Stress is a term that is used widely amongst doctors as well as the general public. Most of you would recognise stress as an integral part of your lives in this modern society. However, more often than not, you do not recognise its presence until it has caused significant problems in your lives. Stress often leads to the feeling of physical and mental exhaustion with an inability to manage your situation effectively. Although it is well known that it causes a number of significant health problems, people often do not have the right understanding of what stress is and how it causes and contributes to various illnesses. 

Origin of stress 
Living organisms survive by maintaining an immensely complex dynamic and harmonious equilibrium which is called homeostasis. Human societies have become more complex and more demanding, but our physiological mechanisms for coping with adversities have not evolved significantly along with this. Hence it seems that our physiological response to pressures and rapid changes occurring in the society around us resemble those that are set in to motion during physical danger and outright threat to survival. This is constantly challenged and threatened by internal or external disturbing forces or stressors. A successful adaptation to these stressors is maintained by counteracting forces or adaptational responses attempting to re-establish homeostasis. Under normal circumstances these adaptational responses are regulated by a negative feedback loop occurring in the connection between our brain, endocrine system and immune system. 

'The stress response system' 
Stress is frequently seen as our reaction to what is in our environment. When a threat is identified, the body's first response is a state of alarm resulting in a burst of hormone release and a fight-or-flight response. Both physical and emotional stressors trigger off certain central and peripheral responses intended to maintain homeostasis. When a stressor disturbs an organism’s equilibrium, the response consists of the initiation of physiological adjustments that help to restore homeostasis. In the brain there is a facilitation of pathways mediating arousal, alertness, vigilance, cognition and focussed attention and inhibition of pathways that promote vegetative functions such as feeding and reproduction. Peripherally also there are changes that occur principally to promote a redirection of energy. As a result oxygen and nutrients are directed to the brain and the stressed body sites that are involved in the stress response system. There is an increase in blood pressure, heart rate, respiratory rate and there is more production of glucose, all promoting an enhanced ability to counter the stressor. Parall to this there is a peripherally mediated restraint of growth and reproduction that helps to preserve energy that could be used more efficiently for a successful adaptational response to a stressor. 

Psychology of stress 
All human beings have an inborn internal tension ingrained in them as a result of a barrier between the conscious and unconscious mind. Although, this internal tension can be reduced through a continuous soul searching, it is never fully eliminated. As social beings, we have a hierarchy of needs, starting from the basic physiological needs to the need for safety, need for belongingness and love, need for maintaining our self esteem and ultimately the need for self actualization (the full realization of one's potential). There is often a constant tension between the body and the mind, as the mind attempts to cater to these needs in a socially acceptable way. In your pursuit towards self actualisation, you invariably go through various forms of hurt and suffering, which often accumulates if there is no attempt to understand the origin & meaning of this suffering. This pursuit can also bring expectations on yourself, which if remaining unmet, can lead to a build up of the stress. During this pursuit of self actualisation one may go through various stages of coping mechanisms such as denial, avoidance, anger, bargaining & humour, but when stress builds up it can lead to worry, guilt, anxiety and depression. Stress often starts resolving when the earlier stages are effectively managed, finally giving way to a stage of acceptance. 

Stress becomes pathological when there is an adaptive failure 
Normally the stress reaction helps a person to cope with adverse circumstances. There is an element of individuality in how people cope with stressors. In fact, it is observed that whilst some people are more vulnerable to stress and tends to get the pathological effects of stress, some others thrive under stress. This is primarily because, in those individuals who are vulnerable to stress, there is an adaptive failure in the stress response system. This sort of adaptive failure is usually seen when the stressful events are overwhelming and when the stressor is seen as unchangeable. Due to the frequent occurrence of stressors in the modern life, the stress response could become a chronic phenomenon. This could enhance the possibility of depletion of the body’s resources for an effective alarm system and could eventually progress to a stage of exhaustion, leading to the manifestation of pathological states of stress. 

Common signs of stress 
  • Having a hard time making decisions
  • Trouble meeting important deadlines
  • Feelings of fatigue or sleepiness
  • Not feeling good about oneself
  • moodiness 
  • Irritability
  • Anger
  • tendency to criticize and be argumentative
  • Lack of focus & forgetfulness
  • Getting the constant feeling that something is wrong
  • Changes in appetite ( eating more or less than usual )
  • Smoking, drinking, or using drugs to cope
  • Social withdrawal
  • Relationship conflicts
  • Rapid heart beats ( Palpitation )
  • Rapid breathing ( hyperventilation )
  • Muscle tension
  • Muscle aches
  • Headaches/migraines
  • High blood pressure 
Stress and illnesses 
As a result of long term stress, you can experience various mental health problems, such as depression, anxiety and psychotic illnesses. Chronic stress can also cause various physical health problems, such as headaches / migraines, general increase of aches and pains, hair loss, weight gain / loss, menstrual irregularities in women, peptic ulcers, irritable bowel syndrome, hypertension, coronary artery disease, allergies, asthma, psoriasis and arthritis. It can also alter the immune system, where by increasing the risk of infections. 

Managing your stress 
Having known what stress really is, I will give you some simple but effective tips to resolve this difficult problem in your life. To begin with you have to correct your perception towards the stressor. If there is a positive attitude that helps you to take the stressor as a challenge, you can turn around the negative consequences of stress in to positive achievements that help boost you confidence and self esteem. However, you will have to take enough care of your body, as even though your mind is ready to face the stressor, the body could get weakened by the constant strain on it. This means that you need to give enough rest and relaxation to your body by means of good sleep, which helps to give enough rest to your brain and maintain your body’s immunity and good leisure activities that helps you to relax. Adequate exercise and healthy diet helps maintain the energy state that is required to keep you fighting against the stressor, thereby helping you to maintain your positive attitude that helps you manage the stress in your life effectively. Thus you can turn around a negative vicious circle of stress in to a positive vicious circle of determination, confidence and improved self esteem. Stressful situations will always exist in your daily life. You may not be able to eliminate those situations altogether, but may still be able to manage it. When it is the relationships that causes the major stress in your life, you need to develop good interpersonal communication skills which is very helpful in preventing the buildup of stress. You should know your limits and should practice peaceful disagreements. Try to avoid manipulation when there are unreasonable demands on yourself, but try to be assertive. Make sure that you are not using aggressive approach in dealing with these situations as they can be counter productive. Learn to respond thoughtfully & effectively, rather than reacting impulsively. There are various helpful ways to reduce the biological effects of stress, such as exercise, breathing exercises, imagery techniques, yoga, meditation, massage, journal writing, art therapy, humor therapy, creative problem solving, communication skills training, developing good time management skills etc. Finally, if you feel unable to manage the stress yourself, you should seek expert help from a psychiatrist as there are other means to treat the stress and the pathological states that results from the stress.

Dr Aju Abraham, Consultant Psychiatrist

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