In a way that causes or expresses distress; in a manner full of worry or suffering.
Adverbial form of 'distressful' created with '-ly.' The word builds on the adjectival '-ful' form, making it: distress → distressful → distressfully.
This word shows the productive power of English suffixes—you can keep adding layers ('-full,' '-ly') to create new words that stack meaning upon meaning, though the resulting word gets less common the more layers you add.
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