distress

Meaning: Stress is the response to a demand, called a stressor. Distress is the unpleasant, harmful version, which tends to arise when a person judges a stressor to be a threat or to exceed their ability to cope. Eustress is the positive version, such as the excitement of a new job or a wedding, which feels manageable and can be motivating. Both can produce similar physiological arousal (sympathetic activation, cortisol release), as described in the general adaptation syndrome: alarm, resistance, exhaustion. Prolonged distress is associated with the exhaustion stage and with poorer physical and mental health.

On the MCAT: Passages use the cognitive appraisal model. In primary appraisal, the person decides whether an event is irrelevant, benign-positive, or stressful. In secondary appraisal, the person judges whether they have the resources to cope. Distress is most likely when an event is judged stressful and coping resources seem inadequate. Questions may ask you to classify a scenario as distress or eustress, or to predict that changing the appraisal or improving coping (problem-focused or emotion-focused) should reduce distress.

Common confusion: Students assume that negative events cause distress and positive events cause eustress. Appraisal decides, so a promotion that feels overwhelming can produce distress, and a challenging event that feels manageable can produce eustress. Stress itself is not defined as harmful.