Stress is a person’s physical and emotional response to change. Although most people tend to think of all stress as bad, it can be either positive or negative. An example of positive stress is having a new baby. The death of a loved one is an example of negative stress.

Stress can also be acute (short-term) or chronic (long-term) in nature. Acute stress may occur after hearing a sudden, loud noise, whereas chronic stress may stem from ongoing financial problems. Chronic stress is associated with a number of conditions, including insomnia, major depression and digestive problems.

Reactions to a specific stressor (an agent that causes stress) vary among individuals. However, stress affects everybody in predictable, physical ways. It causes the release of certain chemicals that raise the blood pressure and heart rate, increase the metabolic rate, and prepare the body for a “fight or flight” response.

Stress can be caused by a number of factors including life events, such as being laid off from work, and daily events, such as traffic congestion. Genetic predisposition may also play a role in how a person copes with stress.  

Symptoms of stress can be either behavioral or physical. Behavioral symptoms of stress include either difficulty sleeping (insomnia) or excessive sleeping (hypersomnia), nightmares and irritability.

Physical symptoms of stress include anxiety, depression and headaches.Individuals should seek assistance from a physician if symptoms of stress are alarming in nature (e.g., pounding heart, shortness of breath) or impede daily functioning.

Because of the many physical dangers of stress, stress management has been proposed as a vital component in the treatment of many stress-related conditions.

About stress

Stress is the medical term for a person’s physical and emotional response to change. It affects individuals of all ages.

Although most people tend to view all types of stress as bad, stress can be either positive or negative. Sources of positive stress include having a new baby and starting an exciting new job.

Sources of negative stress include divorce, unemployment and legal battles. It may take only a short time to adjust to the change (acute stress), or the adjustment may be more gradual (chronic stress).

Acute stress is an immediate reaction to a change that is perceived as threatening (stressor). Sources of acute stress include suddenly being cut off by a car in traffic, and hearing a loud, unexpected noise. In addition to creating feelings such as fear and/or anxiety in the person, stress can also set off the body’s alarm system, triggering a “fight or flight” response. This short-term response prepares the body to either fight or flee from a perceived threat.

If all stressors were acute, people would simply respond to an immediate threat, and then their body’s systems would return to normal. However, people encounter many changes to which it is more difficult to respond, such as daily job stress, unrelenting financial pressures and dysfunctional, long-term relationships.

The longer people go without either changing or adapting to these changes, the longer they will experience stress. The type of stress that people experience for a long period of time is called chronic stress.

Because chronic stress results from changes that are not addressed, this lack of action leaves the body in a state of heightened awareness or tension. Sooner or later, the energy drain on the system will cause the body to fall behind in the self-repair and maintenance necessary for good health. The unrelenting wear and tear brought about by stress hormones can affect the following body systems:

  • Nervous system. Hormones related to chronic stress produce persistent feelings of helplessness, anxiety and impending doom. Oversensitivity to chronic stress has been associated with major depression. This may be because individuals with depression find it more difficult to adapt to the negative effects of the hormone cortisol, which is responsible for supplying the body with the energy necessary to respond to a stressful situation. Excess levels of cortisol can also lead to sleep disturbances (e.g., insomnia) and decreased sex drive.
  • Digestive system. Chronic stress is associated with a number of digestive problems, including stomachache, heartburn, diarrhea, irritated ulcers, colitis (inflamed colon) and irritable bowel syndrome (IBS). Stress triggers these digestive problems in a number of ways. Stress hormones may delay the release of stomach acid and increase the amount of time it takes to empty the stomach.  They also stimulate the colon, causing its contents to pass more quickly. Excess levels of the hormone cortisol can also lead to either increased appetite or appetite loss.
  • Immune system. Chronic stress can suppress the immune system, resulting in more upper respiratory infections and other infectious diseases as well as slowed wound healing. Individuals with compromised immune systems (e.g., due to disease) are even more vulnerable to the effects of stress. For instance, stress can affect blood sugar levels in patients with diabetes, and may trigger outbreaks in individuals with herpes simplex virus.

Conversely, stress can also cause the immune system to become overactive in some instances. This increases a person’s risk of developing an autoimmune disease (in which the immune system attacks its own cells).

In addition, stress can worsen the symptoms of a pre-existing autoimmune disease. For example, stress can trigger symptom flare-ups in individuals with lupus or multiple sclerosis (MS).

  • Cardiovascular system. Excess amounts of cortisol can raise a patient’s heart rate and increase their blood pressure, cholesterol and triglyceride levels, placing them at increased risk for heart attack and stroke. Elevated cortisol levels may also lead to excess body fat in the abdominal region, a risk factor of both diabetes and heart disease. In addition, stress can induce angina, which is a risk factor of heart attack.
  • Muscular system. Stress has been associated with muscles spasms and aching in the jaw, neck, back and shoulders.

Other systems. Stress is also associated with the following:

  • Elevated blood pressure
  • Skin conditions (e.g., acne, hives)
  • Asthma attacks
  • Arthritis flare-ups
  • Increased chronic pain

Furthermore, chronic stress takes an emotional toll because the feelings of anger, fear, frustration and/or anxiety remain constant. Because of the many physical dangers of stress, stress management has been proposed as a vital component in the treatment of many stress-related conditions.

Effects of stress

Reactions to a specific stressor (an agent that causes stress) vary among individuals. For instance, some people experience frustration and anxiety when confronted with a deadline whereas others do not. The chemical processes that take place in the body when it perceives stress, however, are fairly consistent among all people.

The body’s response to a perceived threat (stress) is also known as the “fight or flight” response. In situations of physical danger, the person’s sensory receptors (e.g., eyes and ears) detect the change and send messages to the brain via somatosensory fibers.

These messages basically instruct the brain to assess the situation and determine if it is threatening. The limbic system, the part of the brain associated with emotion, may send out a “red alert” message if it perceives a threat.

The part of the brain that responds to the emergency call is the hypothalamus, which is responsible for a wide variety of functions from sleeping and waking to sexual response. The hypothalamus sends out the warning to the rest of the body by doing four things very quickly.

First, it sends a message directly to the adrenal glands, which are located on top of the kidneys, to release two hormones: epinephrine (adrenaline), and norepinephrine (noradrenaline). These two hormones race through the bloodstream to speed up the body’s organs in preparing for fight or flight. For example, the rate and force of the heartbeat will increase significantly.

Second, the hypothalamus releases a chemical called corticotrophin releasing factor (CRF). The CRF carries the warning message to the nearby pituitary gland, which responds by releasing adrenocorticotropic hormone (ACTH). The ACTH travels quickly to the adrenal glands, which receive the message and release a variety of chemicals in response, especially cortisol and aldosterone.

Cortisol is responsible for supplying the body with necessary energy for the situation, which it does in a variety of ways. For example, cortisol stimulates the liver’s release of cholesterol, fats, protein and glucose, and it takes energy from the immune system, thus temporarily shutting the immune system down.

Aldosterone is responsible for increasing blood pressure for maximum readiness, which it does by helping the body maintain a high sodium level (and therefore a high level of water) in the blood.

Third, the hypothalamus stimulates the pituitary gland to release two other hormones: oxytocin and vasopressin (antidiuretic hormone). These hormones are responsible for keeping the blood pressure elevated, so that the heart, muscles and brain can get the oxygen needed for optimal functioning in the face of danger.

Saliva may dry up in the mouth as fluids are transferred to more essential areas, such as the brain and muscles. The blood’s clotting ability is also increased, so that the body will lose less blood/fluids in the event of an injury.

Finally, the hypothalamus releases thyrotropic hormone releasing factor (TRF), which stimulates the pituitary gland to release thyrotropic hormone (TTH). As this hormone travels through the bloodstream, it stimulates the thyroid gland (located in the neck) to produce two chemicals: thyroxine and triiodothyronine.

These two chemicals are responsible for speeding up the body’s metabolism, resulting in the acceleration of the following processes: blood pressure, breathing, heart rate, thinking processes and perspiration. The liver produces sugar from its stores of glycogen (composed of excess sugars, proteins and fat) and releases it into the bloodstream to provide extra energy for the body.

Causes of stress

Different people will be affected by different types of changes, but common stressors (agents that cause stress) include:

  • Life events. Events such as divorce or separation, death of a loved one, infertility or the birth of a child, moving, a major financial setback and employment changes are common stressors. Stress may also result from becoming the victim of a crime or natural disaster. Individuals who witness or experience such traumatic events may develop post-traumatic stress disorder (PTSD), an anxiety disorder that involves feelings of intense fear, helplessness and/or horror brought on by experiencing or watching an especially terrifying event.
  • Daily events. Events such as traffic congestion, long commutes, working overtime, deadlines, personal conflicts, car trouble, job stress, and juggling household chores and childcare can be stressful for many people.
  • Environmental stressors. Common environmental stressors include pollution, weather extremes and excessive noise.
  • Physical stressors. Physical injury, chronic pain and/or disease, tiring physical activity (e.g., traveling), and unsatisfied physical needs, such as hunger, thirst or lack of sleep, can all induce stress.

There are also some characteristics that may impede a person’s ability to cope with change, causing them to experience more stress. These characteristics include:

  • Genetic predisposition. Some inherited psychological factors can inhibit an individual’s ability to cope with change.
  • Inability to adapt. Most people are eventually able to adapt more comfortably to a change, such as learning to drive on a particularly busy highway in the morning. However, some people never make this adjustment and each repeated event produces the same intense physical response.
  • Inadequate relaxation response. The stress hormones of some people do not return to normal levels following an acute stress event. The elevated hormone levels cause prolonged wear and tear on the body. This is particularly common in highly competitive athletes and individuals with a history of major depression.
  • Age. Both the young and the elderly tend to be more susceptible to stress than people of other age groups. Children are particularly susceptible because they often have little control over change and because they cannot communicate their feelings well enough to help manage stress. Seniors are susceptible because they are often exposed to multiple major stressors, such as the loss of a spouse, medical problems, financial worries and/or a change of living situation.
  • Isolation. Individuals who lack a solid social network of friends and family are more likely to have trouble adjusting to change.
  • Environment. Stress can be job-related. Interpersonal conflicts with others and office politics are just two examples. People with a high level of responsibility, such as air-traffic controllers, are also prone to stress.

Symptoms of stress

Symptoms of stress can be either behavioral or physical. Behavioral symptoms include:

  • Anxiety
  • Depression
  • Too much sleep (hypersomnia) or too little sleep (insomnia)
  • Nightmares
  • Nervous habits (e.g., nail-biting, foot-tapping)
  • Decreased sex drive
  • Teeth grinding
  • Irritability or impatience
  • Laughing for no apparent reason
  • Crying over minor incidents
  • Dreading going to work or other activities
  • Poor concentration
  • Overeating or undereating
  • Relationship problems
  • Guilt

Physical symptoms of stress include:

  • Fatigue
  • Chest pain
  • Pounding heart
  • Dental problems (due to teeth grinding)
  • Dry, tight throat
  • Migraine or tension-type headaches
  • Digestive problems (e.g., heartburn, upset stomach)
  • Shortness of breath, shallow breathing or sighing
  • Muscular tension and aches in the jaw, neck, back or shoulders
  • Weight loss or gain
  • Cold or sweaty palms
  • High blood pressure

Individuals should seek assistance from a physician if symptoms of stress are alarming in nature (e.g., pounding heart, shortness of breath) or impede daily functioning.

Questions for your doctor regarding stress

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following stress-related questions:

  1. What do you suspect is causing my stress?
  2. How can stress impact my health?
  3. Is stress making my medical condition worse?
  4. How can I help my loved ones cope with their stress?
  5. What activities can help me cope with my high stress level?
  6. Should I take medication to help reduce my stress?
  7. Why do I seem to be more prone to stress than others?
  8. Do you suspect that my stress is acute or chronic?
  9. Does it seem like I am experiencing a disproportionate amount of stress?
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