If the reactions that compose the stress response are chronic or if they frequently exceed normal ranges, they can lead to cumulative wear and tear on the body, in much the same way that running your air conditioner on full blast all summer will eventually cause wear and tear on it. For example, the high blood pressure that a person under considerable job strain experiences might eventually take a toll on their heart and set the stage for a heart attack or heart failure. Also, someone exposed to high levels of the stress hormone cortisol might become vulnerable to infection or disease because of weakened immune system functioning (McEwen, 1998). Link to Learning Neuroscientists Robert Sapolsky and Carol Shively have conducted extensive research on stress in non-human primates for over 30 years. Both have shown that position in the social hierarchy predicts stress, mental health status, and disease. Their research sheds light on how stress may lead to negative health outcomes for stigmatized or ostracized people. Here are two videos featuring Dr. Sapolsky: one is regarding killer stress and the other is an excellent in-depth documentary from National Geographic. Physical disorders or diseases whose symptoms are brought about or worsened by stress and emotional factors are called psychophysiological disorders. The physical symptoms of psychophysiological disorders are real and they can be produced or exacerbated by psychological factors (hence the psycho and physiological in psychophysiological). A list of frequently encountered psychophysiological disorders is provided in Table 14.3. Type of Psychophysiological Disorder Examples Cardiovascular hypertension, coronary heart disease Gastrointestinal irritable bowel syndrome Respiratory asthma, allergy Musculoskeletal low back pain, tension headaches Skin acne, eczema, psoriasis Table 14.3 Types of Psychophysiological Disorders (adapted from Everly & Lating, 2002) Friedman and Booth-Kewley (1987) statistically reviewed 101 studies to examine the link between personality and illness. They proposed the existence of disease-prone personality characteristics, including depression, anger/hostility, and anxiety. Indeed, a study of over 61,000 Norwegians identified depression as a risk factor for all major disease-related causes of death (Mykletun et al., 2007). In addition, neuroticism—a personality trait that reflects how anxious, moody, and sad one is—has been identified as a risk factor for chronic health problems and mortality (Ploubidis & Grundy, 2009). Below, we discuss two kinds of psychophysiological disorders about which a great deal is known: cardiovascular disorders and asthma. First, however, it is necessary to turn our attention to a discussion of the immune system—one of the major pathways through which stress and emotional factors can lead to illness and disease. Everyday Connection Social Status, Stress, and Health Care Psychologists have long been aware that social status (e.g., wealth, privilege) is intimately tied to stress, health, and well-being. Some factors that contribute to high stress and poor health among people with lower social status include lack of control and predictability (e.g., greater unemployment) and resource inequality (e.g., less access to health care and other community resources) (Marmot & Sapolsky, 2014). In the United States, resource inequalities tied to social status often create race and gender differences in health care. For example, African American women have the highest rates of emergency room visits and unmet health care needs compared to any other group, and this disparity increased significantly from 2006 to 2014 (Manuel, 2018). Lesbian, gay, bisexual, and transgender youth often experience poor quality of care as a result of stigma, lack of understanding, and insensitivity among health care professionals (Hafeez, Zeshan, Tahir, Jahan, & Naveed, 2017). One goal of the U.S. government’s Healthy People 2020 initiative is to eliminate gender and race disparities in health care. Their interactive dataset provides an updated snapshot of health disparities: https://www.healthypeople.gov/2020/data-search/health-disparities-data.