Five Factors That Cause Emotional Stress
This myth has never been substantiated by research and the DSM is largely dismissed as a belief system created to sell pharmaceuticals.
What if, instead, we threw away the disease model of mental illness? What if we tried to understand emotional experiences based on what we really DO know about psychology and biology? Well, we’d come up with Five Factors that cause emotional distress:
- Factor 1. The Primal Threat Response or “Fight-or-Flight”
- Factor 2. Fear of Social Exclusion
- Factor 3. Shame as an Attempt to Prevent Social Exclusion
- Factor 4. Trauma
- Factor 5: Attachment Status
These Five Factors combine to lead to low self-worth, poor emotional regulation skills, and difficulties with social and emotional functioning. The DSM labels these experiences as “mental disorders,” but they are merely adaptive and self-protective behaviors learned in childhood to manage distressing experiences.
Based on these Five Causative Factors, Three Counterproductive Shame Management Strategies often develop that explain most human relationship problems.
Five Causative Factors
Let’s briefly discuss how these Five Factors make more sense than the disease model in the DSM.
For a more in-depth description of each of these factors, click on each headline or the “read more” link below each section.
Factor 1. The Primal Threat Response or “Fight-or-Flight”
When we are reacting with self-protection we are less capable of being caring or empathic — even toward ourselves.
With this understanding, it provides a framework for consolidating the many diagnoses in the DSM based on the threat response:
- Conditions such as anxiety or ADHD are examples of over-sensitivity to and over-reactivity to threat. The body and mind are adapting to threatening situations with fear and emotional dysregulation.
- Conditions such as depression, schizoaffective disorder, and the depressive stage of bi-polar disorders are examples of under-reactivity to threat and over-control of emotions, often as a result of chronic exposure to external threat or internal threats of self-shaming messages.
Fear is one of the most powerful emotions humans experience and has wide-ranging effects on physiology, emotions, attitudes, cognitions, and behaviors. Yet despite the volumes of research and evidence on the threat response, the disease model essentially ignores this common-sense information when describing human behavior.
How can the profession continue to overlook the obvious fact that “mental disorders” labeled as anxiety, depression, bi-polar disorder, PTSD, and ADHD are merely natural, protective responses to fear-provoking situations? Why should we label them as “disorders,” causing stigma and shame, and treat them with harmful, brain-altering medicines when these responses are merely unhealthy reactions to threat?
Wouldn’t it make more sense to eliminate the fear-provoking situation in the person’s life, such as a critical or abusive parent? Or teach the person to reduce self-critical messages that provoke an internal sense of fear? Or teach the person to manage fear in a healthier way, such as with mindfulness and self-acceptance?
And, since all emotions are valuable and natural responses, it makes one wonder: If fear is to be considered a “mental disorder,” then why is happiness not considered a “mental disorder?”
It is time to reframe and de-stigmatize mistaken beliefs about normal human experiences and emotions.
Fear is not a “mental disorder.”
Humans have developed emotions to encourage social inclusion, causing us to have a strong natural desire to avoid feeling shamed, rejected, and cast out. As a result, when we feel we may be ostracized, we generally have predictable reactions, including fear, humiliation, submission, and compliance.
This urge to belong is so elemental that when anticipating social disconnection, our primal brain believes our survival is at stake and responds with the threat response (Factor #1). Essentially, to your brain a breakup with your girlfriend may feel the same as a tiger leaping at you.
Considerable social psychology research has been done on the power of social affiliation or rejection sensitivity and its links to anxiety, yet the DSM never mentions this need as the main driver of human behavior or uses it in its diagnostic criteria.
It seems obvious to ask: Why is this evidence completely excluded from the DSM, from graduate training in psychiatry and psychology, and from psychiatry’s explanations for human behavior?
In clinical settings, loneliness or the fear of being excluded underlie nearly all complaints of anxiety, depression, obsessive-compulsive disorder, social anxiety, relationship problems, and other psychological conditions. With just a few questions, it is easy for a clinician to discover that most clients have fears of being judged as inadequate and being rejected, leading to fears of being seen as unlovable.
It is time to reframe and de-stigmatize mistaken beliefs about normal human experiences and emotions:
Loneliness is not a “mental disorder.”
Factor 3. Shame as an Attempt to Prevent Social Exclusion
If we want to be a trusted and accepted part of the tribe, our reputation becomes an important asset to our survival. Most of us do not want to be seen as cheaters and therefore ostracized, so we cooperate and are generous with others to boost our reputation.
Shame, guilt, and embarrassment are pro-social emotions that are intended to teach us to modify inappropriate behavior.
By feeling guilt when we do something wrong, we can apologize and choose different behavior in the future, helping to ensure that we are accepted by society. Guilt is often communicated through submission.
All social groups have a hierarchy and members communicate that they understand that hierarchy with predictable behaviors. Primatologists and social psychologists have done extensive research on social ranking, including:
- placating or submissive behaviors, such as shame-based “avoidance,” “flight,” and “fold” behaviors of apologizing, groveling, and supplicating
- dominating behaviors, such as “fight” behaviors of physical aggression or intimidation, rejecting, and controlling
However, these well-known primal social behaviors and their associated emotions are never mentioned in the DSM.
During the shaming experience of submission, fear is also triggered. Shame signals the adrenal gland to release cortisol, the primary stress hormone, leading to increased heart rate and the flooding of major muscles with glucose — all physiological reactions to threat.
It seems obvious that the shame/fear reaction causes: emotional under-regulation (which the DSM labels as ADHD, anxiety, oppositional defiant disorder, mania, etc.) over-regulation (depression, social avoidance, etc.) or a mix of under-regulation and over-regulation (bi-polar disorders)
So we know that finding acceptance and avoiding ostracism are natural, primal elements of human social nature (Factor #2). And when we are afraid, we react with “fight-or-flight” fear responses (Factor #1), even if those fears are only caused by an emotional threat, such as criticism or humiliation (Factor #3). Combined, these primal feelings and behaviors are the cause of our modern psychological and behavioral problems. Most of the diagnoses in the DSM are actually descriptions of a person who is hyper-vigilant to being shamed, victimized, or rejected by others. Or who has also become highly self-shaming as a way to forestall criticism by others, leading to feelings of self-rejection.
If shame, fear of social exclusion, and the threat response are such major drivers of human behavior, why are these facts completely ignored in the DSM? Why should the emotion of shame and its associated behavioral reactions be considered a “mental disorder?”
It is time to reframe and de-stigmatize mistaken beliefs about normal human experiences and emotions:
Shame is not a “mental disorder.”
Factor 4. Trauma
Trauma is one of the most widely recognized sources of emotional difficulty, especially following the Adverse Childhood Experiences Study (ACES) in the mid-1990s.
The ACES study found that 1 in 11 middle-class adults had experienced 6 or more childhood traumas, an exposure level far higher than had been anticipated. And of those who had 6 or more events, the resulting emotional, behavioral, and health consequences were staggering. Among other results, they were 4,600 percent more likely to become IV drug users and 30 times more likely to attempt suicide.
Based on such unquestionably clear results, trauma cannot be ignored as a cause of emotional, behavioral, and cognitive suffering. And yet the DSM makes essentially no accommodation for the effect of trauma except for in “diagnoses” labeled as “post-traumatic stress disorder” and “acute stress disorder.”
Some of the most harmful traumas are chronic developmental traumas, including:
- lack of attachment or bond to caregivers
- verbally abusive, rejecting, critical, or shaming parenting styles
- substance abusing, depressed, or anxious parents
- neglect, poverty, or chaotic home environments
Quite simply, trauma (Factor #4) turns up the volume on our natural human alarm system that signals social exclusion (Factor #2). Those who have been emotionally or physically harmed or rejected will be especially sensitive to rejection in the future.
Trauma also habituates the brain to the fear response (Factor #1), leading to being more easily triggered into “fight-or-flight” responses.
Why does the DSM completely disregard the impact of childhood trauma, especially given the magnitude of the ACES results and other research?
It is time to reframe and de-stigmatize mistaken beliefs about normal human experiences and emotions:
Trauma is not a “mental disorder.”
A “secure attachment pattern” teaches a child to accept care and develop a sense of trust and emotional connection with others. This helps the child learn a positive model of how another person feels about him and an abiding belief in self-worth. It predicts that a person will likely grow into someone who has healthy, loving relationships with others and with himself.
In contrast, if a parent is emotionally unavailable and unable to develop a strong, nurturing bond with an infant, that child can develop deep-seated fears that he is inadequate and unlovable. “Insecure attachment” in infancy leads a person to feel threatened and become emotionally reactive when he perceives he will be abandoned or rejected, even later in life.
Children who do not consistently experience the warmth, nurturing, and empathy of emotionally caring parents learn to view relationships as untrustworthy, or possibly frightening and shame-invoking, which provokes the threat response (Factor #1).
Generally, when we feel unsafe, evolution has primed us to look for safety and comfort via emotional and physical connection with others. For a child, the natural place to look for security is with parents. Yet if there is a lack of secure attachment these are the very individuals who are not providing this basic need and instead are rejecting.
If people view relationships as threatening, they find themselves consistently viewing themselves as outside the social group and isolated. Researchers believe that rejection sensitivity stems from early attachment relationships and parental rejection.
What is more shaming and fear-provoking than feeling unloved and unwanted by one’s key social group — the family? (Factor #2)
Many types of chronic developmental trauma (Factor #4) lead to insecure attachment, such as depressed, distressed, or distracted parents.
For those who have rejecting experiences in childhood and subsequent adult patterns of insecure attachment, there is hope. It is possible to develop “earned secure attachment,” also known as self-acceptance, to generate internal emotional safety.
It is time to reframe and de-stigmatize mistaken beliefs about normal human experiences and emotions:
Insecure attachment and the need for love is not a “mental disorder.”
Self-Acceptance Psychology Connects the Five Causative Factors
Human psychology and behavior are largely driven by the Five Causative Factors.
Consider the Five Causative Factors as a perfect storm that leads individuals to feel intrinsically unworthy and shameful. Factors #1, #2, and #3 are natural tendencies and all humans respond to these experiences within normal ranges. A healthy childhood predisposes a person to have more resilient responses to experiences of fear, shame and social exclusion. However, developmental trauma (Factor #4) or insecure attachment (Factor #5) are variables in each person’s life that can increase maladaptive behaviors, including hyper-vigilance to threat and rejection, high levels of shame, lack of emotional intelligence, and lack of cognitive coping skills.
Combining these foundational ideas forms a compelling and innovative paradigm of human psychology that is more easily understood, more accurate, and more powerful than the current disease model. It also elucidates both inter-personal relationships and intra-personal relationships, or the relationship with self.
Based on the Five Causative Factors, it becomes quite clear that shame is a key underlying emotion that drives a large part of human behavior for both inter-personal and intra-personal relationships.
If you grow up not feeling loved and accepted by your parents, this leads to not only a difficulty feeling safe in relationships with others, but also a tendency to not feel safe with yourself. If you loathe yourself, it makes it difficult to be comfortable with and accepting of yourself, leading to an experience of fear or threat merely due to the relationship you have with yourself.
Self-shaming can be considered self-protective and adaptive. It is a way to attempt to fit in and find love and, more importantly, as a way to figure out how to love yourself. Yet chronic high levels of unwarranted self-criticism lead to feeling deeply unlovable to others and unlovable to yourself.
If you dislike yourself, you will attempt to “fix” that feeling in various ways (See Three Shame-Management Strategies.)
If you are not self-accepting, the world looks frightening and relationships look frightening. Even your intrinsic self looks unknowable, frightening, and unworthy. Many authors have noted the importance of having a healthy relationship with yourself to have healthy relationships with others. Yet most interventions in psychology fail because they do not address self-shaming, self-acceptance, and self-compassion.
It should be noted that the DSM-IV fails to mention the significance of self-attachment or self-acceptance even once in its 900-plus pages.
Because of their complete devotion to the disease model, the authors of the DSM have overlooked five essential factors that lead to normal human emotions and behaviors. How can we trust a belief system like the DSM that does not take into account current scientific information and the most powerful explanatory elements of human psychology?