ABSTRACT | PDF

FACULTY FORUM

Stress-related disorders

Raju Sah
Assistant Professor of Psychiatry
Silchar Medical College and Hospital

Stress at a glance
Stress is a normal part of life that can either help us learn and grow or can cause us significant problems. Stress releases powerful neurochemicals and hormones that prepare us for action (to fight or flee). If we don't take action, the stress response can create or worsen health problems. Prolonged, uninterrupted, unexpected, and unmanageable stresses are the most damaging types of stress.
Stress can be managed by regular exercise, meditation or other relaxation techniques, structured timeouts, and learning new coping strategies to create predictability in our lives. Many behaviours that increase in times of stress and maladaptive ways of coping with stress - drugs, pain medicines, alcohol, smoking, and eating - actually worsen the stress and can make us more reactive to further stress. The management of stress is mostly dependent on the willingness of a person to make the changes necessary for a healthy lifestyle.
What is stress?
Stress is related to both external and internal factors. External factors include the physical environment, including your job, your relationships with others, your home, and all the situations, challenges, difficulties, and expectations you're confronted with on a daily basis. Internal factors determine your body's ability to respond to, and deal with the external stress-inducing factors. Internal factors which influence your ability to handle stress include your nutritional status, overall health and fitness levels, emotional well-being, and the amount of sleep and rest you get. 
Vulnerability to stress
Stress comes in many forms and affects people of all ages and all walks of life. The degree of stress in our lives is highly dependent upon individual factors such as physical health, the quality of our interpersonal relationships, the number of commitments and responsibilities we carry, the degree of others' dependence upon us, expectations of us, the amount of support we receive from others, and the number of changes or traumatic events that have recently occurred in our lives.
People with adequate social support networks report less stress and overall improved mental health. Some stressors are particularly associated with certain age groups or life stages. Children, teens, working parents, and seniors are examples of the groups who often face common stressors related to life transitions.
Teen stress
The teen years often bring about an increase in perceived stress as young adults learn to cope with increasing demands and pressures. Excessive stress during the teen years can have a negative impact upon both physical and mental health later in life. Teen stress is a risk factor for the development of depression, a serious condition that carries an increased risk of suicide.
What causes you to experience stress symptoms?
Take some time to think about the things that cause you stress. Your stress may be linked to external factors such as:
the state of the world, the country, or any community to which you belong, unpredictable events, the environment in which you live or work, work itself, family. 
Stress can also come from your own:
irresponsible behaviour, poor health habits, negative attitudes and feelings, unrealistic expectations, perfectionism.
Healthy response to stress
Healthy human responses to stress involve three components: The brain handles the immediate response. This response signals the adrenal medulla to release epinephrine and norepinephrine. The hypothalamus and the pituitary gland trigger the slower maintenance response by signaling the adrenal cortex to release cortisol and other hormones. Many neural circuits are involved in the behavioural response. This response increases arousal (alertness, heightened awareness), focuses attention, inhibits feeding and reproductive behaviour, reduces pain perception, and redirects behaviour.
The combined results of these three components maintain the internal balance and optimize energy production and utilization. They also gear up the organism for a quick reaction through the sympathetic nervous system (SNS). The SNS operates by increasing the heart rate, increasing blood pressure, redirecting blood flow to the heart, muscles, and brain and away from the gastrointestinal tract, and releasing fuel (glucose and fatty acids) to help fight or flee the danger.
Body response to stress
The two main systems involved are hypothalamic-pituitary-adrenal (HPA) axis and SNS. The five most important concepts about these two systems are: 
1. they are governed by a feedback loop to regulate their response; 
2. they interact with each other;
3. they influence other brain systems and functions;
4. genetic variability affects the responses of both systems;
5. prolonged or overwhelming responses of these systems can be harmful to an individual.
Neuroanatomy 
The locus coeruleus secretes norepinephrine and increases arousal (heightened awareness, alertness) and vigilance (watchfulness, carefulness), and adjusts the action of the autonomic nervous system (ANS), which includes the SNS. The ANS regulates blood flow, heart rate, blood pressure, and breathing. It can also temporarily shut down the gastrointestinal and sexual systems until the crisis is over. These initial reactions, to get our blood flowing, heart pumping, and muscles energized, occur very quickly and automatically.
The HPA axis and the locus coeruleus systems are linked through the hypothalamus and the limbic system. The limbic system is the control area for emotion and the processing area for memory. The connections also include the endogenous opiate (opium-like) system and the reward (dopamine) system. Thereby, during stress, pain is reduced and an extremely happy feeling (euphoria) may result. These connections partially account for "runner's high" and have a great deal to do with why we like roller coasters and scary movies.
The limbic system performs an emotional analysis and memory review of the information provided by the senses. The multiplicity of connections allows us to determine whether the current stress is one that has been mastered in the past and successfully adapted to, not a threat at all, or a clear and present danger. All of this internal activity must occur in milliseconds, and it does.
HPA-axis role
The hypothalamus releases corticotrophin releasing factor (CRF). The CRF then travels to the pituitary gland, where it triggers the release of a hormone, adrenocorticotrophic hormone (ACTH). ACTH is released into the bloodstream and causes the cortex of the adrenal gland to release the stress hormones, particularly cortisol, which is a corticosteroid hormone. Cortisol increases the availability of the body's fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress.
Physical effect
Abnormal stress responses causing various diseases or disorders - high blood pressure and cardiovascular disease, certain gastrointestinal diseases, even the process of aging itself, increase the frequency and severity of migraine headaches, episodes of asthma, and fluctuations of blood sugar in diabetics.
Psychological effect 
Anxiety disorders - acute stress reaction, posttraumatic stress disorder (PTSD), adjustment disorder, phobias (agoraphobia, social phobia, specific phobia), panic disorder, generalized anxiety disorder, obssesive-compulsive disorder, dissociative disorders (amnesia, stupor, possession, motor, convulsion, sensory loss); depression — mild, moderate, severe; psychosis.
Sign and symptoms of stress 
Excess stress can manifest itself in a variety of emotional, behavioural, and physical symptoms. Symptoms of stress vary enormously among different individuals.
What are the signs and symptoms of stress?
Intellectual symptoms: How stress can affect your mind - problems with memory, difficulty making decisions, inability to concentrate, shortened attention span, confusion, repetitive or continual thoughts, misunderstanding of what others tell you, poor judgement, thoughts of escaping, running away, inability to slow down thought process, loss of objectivity.
Physical symptoms
Headaches, digestive disorders, muscle tension and pain, sleep disturbances, fatigue, chest pain, irregular heartbeat, high blood pressure, weight gain or loss, hair loss, asthma or shortness of breath, skin problems, periodontal disease, jaw pain, reproductive problems, such as missed periods, immune system suppression, sweatiness.
Emotional symptoms
Less interest in hobbies or fun, sudden shifts in mood, frequent uneasiness, restlessness, frustration, anger, resentment, unwarranted jealousy, quick irritability with others, oversensitivity, overreaction to unexpected situations or events, sense of being overwhelmed or swamped, anxiety, increased fear of failure, inadequacy, reduced confidence, depression, apathy, desire to cry.
Behavioural symptoms
Eat more or less, sleep too much or too little, isolate yourself from others, including people close to you, stay home from work or stay at work extended hours, increase use of tobacco, alcohol, drugs, caffeine, have sex more or less, engage in nervous habits such as nail biting, hair twisting, pacing, grind your teeth, laugh or cry at inappropriate times, overdo activities such as exercising or shopping, become bossy or inflexible with others, lose your temper, argue with people, become violent, take inappropriate risks, exhibit road rage.
People under stress have a greater tendency to engage in unhealthy behaviours, excessive use or abuse of alcohol and drugs, cigarette smoking, and making poor nutritional choices, than their less-stressed counterparts. These unhealthy behaviours can further increase the severity of symptoms related to stress, often leading to a "vicious cycle" of symptoms and unhealthy behaviours.
Long term effects of stress
Physical and psychological conditions - heart disease, cancer, diabetes, depression, obesity, anorexia nervosa, substance abuse, ulcers, irritable bowel syndrome, memory loss, child, elder, and sexual abuse.
Management
Stress is part of life and will always be around. The keys to dealing with stress are appropriate control of stressors and management of our physical and mental responses. A first step in stress management is exercise. Since the stress response prepares us to fight or flee, our bodies are primed for action. Exercise on a regular basis helps to turn down the production of stress hormones and associated neurochemicals. One or two 20-30 minute meditation sessions a day can have lasting beneficial effects on health. Elimination of drug use and no more than moderate alcohol use are important for the successful management of stress. When stress produces a full-blown psychiatric problem, like PTSD, clinical depression, or anxiety disorders, then psychotropic medications, particularly the selective serotonin reuptake inhibitors (SSRIs), are extremely useful. 
Chronic or uninterrupted stress is very harmful. Take breaks and decompress. Take a lunch break and don't talk about work. Take a walk instead of a coffee break. Use weekends to relax, and don't schedule so many events that Monday morning will seem like a relief. Learn your stress signals. Take regular vacations or even long weekends. Create predictability in your work and home life as much as possible. 
Think ahead and try to anticipate the varieties of possibilities, good and bad, that may become realities at work or home. Generate scenarios and response plans. With this kind of preparation, you can turn stress into a positive force to work for your growth and change. Stress counseling and group discussion therapy have proven to reduce stress symptoms and improve overall health and attitude.
Conclusion
Uncontrollable, unpredictable, and constant stress has far-reaching consequences on our physical and mental health. Stress can begin in the womb and recur throughout life. One of the pathological consequences of stress is a learned helplessness that leads to the hopelessness and helplessness of clinical depression, but in addition, many illnesses, such as chronic anxiety states, high blood pressure, heart disease, and addictive disorders, to name a few, also seem to be influenced by chronic or overwhelming stress. Nature, however, has provided us with wonderful processes to cope with stressors through the HPA axis and the locus coeruleus/SNS. Too much stress, particularly when we cannot predict it or control its recurrence, is harmful to our health.
Stress is part of life and will always be around.

 

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Nach oben