What is Stress?
Stress (also called: Psychological stress)
We all have stress sometimes. For some people, it happens before having to speak in public. For other people, it might be before a first date.
What Causes Stress?
What causes stress for you may not be stressful for someone else. Sometimes stress is helpful - it can encourage you to meet a deadline or get things done. But long-term stress can increase the risk of diseases like depression, heart disease and a variety of other problems. A stress-related illness called post-traumatic stress disorder (PTSD) develops after an event like war, physical or sexual assault, or a natural disaster.
How Do I Deal with Chronic Stress?
If you have chronic stress, the best way to deal with it is to take care of the underlying problem. Counseling can help you find ways to relax and calm down. Medicines may also help.
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Stress Frequently Asked Questions
- What are some of the most common causes of stress?
- What are some early signs of stress?
- How do women tend to react to stress?
- How does stress affect my body and my health?
- What are some of the most stressful life events?
- What is post-traumatic stress disorder (PTSD)?
- How can I help handle my stress?
- I heard deep breathing could help my stress. How do I do it?
- Does stress cause ulcers?
- For More Information
I have two full time jobs - I'm a customer service center manager and a mom of two young kids. I see myself as a happy person and a hard worker. But last month, the commute to work, my job, the chores around the house, and trying to spend enough time with my kids was really stressing me out. I have to get up really early in the morning to get the kids ready for school, then it takes me so long to get to work that I'm in a bad mood by the time I get there. My office is short-staffed and we had a lot of deadlines to meet so I was working overtime. My home life suffered - traffic going home doesn't help my mood, and when I got there, I was just so tired I didn't want to do anything! But I was faced with making dinner and doing laundry. My kids need my attention too!
I wanted to handle my stress before it got the best of me. I talked with my boss about working later hours so I don't run into so much traffic and am in a better mood when I get there and get home. I asked my husband to pick up the kids from school, and he has offered to help more with dinner and the laundry. When he cooks, I go for a bike ride with my kids. I also started setting five minutes aside in the morning and in the afternoon at work for me to relax and take a deep breath. These small changes have made a big difference in my life!
What are some of the most common causes of stress?
Stress can arise for a variety of reasons. Stress can be brought about by a traumatic accident, death, or emergency situation. Stress can also be a side effect of a serious illness or disease.
There is also stress associated with daily life, the workplace, and family responsibilities. It's hard to stay calm and relaxed in our hectic lives. As women, we have many roles: spouse, mother, caregiver, friend, and/or worker. With all we have going on in our lives, it seems almost impossible to find ways to de-stress. But it's important to find those ways. Your health depends on it.
What are some early signs of stress?
Stress can take on many different forms, and can contribute to symptoms of illness. Common symptoms include headache, sleep disorders, difficulty concentrating, short-temper, upset stomach, job dissatisfaction, low morale, depression, and anxiety.
How do women tend to react to stress?
We all deal with stressful things like traffic, arguments with spouses, and job problems. Some researchers think that women handle stress in a unique way: we tend and befriend.
- Tend : women protect and care for their children
- Befriend : women seek out and receive social support
During stress, women tend to care for their children and find support from their female friends. Women's bodies make chemicals that are believed to promote these responses. One of these chemicals is oxytocin (ahk-see-toe-sin), which has a calming effect during stress. This is the same chemical released during childbirth and found at higher levels in breastfeeding mothers, who are believed to be calmer and more social than women who don't breastfeed. Women also have the hormone estrogen, which boosts the effects of oxytocin. Men, however, have high levels of testosterone during stress, which blocks the calming effects of oxytocin and causes hostility, withdrawal, and anger.
How does stress affect my body and my health?
Everyone has stress. We have short-term stress, like getting lost while driving or missing the bus. Even everyday events, such as planning a meal or making time for errands, can be stressful. This kind of stress can make us feel worried or anxious.
Other times, we face long-term stress, such as racial discrimination, a life-threatening illness, or divorce. These stressful events also affect your health on many levels. Long-term stress is real and can increase your risk for some health problems, like depression.
Both short and long-term stress can have effects on your body. Research is starting to show the serious effects of stress on our bodies. Stress triggers changes in our bodies and makes us more likely to get sick. It can also make problems we already have worse. It can play a part in these problems:
- trouble sleeping
- lack of energy
- lack of concentration
- eating too much or not at all
- higher risk of asthma and arthritis flare-ups
- stomach cramping
- stomach bloating
- skin problems, like hives
- weight gain or loss
- heart problems
- high blood pressure
- irritable bowel syndrome
- neck and/or back pain
- less sexual desire
- harder to get pregnant
What are some of the most stressful life events?
Any change in our lives can be stressful, even some of the happiest ones like having a baby or taking a new job. Here are some of life's most stressful events.
- death of a spouse
- marital separation
- spending time in jail
- death of a close family member
- personal illness or injury
From the Holmes and Rahe Scale of Life Events (1967)
What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) can be a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat.
Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects that remind them of the trauma. Anniversaries of the event can also trigger symptoms. People with PTSD also can have emotional numbness, sleep disturbances, depression, anxiety, irritability, or outbursts of anger. Feelings of intense guilt (called survivor guilt) are also common, particularly if others did not survive the traumatic event.
Most people who are exposed to a traumatic, stressful event have some symptoms of PTSD in the days and weeks following the event, but the symptoms generally disappear. But about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these people develop a chronic, or long-lasting, form that persists throughout their lives.
How can I help handle my stress?
Don't let stress make you sick. As women, we tend to carry a higher burden of stress than we should. Often we aren't even aware of our stress levels. Listen to your body, so that you know when stress is affecting your health. Here are ways to help you handle your stress.
- Relax. It's important to unwind. Each person has her own way to relax. Some ways include deep breathing, yoga, meditation, and massage therapy. If you can't do these things, take a few minutes to sit, listen to soothing music, or read a book.
- Make time for yourself. It's important to care for yourself. Think of this as an order from your doctor, so you don't feel guilty! No matter how busy you are, you can try to set aside at least 15 minutes each day in your schedule to do something for yourself, like taking a bubble bath, going for a walk, or calling a friend.
- Sleep. Sleeping is a great way to help both your body and mind. Your stress could get worse if you don't get enough sleep. You also can't fight off sickness as well when you sleep poorly. With enough sleep, you can tackle your problems better and lower your risk for illness. Try to get seven to nine hours of sleep every night.
- Eat right. Try to fuel up with fruits, vegetables, and proteins. Good sources of protein can be peanut butter, chicken, or tuna salad. Eat whole-grains, such as wheat breads and wheat crackers. Don't be fooled by the jolt you get from caffeine or sugar. Your energy will wear off.
- Get moving. Believe it or not, getting physical activity not only helps relieve your tense muscles, but helps your mood too! Your body makes certain chemicals, called endorphins, before and after you work out. They relieve stress and improve your mood.
- Talk to friends. Talk to your friends to help you work through your stress. Friends are good listeners. Finding someone who will let you talk freely about your problems and feelings without judging you does a world of good. It also helps to hear a different point of view. Friends will remind you that you're not alone.
- Get help from a professional if you need it. Talk to a therapist.A therapist can help you work through stress and find better ways to deal with problems. For more serious stress related disorders, like PTSD, therapy can be helpful. There also are medications that can help ease symptoms of depression and anxiety and help promote sleep.
- Compromise. Sometimes, it's not always worth the stress to argue. Give in once in awhile.
- Write down your thoughts. Have you ever typed an email to a friend about your lousy day and felt better afterward? Why not grab a pen and paper and write down what's going on in your life! Keeping a journal can be a great way to get things off your chest and work through issues. Later, you can go back and read through your journal and see how you've made progress!
- Help others. Helping someone else can help you. Help your neighbor, or volunteer in your community.
- Get a hobby. Find something you enjoy. Make sure to give yourself time to explore your interests.
- Set limits. When it comes to things like work and family, figure out what you can really do. There are only so many hours in the day. Set limits with yourself and others. Don't be afraid to say NO to requests for your time and energy.
- Plan your time. Think ahead about how you're going to spend your time. Write a to-do list. Figure out what's most important to do.
- Don't deal with stress in unhealthy ways. This includes drinking too much alcohol, using drugs, smoking, or overeating.
I heard deep breathing could help my stress. How do I do it?
Deep breathing is a good way to relax. Try it a couple of times every day. Here's how to do it.
- Lie down or sit in a chair.
- Rest your hands on your stomach.
- Slowly count to four and inhale through your nose. Feel your stomach rise. Hold it for a second.
- Slowly count to four while you exhale through your mouth. To control how fast you exhale, purse your lips like you're going to whistle. Your stomach will slowly fall.
- Repeat five to 10 times.
Does stress cause ulcers?
Doctors used to think that ulcers were caused by stress and spicy foods. Now, we know that stress doesn't cause ulcers, it just irritates them. Ulcers are actually caused by a bacterium (germ) called H. pylori. Researchers don't yet know for sure how people get it. They think people might get it through food or water. It's treated with a combination of antibiotics and other drugs.
For More Information
You can find out more about stress by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations:
National Institute of Mental Health Phone: (301) 443-4513 Internet Address: http://www.nimh.nih.gov
National Mental Health Consumers' Self-Help Clearinghouse Phone: (800) 553-4539 Internet Address: http://www.mhselfhelp.org
National Mental Health Information Center Phone: (800) 789-2647 Internet Address: http://www.mentalhealth.org
American Institute of Stress Phone: (914) 963-1200 Internet Address: http://www.stress.org
American Psychiatric Association Phone: (703) 907-7300 Internet Address: http://www.psych.org
American Psychological Association Phone: (800) 374-2721 Internet Address: http://www.apa.org
Anxiety Disorders Association of America Phone: (240) 485-1001 Internet Address: http://www.adaa.org
National Alliance for the Mentally Ill Phone: (800) 950-6264 Internet Address: http://www.nami.org
National Center for Post Traumatic Stress Disorder Phone: (802) 296-5132 Internet Address: http://www.ptsd.va.gov/
National Mental Health Association Phone: (800) 969-6642 Internet Address: http://www.nmha.org
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More Stress Information
Stress System Malfunction Could Lead to Serious, Life Threatening Disease
Whether from a charging lion, or a pending deadline, the body's response to stress can be both helpful and harmful. The stress response gives us the strength and speed to ward off or flee from an impending threat. But when it persists, stress can put us at risk for obesity, heart disease, cancer, and a variety of other illnesses.
Perhaps the greatest understanding of stress and its effects has resulted from a theory by George Chrousos, M.D., Chief of the Pediatric and Reproductive Endocrinology Branch at the National Institute of Child Health and Human Development (NICHD), and Philip Gold, MD, of the Clinical Neuroendocrinology Branch at the National Institute of Mental Health (NIMH).
A threat to your life or safety triggers a primal physical response from the body, leaving you breathless, heart pounding, and mind racing. From deep within your brain, a chemical signal speeds stress hormones through the bloodstream, priming your body to be alert and ready to escape danger. Concentration becomes more focused, reaction time faster, and strength and agility increase. When the stressful situation ends, hormonal signals switch off the stress response and the body returns to normal.
But in our modern society, stress doesn't always let up. Many of us now harbor anxiety and worry about daily events and relationships. Stress hormones continue to wash through the system in high levels, never leaving the blood and tissues. And so, the stress response that once gave ancient people the speed and endurance to escape life-threatening dangers runs constantly in many modern people and never shuts down.
Research now shows that such long-term activation of the stress system can have a hazardous, even lethal effect on the body, increasing risk of obesity, heart disease, depression, and a variety of other illnesses.
Much of the current understanding of stress and its effects has resulted from the theory by Drs. Chrousos and Gold. Their theory explains the complex interplay between the nervous system and stress hormones - the hormonal system known as the hypothalamic-pituitary-adrenal (HPA) axis. Over the past 20 years, Dr. Chrousos and his colleagues have employed the theory to understand a variety of stress-related conditions, including depression, Cushing's syndrome, anorexia nervosa, and chronic fatigue syndrome.
The Stress Circuit
The HPA axis is a feedback loop by which signals from the brain trigger the release of hormones needed to respond to stress. Because of its function, the HPA axis is also sometimes called the "stress circuit."
Briefly, in response to a stress, the brain region known as the hypothalamus releases corticotropin-releasing hormone (CRH). In turn, CRH acts on the pituitary gland, just beneath the brain, triggering the release of another hormone, adrenocorticotropin (ACTH) into the bloodstream. Next, ACTH signals the adrenal glands, which sit atop the kidneys, to release a number of hormonal compounds.
These compounds include epinephrine (formerly known as adrenaline), Norepinephrine (formerly known as noradrenaline) and cortisol. All three hormones enable the body to respond to a threat. Epinephrine increases blood pressure and heart rate, diverts blood to the muscles, and speeds reaction time. Cortisol, also known as glucocorticoid, releases sugar (in the form of glucose) from the body reserves so that this essential fuel can be used to power the muscles and the brain.
Normally, cortisol also exerts a feedback effect to shut down the stress response after the threat has passed, acting upon the hypothalamus and causing it to stop producing CRH.
This stress circuit affects systems throughout the body. The hormones of the HPA axis exert their effect on the autonomic nervous system, which controls such vital functions as heart rate, blood pressure, and digestion.
The HPA axis also communicates with several regions of the brain, including the limbic system, which controls motivation and mood, with the amygdala, which generates fear in response to danger, and with the hippocampus, which plays an important part in memory formation as well as in mood and motivation. In addition, the HPA axis is also connected with brain regions that control body temperature, suppress appetite, and control pain.
Similarly, the HPA axis also interacts with various other glandular systems, among them those producing reproductive hormones, growth hormones, and thyroid hormones. Once activated, the stress response switches off the hormonal systems regulating growth, reproduction, metabolism, and immunity. Short term, the response is helpful, allowing us to divert biochemical resources to dealing with the threat.
Stress, heredity, and the environment
According to Dr. Chrousos, this stress response varies from person to person. Presumably, it is partially influenced by heredity. For example, in most people the HPA axis probably functions appropriately enough, allowing the body to respond to a threat, and switching off when the threat has passed. Due to differences in the genes that control the HPA axis, however, other people may fail to have a strong enough response to a threat, while still others may over respond to even minor threats.
Beyond biological differences, the HPA axis also can alter its functioning in response to environmental influences. The HPA axis may permanently be altered as a result of extreme stress at any time during the life cycle - during adulthood, adolescence, early childhood, or even in the womb.
If there are major stresses in early childhood, the HPA feedback loop becomes stronger and stronger with each new stressful experience. This results in an individual who, by adulthood, has an extremely sensitive stress circuit in place. In life threatening situations - such as life in an area torn by war - this exaggerated response would help an individual to survive. In contemporary society, however, it usually causes the individual to overreact hormonally to comparatively minor situations.
Effects on the body
Stress and the Reproductive system
Stress suppresses the reproductive system at various levels, says Dr. Chrousos. First, CRH prevents the release of gonadotropin releasing hormone (GnRH), the "master" hormone that signals a cascade of hormones that direct reproduction and sexual behavior. Similarly, cortisol and related glucocorticoid hormones not only inhibit the release of GnRH, but also the release of luteinizing hormone, which prompts ovulation and sperm release. Glucocorticoids also inhibit the testes and ovaries directly, hindering production of the male and female sex hormones testosterone, estrogen, and progesterone.
The HPA overactivity that results from chronic stress has been shown to inhibit reproductive functioning in anorexia nervosa and in starvation, as well as in highly trained ballet dancers and runners. For example, in one study, Chrousos found that men who ran more than 45 miles per week produced high levels of ACTH and cortisol in response to the stress of extreme exercise. These male runners had low LH and testosterone levels. Other studies have shown that women undertaking extreme exercise regimens had ceased ovulating and menstruating.
However, the interaction between the HPA axis and the reproductive system is also a two way street. The female hormone estrogen exerts partial control of the gene that stimulates CRH production. This may explain, why, on average, women have slightly elevated cortisol levels. In turn, higher cortisol levels, in combination with other, as yet unknown, factors, may be the reason why women are more vulnerable than men to depression, anorexia nervosa, panic disorder, obsessive compulsive disorder, and autoimmune diseases like lupus and rheumatoid arthritis.
Growth and stress
The hormones of the HPA axis also influence hormones needed for growth. Prolonged HPA activation will hinder the release of growth hormone and insulin-like growth factor 1 (IGF-1), both of which are essential for normal growth. Glucocorticoids released during prolonged stress also cause tissues to be less likely to respond to IGF-1. Children with Cushing's syndrome - which results in high glucocorticoid levels - lose about 7.5 to 8.0 centimeters from their adult height.
Similarly, premature infants are at an increased risk for growth retardation. The stress of surviving in an environment for which they are not yet suited, combined with the prolonged stress of hospitalization in the intensive care unit, presumably activates the HPA axis. Growth retarded fetuses also have higher levels of CRH, ACTH, and cortisol, probably resulting from stress in the womb or exposure to maternal stress hormones.
Old research has also shown that the stress from emotional deprivation or psychological harassment may result in the short stature and delayed physical maturity of the condition known as psychosocial short stature (PSS).
PSS was first discovered in orphanages, in infants who failed to thrive and grow. When these children were placed in caring environments in which they received sufficient attention, their growth resumed. The children's cortisol levels were abnormally low, a seeming contradiction, which Chrousos investigated by studying a small, non-human primate, the common marmoset. These monkeys live in small family groups in which infants are cared for by both parents. As in human society, the infants are sometimes well cared for, but sometimes abused. Like humans, the abused monkeys showed evidence of PSS.
The researchers determined that the stressed and abused monkeys appeared to respond normally to stress, but seemed unable to "switch off" the stress response by secreting appropriate cortisol levels, thereby remaining in a state of prolonged stress arousal as compared to their peers.
The gastrointestinal tract and stress
As many of us know, stress can also result in digestive problems. The stress circuit influences the stomach and intestines in several ways. First, CRH directly hinders the release of stomach acid and emptying of the stomach. Moreover, CRH also directly stimulates the colon, speeding up the emptying of its contents. In addition to the effects of CRH alone on the stomach, the entire HPA axis, through the autonomic nervous system, also hinders stomach acid secretion and emptying, as well as increasing the movement of the colon.
Also, continual, high levels of cortisol - as occur in some forms of depression, or during chronic psychological stress - can increase appetite and lead to weight gain. Rats given high doses of cortisol for long periods had increased appetites and had larger stores of abdominal fat. The rats also ate heavily when they would normally have been inactive. Overeating at night is also common among people who are under stress.
The immune system and stress
The HPA axis also interacts with the immune system, making you more vulnerable to colds and flu, fatigue and infections.
In response to an infection, or an inflammatory disorder like rheumatoid arthritis, cells of the immune system produce three substances that cause inflammation: interleukin 1 (IL-1), interleukin 6 (IL-6), and tumor necrosis factor (TNF). These substances, working either singly or in combination with each other, cause the release of CRH. IL-6 also promotes the release of ACTH and cortisol. Cortisol and other compounds then suppress the release of IL-1, IL-6, and TNF, in the process switching off the inflammatory response.
Ideally, stress hormones damp down an immune response that has run its course. When the HPA axis is continually running at a high level, however, that damping down can have a down side, leading to decreased ability to release the interleukins and fight infection.
In addition, the high cortisol levels resulting from prolonged stress could serve to make the body more susceptible to disease, by switching off disease-fighting white blood cells. Although the necessary studies have not yet been conducted, Dr. Chrousos considers it possible that this same deactivation of white blood cells might also increase the risk for certain types of cancer.
Conversely, there is evidence that a depressed HPA Axis, resulting in too little corticosteroid, can lead to a hyperactive immune system and increased risk of developing autoimmune diseases - diseases in which the immune system attacks the body's own cells. Overactivation of the antibody-producing B cells may aggravate conditions like lupus, which result from an antibody attack on the body's own tissues.
One of the major disorders characteristic of an overactive HPA axis is melancholic depression. Chrousos' research has shown that people with depression have a blunted ability to "counterregulate," or adapt to the negative feedback of increases in cortisol. The body turns on the "fight or flight" response, but is prevented from turning it off again. This produces constant anxiety and overreaction to stimulation, followed by the paradoxical response called "learned helplessness," in which victims apparently lose all motivation.
Hallmarks of this form of depression are anxiety, loss of appetite, loss of sex drive, rapid heart beat, high blood pressure, and high cholesterol and triglyceride levels. People with this condition tend to produce higher-than-normal levels of CRH. The high levels of CRH are probably due to a combination of environmental and hereditary causes, depending on the person affected.
However, rather than producing higher amounts of ACTH in response to CRH, depressed people produce smaller amounts of this substance, presumably because their hippocampuses have become less sensitive to the higher amounts of CRH. In an apparent attempt to switch off excess CRH production, the systems of people with melancholic depression also produce high levels of cortisol. However, by-products of cortisol, produced in response to high levels of the substance, also depress brain cell activity. These by-products serve as sedatives, and perhaps contribute to the overall feeling of depression.
Other conditions are also associated with high levels of CRH and cortisol. These include anorexia nervosa, malnutrition, obsessive-compulsive disorder, anxiety disorder, alcoholism, alcohol and narcotic withdrawal, poorly controlled diabetes, childhood sexual abuse, and hyperthyroidism.
The excessive amount of the stress hormone cortisol produced in patients with any of these conditions is responsible for many of the observed symptoms. Most of these patients share psychological symptoms including sleep disturbances, loss of libido, and loss of appetite as well as physical problems such as an increased risk for accumulating abdominal fat and hardening of the arteries and other forms of cardiovascular disease. These patients may also experience suppression of thyroid hormones, and of the immune system. Because they are at higher risk for these health problems, such patients are likely to have their life spans shortened by 15 to 20 years if they remain untreated.
Although many disorders result from an overactive stress system, some result from an under active stress system. For example, in the case of Addison's disease, lack of cortisol causes an increase of pigment in the skin, making the patient appear to have a tan. Other symptoms include fatigue, loss of appetite, weight loss, weakness, loss of body hair, nausea, vomiting, and an intense craving for salt. Lack of the hormone CRH also results in the feelings of extreme tiredness common to people suffering from chronic fatigue syndrome. Lack of CRH is also central to seasonal affective disorder (SAD), the feelings of fatigue and depression that plague some patients during winter months.
Chrousos and his team, showed that sudden cessation of CRH production may also result in the depressive symptoms of postpartum depression. In response to CRH produced by the placenta, the mother's system stops manufacturing its own CRH. When the baby is born, the sudden loss of CRH may result in feelings of sadness or even severe depression for some women.
Recently, Dr. Chrousos and his coworkers uncovered evidence that frequent insomnia is more than just having difficulty falling asleep. The researchers found that, when compared to a group of people who did not have difficulty falling asleep, the insomniacs had higher ACTH and cortisol levels, both in the evening and in the first half of the night. Moreover, the insomniacs with the highest cortisol levels tended to have the greatest difficulty falling asleep.
The researchers theorized that, in many cases, persistent insomnia may be a disorder of the stress system. From their ACTH and cortisol levels, it appears that the insomniacs have nervous systems that are on overdrive, alert and ready to deal with a threat, when they should otherwise be quieting down. Rather than prescribing drugs known as hypnotics to regulate the sleep system, the researchers suggested that physicians might have more success prescribing antidepressants, to help calm an overactive stress system. Behavior therapy, to help insomniacs relax in the evening, might also be useful.
After conducting many years of research into the functioning of the HPA axis, Dr. Chrousos concluded that chronic stress should not be taken lightly or accepted as a fact of life.
"Persistent, unremitting stress leads to a variety of serious health problems," Dr. Chrousos said. "Anyone who suffers from chronic stress needs to take steps to alleviate it, either by learning simple techniques to relax and calm down, or with the help of qualified therapists.
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