Stress

Definition

Stress is defined as an organism's total response to environmental demands or pressures. When stress was first studied in the 1950s, the term was used to denote both the causes and the experienced effects of these pressures. More recently, however, the word stressor has been used for the stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. Is it primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions, or is it an internal interpretation of, or reaction to, a stressor; or is it both?

Description

Stress in humans results from interactions between persons and their environment that are perceived as straining or exceeding their adaptive capacities and threatening their well- being. The element of perception indicates that human stress responses reflect differences in personality, as well as differences in physical strength or general health.

Risk factors for stress-related illnesses are a mix of personal, interpersonal, and social variables. These factors include lack or loss of control over one's physical environment, and lack or loss of social support networks. People who are dependent on others (e.g., children or the elderly) or who are socially disadvantaged (because of race, gender, educational level, or similar factors) are at greater risk of developing stress-related illnesses. Other risk factors include feelings of helplessness, hopelessness, extreme fear or anger, and cynicism or distrust of others.

Causes and symptoms

Causes

The causes of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources. Researchers generally agree that a certain degree of stress is a normal part of a living organism's response to the inevitable changes in its physical or social environment, and that positive, as well as negative, events can generate stress as well as negative occurrences. Stress-related disease, however, results from excessive and prolonged demands on an organism's coping resources. It is now believed that 80-90% of all disease is stress-related

Recent research indicates that some vulnerability to stress is genetic. Scientists at the University of Wisconsin and King's College London discovered that people who inherited a short, or stress-sensitive, version of the serotonin transporter gene were almost three times as likely to experience depression following a stressful event as people with the long version of the gene. Further research is likely to identify other genes that affect susceptibility to stress.

One cause of stress that has affected large sectors of the general population around the world since 2001 is terrorism. The events of September 11, 2001, the sniper shootings in Virginia and Maryland and the Bali nightclub bombing in 2002, the suicide bombings in the Middle East in 2003, have all been shown to cause short-term symptoms of stress in people who read about them or watch television news reports as well as those who witnessed the actual events. Stress related to terrorist attacks also appears to affect people in countries far from the location of the attack as well as those in the immediate vicinity. It is too soon to tell how stress related to episodes of terrorism will affect human health over long periods of time, but researchers are already beginning to investigate this question.

Symptoms

The symptoms of stress can be either physical and psychological. Stress-related physical illnesses, such as irritable bowel syndrome, heart attacks, and chronic headaches, result from long-term overstimulation of a part of the nervous system that regulates the heart rate, blood pressure, and digestive system. Stress-related emotional illness results from inadequate or inappropriate responses to major changes in one's life situation, such as marriage, completing one's education, becoming a parent, losing a job, or retirement. Psychiatrists sometimes use the term adjustment disorder to describe this type of illness. In the workplace, stress-related illness often takes the form of burnout--a loss of interest in or ability to perform one's job due to long-term high stress levels.

Diagnosis

When the doctor suspects that a patient's illness is connected to stress, he or she will take a careful history that includes stressors in the patient's life (family or employment problems, other illnesses, etc.). Many physicians will evaluate the patient's personality as well, in order to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that doctors can use to help diagnose the amount of stress that the patient experiences and the coping strategies that he or she uses to deal with them. Stress-related illness can be diagnosed by primary care doctors, as well as by those who specialize in psychiatry. The doctor will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g., thyroid activity) that have psychological side effects.

Treatment

Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of mainstream approaches to stress-related illness. Present treatment regimens may include one or more of the following:

• Medications. These may include drugs to control blood pressure or other physical symptoms of stress, as well as drugs that affect the patient's mood (tranquilizers or antidepressants).
• Stress management programs. These may be either individual or group treatments, and usually involve analysis of the stressors in the patient's life. They often focus on job or workplace related stress.
• Behavioral approaches. These strategies include relaxation techniques, breathing exercises, and physical exercise programs including walking.
• Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs.
• Cognitive therapy. These approaches teach patients to reframe or mentally reinterpret the stressors in their lives in order to modify the body's physical reactions.
• Meditation and associated spiritual or religious practices. Recent studies have found positive correlations between these practices and stress hardiness.

Alternative treatments

Treatment of stress is one area in which the boundaries between traditional and alternative therapies have changed in recent years, in part because some forms of physical exercise (yoga, tai chi, aikido) that were once associated with the counterculture have become widely accepted as useful parts of mainstream stress reduction programs. Other alternative therapies for stress that are occasionally recommended by mainstream medicine include aromatherapy, dance therapy, biofeedback, nutrition-based treatments (including dietary guidelines and nutritional supplements), acupuncture, homeopathy, and herbal medicine.

Prognosis

The prognosis for recovery from a stress-related illness is related to a wide variety of factors in a person's life, many of which are genetically determined (race, sex, illnesses that run in families) or beyond the individual's control (economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress and, thus, change their experiences of it. A person's ability to remain healthy in stressful situations is sometimes referred to as stress hardiness. Stress-hardy people have a cluster of personality traits that strengthen their ability to cope. These traits include believing in the importance of what they are doing; believing that they have some power to influence their situation; and viewing life's changes as positive opportunities rather than as threats.

Prevention

Complete prevention of stress is neither possible nor desirable, because stress is an important stimulus of human growth and creativity, as well as an inevitable part of life. In addition, specific strategies for stress prevention vary widely from person to person, depending on the nature and number of the stressors in an individual's life, and the amount of control he or she has over these factors. In general, however, a combination of attitudinal and behavioral changes works well for most patients. The best form of prevention appears to be parental modeling of healthy attitudes and behaviors within the family.

Top Ten Stressful Life EventsDeath of spouseDivorceMarital separationJail term or death of close family memberPersonal injury or illnessMarriageLoss of job due to terminationMarital reconciliation or retirementPregnancyChange in financial state

Key Terms

Adjustment disorder

A psychiatric disorder marked by inappropriate or inadequate responses to a change in life circumstances. Depression following retirement from work is an example of adjustment disorder.

Biofeedback

A technique in which patients learn to modify certain body functions, such as temperature or pulse rate, with the help of a monitoring machine.

Burnout

An emotional condition, marked by tiredness, loss of interest, or frustration, that interferes with job performance,. Burnout is usually regarded as the result of prolonged stress.

Stress hardiness

A personality characteristic that enables persons to stay healthy in stressful circumstances. It includes belief in one's ability to influence the situation; being committed to or fully engaged in one's activities; and having a positive view of change.

Stress management

A category of popularized programs and techniques intended to help people deal more effectively with stress.

Stressor

A stimulus, or event, that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism.

For Your Information

Resources

Books

• Clark, R. Barkley. "Psychosocial Aspects of Pediatrics and Psychiatric Disorders." Current Pediatric Diagnosis &Treatment. Edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
• Eisendrath, Stuart J. "Psychiatric Disorders." Current Medical Diagnosis & Treatment. Edited by Lawrence M. Tierney, Jr., Stephen J. McPhee, and Maxine A. Papadakis. Stamford, CT: Appleton &Lange, 1997.
• Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part I, "Spirituality and Healing." New York: Simon & Schuster, 2002.
• "Psychiatry in Medicine. " Section 15, Chapter 185 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
• Selye, Hans, MD. The Stress of Life. New York, Toronto, and London: McGraw-Hill Book Company, 1956.

• Antoni, M. H., D. G. Cruess, N. Klimas, et al. "Stress Management and Immune System Reconstitution in Symptomatic HIV-Infected Gay Men Over Time: Effects on Transitional Naive T Cells (CD4(+)CD45RA(+)CD29(+))." American Journal of Psychiatry 159 (January 2002): 143-145.
• Blumenthal, J. A., M. Babyak, J. Wei, et al. "Usefulness of Psychosocial Treatment of Mental Stress-Induced Myocardial Ischemia in Men." American Journal of Cardiology 89 (January 15, 2002): 164-168.
• Cardenas, J., K. Williams, J. P. Wilson, et al. "PSTD, Major Depressive Symptoms, and Substance Abuse Following September 11, 2001, in a Midwestern University Population" International Journal of Emergency Mental Health 5 (Winter 2003): 15-28.
• Gallo, L. C., and K. A. Matthews. "Understanding the Association Between Socioeconomic Status and Physical Health: Do Negative Emotions Play a Role?" Psychological Bulletin 129 (January 2003): 10-51.
• Hawkley, L. C., and J. T. Cacioppo. "Loneliness and Pathways to Disease." Brain, Behavior, and Immunity 17 (February 2003) (Supplement 1): S98-S105.
• Latkin, C. A., and A. D. Curry. "Stressful Neighborhoods and Depression: A Prospective Study of the Impact of Neighborhood Disorder." Journal of Health and Social Behavior 44 (March 2003): 34-44.
• Ottenstein, R. J. "Coping with Threats of Terrorism: A Protocol for Group Intervention." International Journal of Emergency Mental Health 5 (Winter 2003): 39-42.
• Rahe, R. H., C. B. Taylor, R. L. Tolles, et al. "A Novel Stress and Coping Workplace Program Reduces Illness and Healthcare Utilization." Psychosomatic Medicine 64 (March-April 2002): 278-286.
• Solomon, G. D. "Chronic Tension-Type Headache: Advice for the Viselike-Headache Patient." Cleveland Clinic Journal of Medicine 69 (February 2002): 173-174.
• Surwit, R. S., M. A. van Tilburg, N. Zucker, et al. "Stress Management Improves Long-Term Glycemic Control in Type 2 Diabetes." Diabetes Care 25 (January 2002): 30-34.
• West, P., and H. Sweeting. "Fifteen, Female and Stressed: Changing Patterns of Psychological Distress Over Time." Journal of Child Psychology and Psychiatry 44 (March 2003): 399-411.

• The American Institute of Stress. 124 Park Avenue, Yonkers, NY 10703 (914) 963-1200. Fax: (914) 965-6267. http://www.stress.org..
• National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. www.nimh.nih.gov.
• Stress and Anxiety Research Society (STAR). STAR is an international multidisciplinary organization of researchers that began in the Netherlands in 1980. http://www.star-society.org..

• National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs. Fact Sheet: Survivors of Human-Caused and Natural Disasters.
• National Institute of Mental Health (NIMH) news release, July 17, 2003. "Gene More Than Doubles Risk of Depression Following Life Stresses." http://www.nimh.nih.gov/events/prgenestress.cfm.

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Rebecca J. Frey, PhD.

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