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. Since the 1990s, however, the word stressor has been used for a stimulus that provokes a stress response. One recurrent disagreement among researchers concerns the definition of stress in humans. The issue is whether it is primarily an external response that can be measured by changes in glandular secretions, skin reactions, and other physical functions—or if it is an internal interpretation of, or reaction to, a stressor, or 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. Researchers have found that stressors can be:
acute, such as a disaster or death of a loved one
sequential, such as events leading up to a job promotion or a move
intermittent, such as college exams
chronic, such as living with a life-threatening illness, being in an unhappy marriage, or living in poverty
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 (i.e., because of race, gender, education 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
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.
The symptoms of stress can be either physical and psychological. Stress-related physical illnesses, such as irritable bowel syndrome, heart attack, and chronic headache, 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 retiring. 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.
According to the American Institute of Stress:
Forty-three percent of all adults suffer adverse health effects due to stress.
Seventy-five to 90% of all visits to primary care physicans (PCPs) are for stress-related complaints or disorders.
An estimated 1 million workers are absent on an average workday due to stress-related complaints. Stress is believed to be responsible for more than half of the 550 million workdays lost annually because of absenteeism.
Stress has been linked to all the leading causes of death, including heart disease, cancer, lung ailments, cirrhosis, and suicide.
Nearly half of all American workers suffer from symptoms of burnout, a disabling reaction to stress on the job.
Workplace violence is rampant. There are almost 2 million reported instances of homicide, aggravated assault, rape, or sexual assault. Homicide is the second leading cause of fatal occupational injury and the leading cause of death for working women.
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 (i.e., family or employment problems; other illnesses). Many physicians will also evaluate the patient's personality, to assess his or her coping resources and emotional response patterns. There are a number of personality inventories and psychological tests that can be used to help evaluate the amount of stress the patient experiences and the coping mechanisms that he or she uses to deal with it. Stress-related illness can be diagnosed by PCPs or psychiatrists. The physician will need to distinguish between adjustment disorders and anxiety or mood disorders, and between psychiatric disorders and physical illnesses (e.g., thyroid deficiency or surplus) that have psychological side effects. A test that is used for measuring life stress is "Life Events Scale." It is used to determine whether the patient is at risk for stress-related illnesses, and can be administered while taking a social history at no extra cost. The test comprises stressors that are ranked in from most stressful (e.g., death of a spouse) to least stressful (e.g., minor violations of the law). Each item is assigned a value and is based on thousands of interviews and medical histories identifying the kinds of events that people found stressful.
Treatment
Recent advances in the understanding of the many complex connections between the human mind and body have produced a variety of treatments for 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 manifestations of stress, as well as drugs (e.g., tranquilizers and antidepressants) that affect a patient's mood.
Homeopathy and herbal remedies. Some may relieve symptoms of stress.
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, such as walking.
Massage. Therapeutic massage relieves stress by relaxing the large groups of muscles in the back, neck, arms, and legs.
Cognitive therapy. This approach teaches patients to reframe or mentally re-interpret the stressors in their lives, so that they can modify the body's physical reactions.
Meditation and associated spiritual or religious practices. Recent studies have found positive correlations between such activity and ability to manage stress.
Drawing, dance, music, sculpting, and other art forms. These forms of therapy are used to help the patient get in touch with his or her sources of stress, and release them through creative expression.
Biofeedback. Through this form of therapy, a patient learns to control his or her internal reactions to stressors, and discovers how to control them.
Aromatherapy. Scented oils that are designed to generate relaxation.
Nutrition-based treatments (e.g., dietary control; nutritional supplements). These help teach patients undergoing stress to focus on eating healthy foods.
Acupuncture. This treatment corrects the imbalance of body energy that produces stress
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 (i.e., race, sex, illnesses that run in families) or beyond the individual's control (e.g., economic trends, cultural stereotypes and prejudices). It is possible, however, for humans to learn new responses to stress. 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 abilities to cope with stress. 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 threats.
Prevention
Complete prevention of stress is neither possible nor desirable, because stress is an important stimulus of human growth and creativity, and 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 attitude and behavioral changes works well for most patients.
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.
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.
BOOKS
Clark, R. Barkley. "Psychosocial Aspects of Pediatrics andPsychiatric Disorders." In Current Pediatric Diagnosis & Treatment, edited by William W. Hay, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis &Treatment 1998, edited by Lawrence M. Tierney, Jr., Stephen J. McPhee, and Maxine A. Papadakis. Stamford, CT: Appleton & Lange, 1997.
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