. "5 IOM Review: Stress, Psychiatric Disorders, and Their Relationship to Physical Signs and Symptoms." Adequacy of the Comprehensive Clinical Evaluation Program: A Focused Assessment. Washington, DC: The National Academies Press, 1997.
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There are two broad types of stressors: (1) eventful changes that have a discrete onset and a discrete cessation and (2) chronic stressors that emerge from ongoing situations until it becomes apparent that there is a problem. Most chronic stressors are related to the ongoing nature of social organization and social roles. Other chronic stressors include daily hassles (e.g., a slowdown on the freeway) and ambient stressors (e.g., deteriorating aspects of a neighborhood).
Life event stressors refer to objective changes in life circumstances that are of sufficient magnitude to change a person's usual activities (e.g., acute physical illness). These can be expected to occur throughout the life course, and it is the undesirable events that are stressful for people.
Stress proliferation refers to the notion that a particular stressful circumstance is usually not confined in a person's life but tends to spread out and create additional problems in other areas of life (i.e., a primary stressor may produce a secondary stressor). Primary stressors are primary in the sense that they are the root origin of a series of other problematic life circumstances called secondary stressors. These secondary stressors are not necessarily secondary in their potency and refer to the spillover of the primary stressor into other aspects of a person's life (e.g., interference with job, disruption of relationships with family and friends, constriction of social activities).
For traumatic events, if secondary adversities or other stressors arise, the effects may be additive, that is, they may proliferate.
Once these additional or secondary stressors have been created, they then serve as an independent source of stress. Stress may proliferate for the individual who is the primary target of interest and also for the family and friends of that individual.
In general, the duration of an exposure is related to the effects of stress. The more long-term the exposure, the more long-term are the effects. In addition, just because a person is removed from a stressful life circumstance, the effects of having been in that condition or circumstance persist, even though the stressor is absent.
The Gulf War had many very stressful experiences, despite the fact that it was a military success. There were many months leading up to the war in which the US troops were uncertain about the strength of Iraqi troops, whether chemical or biological weapons would be used, and whether they would be injured or killed in the engagement. In addition, troops were rapidly and unexpectedly deployed, separated from family and friends, faced with a harsh desert environment and environmental hazards, and exposed to a direct life threat; they also witnessed death and destruction.
When individuals deployed to the Gulf returned home, it was assumed that since the war itself was brief and the level of loss of US lives was low, problems associated with the war would be few. The Department of Veterans Affairs did develop a Persian Gulf Registry as a means of addressing questions about