Resumen: En la actualidad poseemos numerosa evidencia empiríca que demuestra que muchos cuadros psicopatológicos están influidos por el estrés y/o los traumas. Sin embargo, los manuales de diagnóstico de los sistemas DSM y CIÉ no siempre permiten establecer esta relación de un modo adecuado y preciso. A partir de una definición operativa de los conceptos de estrés y trauma se proponen una serie de especificadores que podrían ser incluidos en el eje I de estos sistemas diagnós-ticos. Los especificadores propuestos son: í) especificadores del estrés: cuando un trastorno se vincula con estrés agudo, crónico, o a un trauma y 2) especifícadcxes de factores asociados al estrés: como factor predisponente, desencadenante o de mantenimiento. El uso de estos especificadores mejoraría la precisión diagnóstica, permitiría disponer de más datos sobre las relaciones entre estrés y psicopatologia, y resultaría beneficioso para la terapéutica de los pacientes.Palabras clave: Estrés, trauma, especificadores diagnósticos. A pmposal ofdiagnostic specifiers rdaled to stress and trauma:A contríbution topsychopathological nosology Abstract: Considerable empirical evidence is now available to show that many psychopathological conditions are influenced by stress and/or traumas. However, the diagnostic mamüds of the DSM and ICD systems do not always allow us to establish this relation in a precise and adequate wt^.Starting from woricing definitions of ^ress and trauma, we propose a seríes ofdiagnostic specifiers which can be included in the I axis of these diagnostic systems. The proposed specifiers are: 1) stress q;)ecifíers: wfaen a disorder is linked to acute stress, chnxiic stress or trauma and 2) specifiers of factors associated with stress: predisposition, trígger factors or maintenance. The use of these specifiers would improve diagnostic accuracy, disclose more Information regarding the relations between stress and psychopathology and would be benefícial in terms of patient therapy.Keywords: stress, trauma, diagnostic specifiers. El presente trabajo paite de estas evidencias para poner de relieve que los manuales diagnósticos habituales sólo reconocen esta relación de modo muy fragmentario y para ciertos cuadros clínicos. Aunque en su descaigo puede argumentarse que se trata de manuales de clasifícK^a, sin referencias a la etiología de los trastornos que mencionan, una revisión más detallada mueirtra qiw esta perspectiva no siempre se mantiene. Por ello presentamos una deñnición openrtiva de los conceptos de «estrés» y «traimta» con la mtención de efectuar una propuesta de especiñcadores diagi^sticos vinculados a ambos conceptos. Mediante el uso de e^)ecifícadores de e^ tipo de problonas psicosociales seria posible señal» con más precisión su presaida en numerosos cuadros psicopatcriógicos. INTRODUCCIÓN

Background:The relationship between immigration and the secondary development of psychopathology remains unclear. Studies have raised contradictory findings, although it generally found that migrants face a higher level of stress than general population. This stress consists of different factors, of which “perceived discrimination” would appear to be the most significant. Clinical experience indicates that there may be an association between the intensity of stress related to perceived discrimination and mental disorders, of which anxiety and affective disorders are the most frequent. This study evaluates the relationship between perceived discrimination and anxiety and affective disorders.Method:The data was drawn from a multicentric, observational, cross-sectional study comparing psychopathology in migrants relative to the autochthonous population attending primary care health centres in Catalonia (Spain). 150 individuals from each cohort were evaluated with the MINI international Neuropsychiatric Interview and the Perceived Discrimination subscale of the Barcelona Immigration Stress Scale. A first step compared scores on anxiety and affective disorders between the two groups. In the second step, multivariate analyses were carried out to determine if perceived discrimination and sociodemographic factors were correlated with the presence of anxiety and affective disorders.Results:Immigrant patients were found to have higher levels of both anxiety and affective disorders relative to the autochthonous population. Perceived discrimination was predictive of psychopathology, and also moderated the impact of certain sociodemographic characteristics such as legal status.