejected.^[46]
• At the end of the conversation, it is a good idea to help them plan their goals, direction and so forth, of future interactions.^[46]

Nonverbal communication methods

• Having a posture that is slightly leaning towards the person communicates interest and encourages them to keep talking.^[45] Reducing physical distance between the other person and the person who is stressed, indicates that they want to be involved in helping the person.^[46]
• "Try maintaining an open, friendly expression without being boisterously cheerful. Avoid furrowed forehead or a distracted or bored expression." ^[45] Making direct eye contact also generally conveys that the listener shows interest and concern for them.^[45]
• It is very beneficial to generally focus on maintaining an open atmosphere when speaking to someone. However, it is also important to pay attention to their nonverbal cues as well. By using their nonverbal cues, the listener can interpret their mood and feelings. This will help with adapting to the situation and communicating better.^[45]

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 happens there tends to be more problems, anger and resentment. There are certain things that need to be done to achieve effective communication.^[47]

The first guideline is to be clear about 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.^[47] One way to use the assertive technique is by manipulating the following formula: I feel [emotion] when you [the behaviour], because [explanation]. An alternative way, favored by proponents of non-violent communication, is to take an attitude that can be expressed by words like: I see [facts] and feel [emotion], because [need], and I ask [request].

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 are: by stopping and understanding what the conversation holds; breathing deeply, as this will release tension and promote relaxation, which will allow one to reflect on the true emotions; and reflecting on how one feels emotionally.

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 communicate properly, whether stressed or not, communicating will become easier and result in fewer misunderstandings and frustrations that can contribute to one’s stress.^[47]

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.^[48] 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.^[11][48]

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.^[11]

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.^[49]

See also

References